Quality is a word we seem to encounter at every turn these days and it’s one that trips off the tongue so lightly that its true meaning can get lost. It can also mean different things to different people. If we turn to the dictionary definition, the first that often appear is along these lines:
- “the standard of something as measured against other things of a similar kind”.
This of course is the way many of us view the requirements of the CQC (after all it is the Care Quality Commission). We measure and audit what we do against national standards to monitor how we meet their requirements.
The British Dental Health Foundation suggests that quality is simply ‘degree of excellence’ but goes on to propose that quality in healthcare has six different dimensions. It should be:
- Safe
- Effective
- Person-centred
- Timely
- Equitable
- Efficient
Those of you keeping up to speed with the way that CQC inspections are likely to go will be familiar with the first five and indeed we can see these in the current CQC outcomes. For the practice owner and manager with an eye on the figures the inclusion of efficient is important. And we are all aware that sometimes you cannot deliver two of these characteristics at the same time. A totally person-centred approach whilst welcomed by an individual patient may not be efficient and may mean that someone else is not seen in a timely way.
We as practice owners should of course get something from doing this and putting in all of this effort. If we manage quality well we should expect this to deliver significant benefits to our practice and patients – benefits which ought to include having happy and consistently satisfied patients, finding out more efficient ways of working which save money and identifying and managing risk in the practice more effectively.
But this is only going to happen if we can answer an honest ‘yes’ to the following questions:
Do we define our management intent and commitment in our policies, in our ways of working and in our systems and are we really behind what we have set out in these rather than simply paying lip service to governance?
Are our systems implemented consistently and well and do we measure people’s performance against these effectively? In other words do we really walk the talk?
Are we really committed to quality assurance, both in the way we go about our business and also the outcomes we are achieving for patients?
Does what we do and the way we do it actually achieve the results we want?
It is easy to get stuck into process without focusing on whether the process is actually achieving the results we want.
Have we made part of our practice culture not just continuous evaluation but also continuous improvement in terms of minimising risks, failures and waste?
Is the entire team committed to quality improvement? Quality after all is not just about measuring things; it is also about improving things and every single member of the practice team has a vital role to play in this.
Yet important though these questions are, perhaps we are missing something. Quality as I have said is more than measurement and more than meeting standards – particularly those set by others. Just meeting the minimum standards required by the CQC for example means we are always trying to keep up with a pace set by others or as a colleague described it to me recently, ensuring we stay in the ranks of the average. Surely this is not what quality is really about?
Perhaps the key to this is the secondary definition of quality to be found in the dictionary; when we talk about people or things having certain qualities we mean that they possess a distinctive attribute or characteristic.
This perhaps then is the true face of quality - using quality management to define our uniqueness as dental practices and the level of service we offer to our patients.
In practice we can use the way we manage quality and the way that we do things to determine our signature or character as a practice which can help to make us stand out from the crowd in an ever more competitive dental market place. Indeed the Chartered Quality Institute tells us that quality is an outcome – ‘a characteristic of a product or service provided to a customer, and the hallmark of an organisation which has satisfied all of its stakeholders’.
What will improve quality in your practice? Well, assuming you have answered yes to the questions above, developing a focus on continuous improvement is key, through communicating with your team and ensuring that they continue to develop their skills to meet the standards you and the external regulators set. It is also important
to make sure that communication between different areas remains open and positive to make sure that all areas of your practice relate to each other in delivering a quality service. To help with this CODE’s iComply application provides a solid framework for a successful implementation of quality assurance system in your practice. With it you are in control of your compliance and have more time to provide quality care to your patients.
It is your patients and your team who hold the key. However much we might feel cynical about coming CQC requirements, the concept of communicating readily with patients to develop our services is a sound one. After all patients are the judge of quality and if they don’t feel they are getting it they will vote with their feet. But your own staff also hold many years of experience between them, may have valuable ideas ready to be shared and knowledge ready to be unlocked about what works well and what doesn’t. Involve them in your quality quest as they will be the ones you are asking to deliver it. They are the real face of quality.