Dental clinics: why continuous quality management makes sense
Quality management in hospitals is common and standard in many parts of the world. Internationally recognized quality accreditation and certification is also common and often used for promotion in the medical tourism market.
Dental treatment is one of the main reasons for people to travel abroad for medical care. However, standardization and quality management in dental clinics are not common, as they are still not required in most countries. As a consequence, the availability of specialized quality management systems for dentistry is very limited. In addition, the reasons for quality management are often not understood. Due to our experience, even when an ISO 9001 certificate has been issued to a dental clinic, this unfortunately often only means that the respective “quality management” is no more than a piece of paper on the wall.
When we discuss with dental clinics about our quality programme we are often asked the following questions:
- As we have enough patients, why should we apply for a quality certification?
- How many more patients will we get when we purchase your certificate?
The first question normally initiates a general discussion about the reasons and benefits of quality management. The second question rather causes frustration and annoyance since we as a certification body are neither a facilitator nor are selling certificates. This question also confirms that there is still a lack of understanding of quality management and quality certification in many dental clinics.
Why does quality management make sense? A practical example:
In the preparation phase of one dental clinic (< 10 chairs) we asked the management to give us an overview about their expired and therefore potentially infectious material. This was not possible since there was no documentation about the storage at that time, however the answer was that it could not be much since the clinic in general works according to the “first in, first out” principle. The clinic staff started counting and found out that they had expired material of approx. € 12.000 in stock.
Today, after implementation of their quality management system they have an electronic documentation system, processes are continuously optimized, staff are trained regularly and highly motivated by the system since it facilitates daily routine and provides legal security.
And the amount of expired material in stock is nearly € 0.
Patients’ position
According to a study carried out by FirstMed Services GmbH with 1038 dental patients from Germany, Italy, and Switzerland, lower treatment costs, personal recommendation, and media information/advertisement are the main decision criteria for patients to travel for dental treatment outside their home country.
Although “better quality” was only mentioned directly by 19 % of the patients as a decision criterion patients rated 9 out of 13 quality related service requirements (e.g. availability of follow-up care in home country, language skills, education of dentists and nurses, certification of clinic, etc.) as very important.
Thus, patients do look for quality, but not necessarily by means of the approved implementation of a quality management system, they define their service requirements and compare their expectation with the services delivered. These points are then reflected in the patient satisfaction rates and also have an effect on patients’ recommendation pro or against the dental service provider.
It is worthwhile to ask for patient satisfaction and feedback, and then use the results to continuously improve quality.
Another practical example
A few months after we certified a dental facility we had some communication problems in the follow up, we also received two complaints about that facility. Shortly we got into contact with the institution to clarify the respective points. Since the communication problems continued we sent an assessor to check onsite what is going on and we had to find out that in the meantime the owners had changed, the quality department had been dismissed, the international patient department consisted of one person that only speaks the country language, and other points also associated with cleaning and hygiene were not acceptable anymore. This all happened within only a few months!
It seemed that the facility was willing to work on quality improvement again and we agreed – including obtaining a written commitment by the new owners – on a three months period to get back to the quality status as it was established before. By means of an action plan and monthly progress reports we wanted to support and accompany the facility. Regrettably, it did not work and consequently we had to withdraw the certificate and exclude the facility from our certified network.
In summary, regular communication and continuous work on quality improvement do not prevent every incident but support patient and staff safety, patient and staff satisfaction, and in most cases saves money in the end due to process optimization, optimized storage systems or prevention of claimed damages due to malpractice or other critical incidences.
And yes, you might also get more patients…