As the Scottish Government’s Quality Strategy starts to impact on the healthcare sector, the dental profession has the chance to take a lead in developing a quality strategy of its own.
That’s the opinion of Jason Leitch, dentist and oral surgeon at Glasgow Dental School who is now on secondment as National Clinical Lead for Quality.
Jason is part of the team spearheading the implementation of the Quality Strategy which was launched in May 2010.
This aims to deliver the highest quality of healthcare services to people in Scotland – and, through this, be recognised as among the best healthcare providers in the world.
However, while his focus is on medical care now, he foresees the momentum of the quality agenda encompassing other healthcare sectors, such as dentistry too.
That’s why he believes it’s the ideal time for the dental profession to take the initiative and take ownership for the development of its own standards in line with the Quality Strategy.
Jason explained: “The Quality Strategy is intended to affect all aspects of NHSScotland, including the dental profession, so now is the perfect opportunity for the profession to take a proactive stance on the issue. Why not take the initiative to develop your own quality systems rather than have them foisted on you?
“In conversations with the Chief Dental Officer and her Deputy, I have found that they are keen on having this conversation too. It’s all about defining what quality looks like in the dental arena: is it about making fillings last longer and better customer care? Are there other aspects that can be looked at, and then how do you measure quality in a dental context?”
In fact, it’s already on Scotland’s Chief Dental Officer’s radar, as Margie Taylor told Scottish Dental magazine earlier this year: “The Quality Strategy has helped focus our attention on what makes a ‘quality dental practice’ and we are going to be engaging with the profession in 2011 to ensure they get an opportunity to help define this clearly.”
So how did an Honorary Consultant in Oral Surgery become an acolyte for the quality mantra? His epiphany came about through a bit of serendipitous surfing on the web while he was looking for PhD funding for the Dental School. His online research led to the internationally renowned and highly influential Institute for Healthcare Improvement (IHI) in the US that was offering Quality Improvement Fellowships – and after reading more, he decided that this was a road he wanted to travel.
Before this happened, Jason was enjoying a successful career as an oral surgeon at Glasgow Dental School. He qualified as a graduate in 1991; and, as dental practice “did not float his boat”, he decided on a career in surgery. He also completed a doctorate on the care of dental patients suffering from anxiety – specifically in the delivery of sedative drugs to patients undergoing dental treatment.
Jason said: “It was unique at the time and we invented a new drug delivery device that could be self-administered to the patient’s needs – it was a leap forward in treating people with a phobia about dentists!”
However, his work in this field was put on hold when he decided to apply for the IHI Fellowship.
“I did not know it at the time, but this was a decision that would turn my career upside down,” he said.
He was successful and in 2005, he left Scotland with his wife for a year studying in Boston at the prestigious Harvard School of Public Health and working with the IHI.
The IHI has an international reputation for its focus on quality systems and Jason, like five other Fellows from that year, came under the thrall of its inspirational leader Dr Donald Berwick.
Jason explained the philosophy: “In Dr Berwick’s world, everyone has two jobs: one that you do to the best of your technical ability; and a second that means striving to find a better way of doing it – and that means embracing a culture of continuous improvement.
“It was a fascinating year and it opened my eyes to quality systems in healthcare. In addition to studying, we also got to travel around the US to see public healthcare best practice in action, such as the Intermountain Healthcare in Salt Lake City, an association of 23 hospitals and medical services, and the Cincinnati Children’s Hospital Medical Center.
“We also compared healthcare systems and I was pleased to see that Scotland compared pretty well with other countries, particularly in the universal provision of healthcare, but there were certainly pockets of excellence within the US and other countries such as Sweden that we could learn from.
“At the end of the year, I was really looking forward to putting my new skills and training to use back in Scotland.”
Jason returned to the Glasgow Dental School in 2006, but it wasn’t long before he got the chance to put his new knowledge to good use in 2008 when he helped lead the Scottish Patient Safety Programme. The main aim was to reduce hospital mortality by 15 per cent in five years… and three-and-a-half years later, hospital standard mortality rates are down seven per cent.
His next challenge came when he was appointed National Clinical Lead for Quality following the publication of the Scottish Government’s Quality Strategy in May 2010. This aims to put Scotland among the best in the world in terms of delivering high-quality healthcare services by putting people at the heart of the services, building on the values of the people working in and with healthcare services, and making measurable improvements in the quality of care.
Jason explained his involvement: “My role is to help implement the Quality Strategy across Scotland to remove geographical variations in effective delivery, while at the same time looking at costs and productivity.”
He said the quality agenda will continue to play a big part in shaping healthcare in the future and will expand its remit into other areas of healthcare provision and eventually link into the social care sector – driven by the ethos that improvements in quality can bring savings in costs.
The key to a successful programme is developing a quality framework that identifies, measures and seeks to improve every aspect of healthcare provision from the technical expertise of practitioners, the patient experience and right through to staff development and job satisfaction.
So far, dentists have not been involved in this quality exercise, but as a former practitioner, Jason believes that the dental profession would find much to gain by taking a proactive role in developing their own quality systems.
“What we are doing in primary and acute healthcare provision can easily be replicated in dentist practices. In fact, I think dental practices have much to teach us, particularly in the area of patient experience. Dentists are small businesses who are very aware of the need for good customer relationships and, like GPs, are very good at developing this trust with whole families.
“I think the challenge for implementing quality systems in dentistry will be in assessing the technical quality of care, how we measure this and then improve on it in the context of providing value to money. If this can be done, there will be real value for dentists to show how accountable they are to public funding. The time is ripe for the dental profession to start a conversation about what quality means to them so they can drive their own quality agenda.”
Jason hasn’t totally turned his back on dentistry – he still uses his dental and oral surgery skills every few years to help a community in south-east India which runs orphanages, schools and other educational work for about 2,000 children and young people.
As trustee for the UK wing of the Indian Rural Evangelical Fellowship,
he helps organise a team of fellow health professionals to visit the remote state of Andhra Pradesh to provide much-needed healthcare.
Since 2006, he’s raised nearly £30,000 for the charity and ran the Glasgow half marathon in September.
The Institute for Healthcare Improvement
The Institute for Healthcare Improvement (IHI) was co-established by Dr Donald Berwick in 1989 in Cambridge, Massachusetts, as a centre to promote safe and effective health care.
Originally a paediatrician in Harvard, Dr Berwick developed an interest in quality systems, and after investigating quality control measures in other industries such as aeronautics and manufacturing, he considered their application in healthcare settings
His vision for healthcare is: care that is safe, effective, patient-centred, timely, efficient, and equitable.
Today, IHI is a highly influential, independent, not-for-profit organisation focused on identifying and testing new models of healthcare in partnership with both patients and healthcare professionals; and ensuring the broadest possible adoption of best practices and effective innovations around the world.
In April 2010, President Obama appointed Dr Berwick as Administrator of the Centres for Medicare and Medicaid to help push through his healthcare reforms.