Page 12 - RADC Bulletin 2018

Clinical Efficiency – Wessex Region
Maj Charlotte Winship RADC
With ever increasing demands on the delivery of dental care within DPHC(D), optimising clinical efficiency is key to maintaining dental fitness levels but also creating a healthier working environment.
As an organisation, every region does things in a slightly different way and, within the region, every practice too. This is Mission Command, and should be celebrated as something we do pretty well within DPHC(D).
There is no denying
the quality service
we provide to our
patients, but at some
time or another we
have probably all
questioned whether
a particular process
could be improved
upon and then likely
implemented a change, which has added value to the practice. What we tend to be less good at is sharing this day to day best practice – probably because there isn’t a clear forum to do so. As a profession, we tend to not like change- “the last PDO told us to do it that way”, or “it’s always been done like that”. Reflecting on one’s own practices is actually very difficult and takes humility and sometimes a thick skin. It was with the above in mind that Wessex region decided to embark upon a new project; this was to increase Clinical Efficiency within
the region. We would do this by dissecting our individual practice protocols and clinical processes in order to identify and overcome obstacles to efficiency and ultimately improve our day to day working practices. Ultimately, working smarter, not harder.
‘Clinical efficiency’ is a broad title and so it was agreed to concentrate on one particular area to start with. The PDI. The PDI is our bread and butter, we see thousands of these a year and yet every practice and every Dentist does it in a slightly different way. What takes one Dentist 15 minutes takes another 30 minutes. Evidence was provided by Capt Susie Lloyd’s audit on
20 Vs 30 minute PDIs where the two timed PDIs were evaluated against a number of parameters. The clinical output, DMICP records, information provided to the patient and quality in each PDI were proven to
be the same. Of course there are always outliers where infrastructure or geography may influence the length of a PDI, but most of us do not fall into this category.
Planning
A Clinical Efficiency SME Team was brought together across the cadres to plan the
‘Regional Clinical Efficiency Symposium’. This involved 3 x DNs, 1 x PM, 1x Receptionist, 1 x DH and 2 x DOs. The Training Officer (Maj Ian Clarke), Clinical Efficiency lead (myself), our own Dental Public Health Lead (Maj Pete Field) and the PDO (Col Johnston) were also present. Finally, we invited a Business Management Consultant to provide an impartial
expert opinion with regards to business improvement. All
ideas would ultimately come from the staff in the region but it was our job to translate this into a process
we could all follow in order to improve our practice.
We discussed a theoretical journey through the PDI. This system, known as
‘Process Mapping’, involved the whole team and the separate steps involved in a PDI; from arrivals to sending out recalls, to waiting room processes, to the PDI itself, the referral to the Hygienist and the clean down/turnover/ final page on DMICP. From the Process Mapping we assigned different ‘sections’ to the cadre ‘owning’ this section. Each group had a group lead whose job
it was to facilitate the discussion. We also ensured each group lead was a civilian; we felt this was more appropriate as our work force is mainly civilian and we wanted to enable open and honest sharing of best practice, there was
to be no dictates
(especially from the
military folk!).
Regional Clinical Efficiency Symposium
We started the day with a lecture from Gp Capt Foster
on Four-Handed
Dentistry. This set
the tone and got
people thinking about ideas for improving processes.
The symposium was planned so that each cadre would go off in separate groups, discuss their processes, any areas for improvement and any potential challenges to this. Large cadres (e.g DNs) would be initially split up and then come together
later in the morning as a whole cadre.
The success of the day relied heavily on everyone having an equal voice and being in an environment where they could speak
freely. Each cadre had to come up with 6 final improved processes. In the afternoon, we came together as a region and linked all the processes together to make ‘the perfect PDI’. We ended up with the ‘Wessex Action Matrix’. This was a list of new processes which everyone could follow in the region.
Outcome
The day was very much a step into the unknown. Participation from the region was outstanding. Giving a voice to everyone enabled idea sharing, streamlining of processes and a chance to calibrate what we were all doing. It also broke down misconceptions and barriers to improving efficiency. We analysed everything we do in detail; e.g why do we add endless charting items to every treatment plan when there’s an easier way to do it, which satisfies all the necessary requirements?
Unsurprisingly, Process Mapping also identified issues such as the great disparity in Hygiene prescriptions across the region and differences in individual interpretation and assignment of NATO Categorisation. The nurses told the dentists exactly where time was being wasted (e.g hogging the computer during a PDI!) and the importance of concurrent activity during the PDI was acknowledged, e.g the nurses inputting charting items and templates onto the Dentist’s treatment plan. From our action matrix we formed further working parties who went away and developed the
region’s ideas further, e.g we created a
more comprehensive and slick ‘arrivals’ procedure. We also rolled out a new ‘Wessex Patient Questionnaire’ for the waiting room, including the usual questions on Medical History and Alcohol but incorporating
risk factors (oral hygiene habits, diet, deployments etc)
which provided much more information to the Dentist at a glance in order to improve clinical notes, justify risk assessments and treatment planning. These are just a few examples of the outcomes and work which continues in Wessex Region.
The Clinical Efficiency Symposium was just the start of the process. The more we reflect on our own practices and share examples of best practice, the better and more efficient we can be.
There is no denying the quality service we provide to our patients
The nurses told the dentists exactly where time was being wasted (e.g hogging the computer during a PDI!)
10 RADC BULLETIN 2018
PROFESSIONAL AND CLINICAL