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High-reliability organisation principles implemented in dentistry

British Dental Journal volume 232, pages 879–885 (2022)Cite this article

Abstract

Introduction/objectives Successful dentistry inherently requires high-reliability and situational awareness to provide consistent high-quality care. However, treatment errors still occur in dentistry as they do in medicine. The importance of avoiding error is elevated for dentistry due to the increased frequency of irreversible procedures in each patient interaction compared to non-surgical specialties in medicine. Although a universal protocol for time-out exists, wrong-site procedures are a persistent healthcare issue in dentistry.

Data By implementing high-reliability organisations (HROs) principles to dentistry, improved safety and quality can be achieved.

Sources There are five essential principles that HROs have been observed to adhere to: preoccupation with failure; situational awareness/sensitivity to operations; a reluctance to simplify; deference to expertise; and commitment to resilience. Deep examination of the potential vulnerabilities in dentistry, using HRO ideology will create effective process improvement strategies. It fosters a culture of accountability using systematic problem-solving as opposed to condemnation.

Study selection Implementation of HRO principles will improve the existing universal time-out process, while placing quality and performance at the central focus of strategic success.

Conclusions Dentists can adopt these HRO principles into their practices to create effective process improvement strategies.

Key points

  • Implementation of HRO ideology will create effective process improvement strategies by fostering a culture of accountability.

  • Empirical evidence is provided to illustrate how the application of HRO principles can improve outcomes in dentistry.

  • HRO model reframes vulnerabilities in dentistry as valuable information for improvement, placing quality and performance as the central focus of strategic success.

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Acknowledgements

The authors warmly thank (Velerie Hefterich, Kathleen Norton) the Justi Educational Department, American Tooth Industries Inc for consolidating the nomenclature onto a schematic diagram.

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Authors and Affiliations

  1. Centre for Reconstructive Dentistry and Oral Surgery, P.C. (Professional Corporation), Dallas, Texas, USA; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

    Helena M. Minyé

  2. Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Ariadne Labs, Brigham and Women´s Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA

    Evan Benjamin

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Contributions

The authors confirm contribution to the paper as follows: Evan Benjamin contributed to study conception and design; Helena M. Minyé contributed to content analysis, data interpretations, draft manuscript preparation and wrote the manuscript with support from Evan Benjamin. All authors reviewed and discussed the results, contributed to the final manuscript and approved the final version of the manuscript.

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Correspondence to Helena M. Minyé.

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Minyé, H., Benjamin, E. High-reliability organisation principles implemented in dentistry. Br Dent J 232, 879–885 (2022). https://doi.org/10.1038/s41415-022-4354-z

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