Abstract
The dental team at Zetland House Clinic are a particularly innovative group. As a result of their parent hospital being the first to complete a whole organization clinical governance programme run by the NHS Modernization Agency, they were consequently the first dental team to do so. Now the clinic is a better place to work where the staff are proud of their clinic and the work that they do. The changes that resulted through their experiences of the program have benefited the patients and staff alike, and was such a success story that they have been taken as an example for the Modernisation Agency website to illustrate good practice in clinical governance. These changes and the way they approached their involvement in the program also earned the Zetland House team a place on the finalist list of the 2002 Focus Awards.
Main
The Focus Awards is a joint initiative between the Department of Health of England and the British Dental Association. It was set up to recognise and celebrate the innovative patient-focused projects being carried out across England.
A major part of the programme for clinical governance development required a survey of what the patients thought. This was difficult: previous attempts at seeking their patients' opinions of care and treatment had proved a problem for Zetland House. They had been paper questionnaire-based and had never really worked. A major reason for this is because as a community dental service clinic, Zetland House has a high proportion of patients who have physical and learning disabilities and communication problems and therefore find writing and filling in forms difficult.
At the suggestion of the Clinical Governance Support Team, the dental clinic tried a more innovative approach to their patient survey. Instead of using traditional methods, a selection of patients were interviewed in a one-to-one situation. They were asked questions from a specially designed questionnaire allowing patients with learning difficulties to contribute their opinion to the smooth running of the clinic. The interviews were structured to cover the patients' opinions of the facilities, staff helpfulness and attitudes and treatment. Significantly, another new approach used, was to ask dental nurses from other locations to do the interviews so that the patients did not feel inhibited; furthermore patient-nurse barriers were overcome by the nurses doing the interviews in their own clothes rather than in uniform.
In an additional step to recording patient opinions, all dentists were also provided with a comments book and were asked to note any comments that their patients made, regardless of whether the comment was good or bad.
As a slightly separate part of the project a mailshot was sent to all people in the area with learning difficulties whether they were a current patient or not. This was another specially designed questionnaire created using the MAKATON system, an internationally recognised vocabulary of symbols designed for people with learning difficulties. The questionnaire asked the recipient if they needed help with their mouth care and was an awareness exercise so that these people and their carers knew that the Zetland House Clinic was available to help them.
Special communication approach
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One-to-one interviews by
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different nurses wearing
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non-uniform clothes.
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A comments book in each surgery
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MAKATON Questionnaire
What did the patients say?
Patients at the Zetland House Clinic are referred by high street dentists from a wide geographical area and therefore many of them travel some distance to the clinic. These patients often have mobility difficulties and being able to park near the clinic is important. Fifty percent of the patients asked, mentioned that they had difficulties with parking.
Several patients complained that the waiting room was poor.
Importantly, the interview process proved to be popular with both the staff and the patients. The staff felt the value of facilitating a better way of communicating, and the patients appreciated the extra effort.
A new improved zetland house
As a result of the patient survey, the problem of access was addressed immediately. Each appointment letter sent out is now accompanied by a map of the surrounding area showing where the parking options are. The spaces immediately outside the clinic are monitored and kept only for disabled badge holders.
In response to the comments regarding the waiting room, a group of patients were consulted to choose a colour scheme and the room was redecorated. This room now has a dual purpose as an education room too; there are information leaflets, posters and activity sheets with key messages of oral health. These are kept up to date and current by a therapist. Occasional light-hearted quizzes introduce a fun element and are a way for patients to learn about the advantages of looking after their teeth.
What really hit home for the judges was that the team were the first dental team to go through the Clinical Governance Development Programme and seized the opportunity with enthusiasm. They then made serious attempts at really trying to communicate, and more importantly listen, to all of their patients, going the extra mile to facilitate communication with those who find communication difficult.
How the practices got involved In order to participate, each entrant had to submit a nomination form specifying the innovations under the categories given below. Any practice that had applied last year was not allowed to use the same innovations in their application.
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Patients' experiences contacting the practice/clinic before, during and after treatment.
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Patients' experiences whilst in the reception or waiting area
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Patients' experiences during clinical treatment
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General communication with the patients
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Any other patient-focused innovation
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Davis, N. Focus awards 2002. Br Dent J 194, 339–340 (2003). https://doi.org/10.1038/sj.bdj.4809950
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DOI: https://doi.org/10.1038/sj.bdj.4809950