What are the factors and barriers leading to change in how dentists practise their dentistry?

Key Points

• This qualitative study has identified a range of personal, organisational and policy factors which influence reported change in GDPs' work patterns.

• Barriers to change need to be addressed to enable GDPs to respond to the needs of their patients and the new organisational structures which are soon to be introduced.

Abstract

Aim The objective of this study was to investigate the barriers and facilitators to change in dental practices among a sample of general dental practitioners (GDPs) from three regions of England.

Method In-depth face-to-face interviews with 60 GDPs were undertaken. The sample was selected from a group of 317 GDPs who had completed a questionnaire in the first phase of this study. The participants were selected to reflect diversity regarding the number and extent of self-reported changes reported in the questionnaire, and personal and practice characteristics. Of the 92 attempted contacts, 60 (65%) of the interviews were successfully completed. The interview schedule formed the basis of the interview. All the interviews and notes were transferred on to NUD^*IST QSR version 4, a qualitative analysis package.

Results No single factor was identified as being more important than another in facilitating change. The main facilitators for change were: financial factors, regular patient attendance, particularly a core patient group, staff loyalty, having regular staff meetings and open communication and having access to peer support. The main barriers to change were the reverse of the facilitators plus not having a financial stakehold in the practice.

Conclusions A range of factors were identified as influencing change in general dental practice. These include GDPs' attitudes and experience of change, patient factors, organisational issues, contact with peers and access to appropriate training courses.

Main

The facilitating factors and barriers influencing change in dental practice in a sample of English general dental practitioners R. Watt, P. McGlone, D. Evans, S. Boulton, J. Jacobs, S. Graham, T. Appleton, S. Perry and A. Sheiham Br Dent J 2004; 197: 485–489

Comment

A previous paper¹ reported the areas in which dentists felt that they were changing and by how much. The question that follows from that is what are the reasons that encourage dentists to change and what they think about change. It is also important to find out what dentists perceive the barriers to change to be.

This study was the second stage to a postal questionnaire of general dental practitioners in three English health authorities. Dentists who had completed the questionnaire were asked if they would be prepared to take part in the second stage of the research. Over 90% of dentists were prepared to take part and a sampling method was used to ensure that a wide range of GDPs were included. Factors taken into consideration included the extent of self-reported change, the proportion of private practice, and the age and sex of the practitioners. The investigators hoped to interview 92 practitioners but for a variety of reasons, eg inability to make contact and withdrawal from the study, interviews were completed for 60 practitioners. Each interview was tape recorded and lasted around one hour.

Factors that were found to act as barriers to change were often the opposite of those which were thought to bring about change. The most frequent response for not changing was financial. It was expressed that any change had a financial risk attached to it and this had to weighed up before a decision was made. The financial benefits were associated with time, improved efficiency, improved clinical outcome or increased patient satisfaction. Many reported having made changes which had caused financial problems and that this made them more reluctant to change in the future.

The paper gives a range of barriers to change and examples of how practitioners perceived them to work both as barriers but also as enabling factors. As a result it is possible to gain a greater understanding of the beliefs and perceptions of GDPs. Some may say, that 'the research is obvious and we all knew that' but that would be unfair. Here we have a very useful summary that practitioners may use to support their views or otherwise while those negotiating for the profession or influencing policy will be able to use to inform their position in a time of change.