As you already know all too well, employers and employees have responsibilities under current quality, safety and health legislation, as well as Approved Codes of Practice (ACOP), relevant guidance from external bodies and elements of Care Quality Commission (CQC) Standards (in England). Then there are the General Dental Council Professional Standards, which state that employers must find out about the laws and regulations that apply to clinical practice and the premises, plus the associated obligations; these must be considered at all times.
To this end, it is important to consider quality, safety and health as part and parcel of everyday practice. Effective system management requires leadership, a framework that integrates quality, safety and health as a core practice function, sound practice procedures, and a trained/skilled dental team operating in an environment where employees are involved in how things are run and trusted in their role.
Achieving and then sustaining adherence to all the relevant quality, safety and health regulations can seem an overwhelming task. This is why the HSE has simplified the process of managing quality, safety and health with a four-step system in its latest HSG65:
- Plan – state what you want to happen.
- Do – make sure there are systems, documentation and evidence in place to manage service delivery.
- Check – make sure the work is being done safely.
- Act and learn – listen to problems and successes, and make improvements.
Managing risk
Assessing quality, safety and health risks is important in order to give proportionate attention to each area. This applies not only to the level of detail and effort put into assessing the risks but also implementing controls,
supervision and monitoring. In reality, what we’re talking about here is achieving a balanced approach, so that effort is proportionate and does not inhibit service delivery – this is not about eliminating risk at any cost.
A risk profile is unique to the practice but there are guidelines that can help every practice to determine the greatest quality, safety and health issues. This profile should examine:
- The nature and level of the threats faced by the practice.
- The likelihood of adverse effects occurring.
- The level of disruption and costs associated with each type of risk.
- The effectiveness of controls in place to manage those risks.
Follow these five steps to assess risks in your practice:
1. Identify the hazard.
2. Decide who might be harmed and why.
3. Evaluate the risks and decide on precautions.
4. Record the findings and implement control measures.
5. Review the assessment and update where appropriate.
It is a good idea to get all employees involved in the risk assessment process but at the very least completed risk
assessments should be brought to the attention of all members of staff so that they are aware of the risks identified. Risk assessment is an ongoing process; in the event of a change in circumstances, legislation or an incident, the control measures need to be reviewed and adjusted accordingly.
Incidents and complaints
Despite best efforts and proactive risk management, things can go wrong. Employers have a legal duty to have effective reporting and management systems in place for incidents, accidents and complaints. There needs to be a sensible approach to this, ensuring that documentation is factual, easily retrievable and enables lessons to be learned and communicated to all relevant parties.
It is important to bear in mind that an investigation of an incident is not about allocating blame but rather understanding why it occurred, trying to prevent reoccurrence, identifying areas of improvement and facilitating shared learning.
Clear procedures need to be in place, known and followed in practice by staff. These procedures need to be monitored and reviewed to ensure the practice maintains robust systems for dealing with and reacting to incidents and complaints. The practice must nominate and appoint someone who will be accountable for managing incidents and complaints.
Infection prevention and control
Employers have a legal duty to put in place suitable arrangements to prevent and control healthcare infection risks. It should be part of the everyday process of running a dental practice and an integral part of practice behaviours and attitudes.
Practice procedures must reflect schemes of work, specialist Health Technical Memorandums (HTMs) guidance, Approved Code of Practice (ACOP), legislation and (in England) CQC Standards, ensuring that all relevant documentation is contained within a bespoke infection control policy that has been approved, circulated, signed, dated and updated.
Nominated appointed individual(s) must be identified in the practice’s policy, who must ensure all within the practice are working within the policy. Regular monitoring, review training and supervision and audit should ensure agreed procedures are adhered to by staff. Regular audits should be carried out on a six-monthly basis and retained for at least two years as audit tool evidence. It is essential that you refer to specific audit tools such as the Infection Prevention Society Audit.
Quality care
Clearly quality, safety and health is a big topic and in this article we can only scratch the surface of what employers and employees need to do to fulfil their legal obligations. In addition to what has been mentioned here there’s also – fire safety, sharps management, Control of Substances Hazardous to Health (COSHH) regulations, and safety suitability and availability of equipment to be considered too.
To protect yourself, your team and your patients, thorough understanding of quality, safety and health in the dental practice is essential, as is meeting your legal obligations and updating your policy, making changes when necessary.