Boredom

Few things make a GDP's heart sink more than a day of back-to-back examinations. It's not just the monotony of repeating the same words and actions for hours, but the knowledge that, if boredom sets in, it's easier to make a mistake and miss something important. To err is human, as they say, and we shouldn't expect ourselves or our colleagues to be infallible. However, it's important to design our working systems to reduce the likelihood of errors occurring and minimise any that slip through the net.

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Human factors, the catch-all term for the study of how we relate to our working equipment and environment, takes its lead from the aviation industry, where there is a culture less inclined to blame individuals for errors and more interested in learning from mistakes. Healthcare, including dentistry, has started to take this on board over recent years, but there is still work to do.

There are many barriers we can place in the way of mishaps, including ones we can take from the airline industry itself. For example, when I travel by plane, I'm reassured that the pilot and co-pilot have completed a walkaround of the aircraft before take-off. Items have been ticked off from the pre-flight checklist to ensure the safety of myself and other passengers. Given the set routine of many dental procedures, shouldn't we use appropriate checklists to guarantee we don't miss anything and reassure patients of the quality of their treatment? And for any particularly complicated treatment, we can draw up a ‘flightplan' at the start of an appointment and tick stages off as we go along. Not only does this reduce the likelihood of errors, but it also helps to keep everyone in the surgery motivated.

Of course, none of these barriers are foolproof, so we end up with a ‘Swiss cheese' model of disaster avoidance, but to my mind, a change in the culture surrounding dentistry is essential.

Culture in healthcare is a complex mishmash of beliefs and values, which we can sum up as ‘how and why we do things'. Shifting culture is complex and unpredictable but always comes via action from the top, whether in surgery, practice, teams, or regulators. Dentistry must move towards a no-blame, or at least lesser-blame, culture recognising that mistakes are inevitable. At the very top of the profession, we now have an excellent opportunity to kickstart this cultural shift, with the GDC announcing the imminent departure of their Chief Executive and Registrar, Ian Brack. The new Chief Executive takes over the day-to-day running of the Council and will uniquely influence how the profession develops in the future.

Many have written about a culture of fear in dentistry thanks to the GDC, affecting dentists from their student days. The new Registrar needs to understand the pressures on our profession and be willing to listen to practitioners and patients when considering regulatory reform. We must replace fear with openness and learning, which can only come from actions speaking louder than words.