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M. Busby, R. Matthews, F. J. T. Burke, A. Mullins and K. Shumacher British Dental Journal 2015; 218: E12

Editor's summary

What shapes our perceptions? A host of personal, cultural and biological factors swirl round us, many of which are subconscious, or at least we are unaware they are influencing us at any given time.

Perception is an important and valuable instinct in terms of daily life and of survival. A sense of danger or of security is central to our existence as much in the practice as in the street. It enables us to reliably make our usually very rapid and accurate assessment of each patient during the handful of seconds that it takes between them coming through the surgery door and sitting in the dental chair. Our perception of their mood, their likely understanding, their reason for attending and a host of other matters immediately dictates and moderates the way in which we communicate with them.

How effective we are in our perceptions then impacts directly on how they generate their perceptions of us and our practices. Perceptions that will already be forming as a result of phone calls, being greeted at the front desk, the condition of the waiting room and a basket full of other impressions and observations.

To recognise this is all well and good but to try to quantify it is quite another matter. This research takes some early and important steps in precisely this domain by attempting to convert qualitative perceptions into quantitative measures. This is a timely piece of initial work since, as pointed out in the paper, the push is on now more than ever before to define and measure quality in healthcare (the immanent NHS Family and Friends initiative for example) rather than the more concrete gauges of counting items, hours and throughputs.

And quality emerges as a key word and key perception in patients' likelihood to recommend a dental practice to family and friends. This is probably not surprising in the overall scheme of things but the tools or instruments to be able to narrow down what exactly contributes to the sense of quality are potentially very valuable. The authors intend to continue their work by reassessing the practices involved every three years and note that it will be particularly interesting in those who have been initially at the lower end of the range...if indeed they are still open for care.

The full paper can be accessed from the BDJ website ( www.bdj.co.uk ), under 'Research' in the table of contents for Volume 218 issue 6.

Stephen Hancocks

Editor-in-Chief

Author questions and answers

1. Why did you undertake this research?

We have used the Net Promoter Score (NPS) methodology in our surveys since 2010. We wanted to test the likely hypothesis that practice recommendation to friends and colleagues was directly related to the level of perceived practice quality. It is obviously important for most practices in maintaining their success that these recommendations continue to flow. It is valuable to know which aspects of perceived quality are most likely to lead to practice promotion in this way. As the NHS Friends and Family test is derived from the NPS, we thought that it would be particularly timely to investigate these issues.

2. What would you like to do next in this area to follow on from this work?

We have already conducted a small study to investigate the hypothesis that practices scoring significantly below the benchmark in DEPS might be motivated to undertake practice development in areas highlighted by their results. As the database grows we plan to do a more extensive study in this area. We are now well into the second round of surveys (we started in 2010 and practices use the same instrument every three years). We will therefore soon be able to analyse the data from the majority of participating practices to measure the scale of perceived improvements over three years. It will be particularly interesting to do this for practices at the lower end of the score range in the first round.

Commentary

I am constantly told that word of mouth is the largest route by which new patients come into my practices. How do I make my patients ambassadors in the first place? What am I doing right, what can I build on and what needs some extra work? Patient feedback is a great way to find out what your strengths and weakness are. The authors of this article take this concept a few stages further by evaluating the link between patient perceptions and the likelihood of them recommending their loved ones to come to see you. What are the factors that make patients promote your practice for you, that is to say what do patients value the most?

This study focuses on 64 general dental practices using the Denplan Excel Patient Survey (DEPS), in the first six months of 2014. The authors point out that this does not give a true comparison for all dental practices but it does give us an insight into what we could all find within our practices, if we looked deeper. With the looming Friends and Family testing starting across the NHS in April 2015 we may have to look sooner than we might like.

The practices completed their DEPS and achieved over 50 responses (10,810 patients responded in total). The practices were then grouped into Net Promoter Score (NPS) levels. The Patient Perception Index (PPI) was then compared for these groups.

The differences between the groups had a 90% significance and demonstrated that the patients were more likely to recommend your practice if they had a higher perception score.

Perceived value for money is highly correlated with the NPS. This result is statistically significant.

My favourite line in the article, 'as professionals and patients we often are reluctant to acknowledge or think about healthcare from a commercial perspective,' demonstrates the changing nature of dental practice. Comparing healthcare and industry is critical as this allows us benchmark ourselves. NHS dentistry is not free at the point of access, therefore, patients perceive value for money. So we must give it the importance it deserves.

The authors highlight how if our patient perception of our care is to improve, we must change our understanding of commercial practice. KPIs and benchmarking is vital in an age where recommendation is becoming so important.