Identification of effective working models using dental therapists in dental practice teams

• Main Author: Sun, Ningwei
• Published: University of Liverpool 2011
• Subjects: 617.60233
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.569520

The World Health report 2000 notes that determining the "right" mix of health personnel are major challenges for most health care organisations and health systems. Health care is labour-intensive and providers continually strive to identify the most effective mix of staff that can be achieved with the available resources taking into account local priorities. These issues are as much as a challenge in dentistry as in other parts of the health care system. For decades the dental team has included a range of different types of personnel that can deliver dental care. Although not all countries include dental therapists (DTs) in the team, in England DTs play an important role and have been able to work in dental practice for many years, with recent years showing an expansion in the number of DTs in the UK. Nevertheless such policies put in place to support a widening of skill mix in dental practice have not been met with a widespread change in the format of dental teams. A great number of UK dual-qualified DTs practise mostly as dental hygienists. Whilst dental practitioners have previously expressed generally favourable attitudes towards the employment of dental therapists, DTs are perceived as having limited financial value to dental practices. Thus there appears to be a gap between the implementation of a skill-mix policy in principle and the actual employment and use of DTs in dental teams. The aim of this study is to explore this area and identify ways in which dental therapists could be . effectively used in UK dental practices. This study used a multiple case study design with both qualitative and quantitative methods of data collection. Semi-structured interviews were carried out with 48 principal dentists, associate dentists, DTs, practice managers and dental hygienists. Non-participant observation was undertaken on the location of the practices, the type of buildings and any phenomena that the researcher thought might contribute to the case studies. A day sheet proforma was used to collect clinical production data. A la-item scale of patient satisfaction (Dental Visit Satisfaction Scale [DVSS]), which provides an outcome measure of overall patient satisfaction as well as three sub-scale outcomes (information- communication; understanding-acceptance; technical competence) was used. Dental practice sites were described as case studies. Interview transcripts were analysed using a Grounded Theory (GT) approach to identify categories and sub-categories. The quantitative data was analysed using statistical methods including t-tests and regression analysis. Drawing upon the findings from multiple sources, this study identifies an effective model of using DTs and offers a theory of factors influencing whether DTs can be successfully used in dental practice teams. Findings show that it is possible to overcome the apparent disincentives to DT delegation embedded within the UDA remuneration system by changing reimbursement arrangements within the practice. In addition, the prevalent management ethos in the dental practices was one geared towards assessing success according to a cost-volume-profit business model, where this was measured on the individuals' contributions rather than on the performance of the team as a whole. A fundamental shift is needed in order for DTs to be fully integrated into dental practice teams. A total number of five categories with seventeen sub-categories have been developed from GT analysis. "Striving for efficiency" emerged as the core category. Since dental practices are complex organisations, their goals may vary and hence the views of using DTs may well be different. The theory presented in this study suggests significant implications for policy and dental practices. Recommendations were as follows: Policy reforming the remuneration system should take account of practitioners' requirement to make the contribution of team members measureable. Teamwork should be integrated into undergraduate and postgraduate education as well as in-practice training. New organisational forms or a shift in practitioner worldviews regarding team-working are needed in order for DTs to be fully integrated into dental practice teams. The strategy for effectively using DTs in dental practice teams may be limited to particular situations where conditions are conducive to such use.