Reasons to smile 2006 QUALITY OF CARE REPORT

Transcription

1 2006 QUALITY OF CARE REPORT Reasons to smile As the State s leading public dental agency, Dental Health Services Victoria (DHSV) is responsible for promoting oral health and providing public dental services to those Victorians most in need. Each year, we work with thousands of people from all corners of the State. This Quality of Care Report has been written for our community to demonstrate our commitment to improving our services to meet the needs of our patients and their families.

2 Language no barrier to dental care Newly arrived families with little or no English may not put a trip to the dentist very high on their to-do list, but when the Western English Language School found many of their students were in need of dental care, DHSV was there to help. Early in 2006, DHSV received a request for assistance from the principal of the Western English Language (WEL) School in Melbourne s western suburbs. The school runs an English as a Second Language program for primary and secondary school students who have recently arrived in Australia on permanent residence visas. Most students spend two to three terms at the school before moving into mainstream schools patient communication initiatives: More than 200 staff participated in communication skills training; State-wide patient communcation strategy developed; More than 300 staff participated in cultural awareness training.

3 The teachers found that many of the students were in serious need of dental care our challenge was to provide them with treatment before they moved on from the school. Following consultation with the principal and teachers, we placed a mobile dental unit in the school grounds and conducted dental examinations on site. Students requiring further dental treatment were referred to the nearby Footscray dental clinic (now part of the Western Region Health Service). Interpreters were also made available to explain the treatment to parents and children. In two busy weeks, the unit examined 195 of the school s 220 students. Treatment at the Footscray clinic, however, proved to be more difficult co-ordinating appointments around the availability of parents and interpreters has sometimes been a challenge, especially in cases where interpreters are scarce. Kay Holwell, DHSV s Western Area Manager, believes establishing relationships with families at the WEL School will take time and patience. Recently arrived families with little or no English, who are trying to get their lives set up, don t necessarily have a trip to the dentist on the top of their list of things to do but we are trying to get it somewhere on their list. We have made the first steps by responding to the need. Now we want to build on this relationship and find ways to engage families coming through the school. DHSV staff are continuing to work with staff at Western Region Health Service and the school to identify ways to provide accessible and responsive dental treatment to WEL School families. Quality of Care Report

4 Reaching remote and high-needs communities DHSV s two new state-of-the-art mobile school dental clinics are helping to deliver dental services to high-needs, rural and remote communities. The two mobile clinics hit the road in early 2006 and are currently servicing the Mornington Peninsula and Wonthaggi communities. Get on board! Each mobile clinic is staffed by three dental therapists and three dental assistants who will treat more than 2,400 school children each year. The new mobile clinics enable DHSV to target communities in areas without permanent dental facilities, thereby increasing the reach of our school dental services. The clinics are equipped to treat patients with special needs and disabilities, and are fitted with modern technologies to meet all the latest occupational health and safety and infection control standards. They feature two separate treatment areas, a sterile suite and a patient waiting area where parents and children can comfortably wait while reading or watching DVDs. The exterior of the clinics have been adorned with Defenders of the Tooth signage, our popular cartoon characters who help reinforce our key oral health messages: Eat Well, Drink Well and Clean Well. Julie Vannistelrooy s four children have all been regular visitors to DHSV s school dental vans, and they ve seen some big changes over the years. Her two youngest children recently visited one of DHSV s new vans while it was stationed at Hastings Primary School. The new van is a lot different to the old ones, says Julie. There s much more room for waiting, and space for the kids to play, which helps keep everyone from getting stressed. There s also room for parents to go in during treatment and not be under the feet of the staff which made me feel better. Julie says her sons really enjoyed their recent visits to the school dental service. They actually cope better with going to the dentist than I do! 2 Dental Health Services Victoria

5 Improving comfort and safety for patients in wheelchairs More than 5,600 patients in wheelchairs visit the Royal Dental Hospital of Melbourne (RDHM) every year. Until recently, they needed their carers and staff to physically move them into the dental chair for treatment, or they had to be treated sitting upright in their wheelchairs. Now there s a more comfortable and safe option for these patients. Dentist Zaklina Stojanvoic admits: it was sometimes pretty uncomfortable for our patients. That s why she and her colleagues in the Dental Hospital s Special Needs Unit are excited about the arrival of a new wheelchair tilter, which will improve the quality of care they can deliver to their patients. Having the tilter means that we don t need to move patients out of their wheelchairs, explains Zaklina. Instead, we can tilt them back so we can gain good access to their mouths, safely and comfortably. We can do our work much more easily and quickly, and patients can stay in a secure and comfortable position. The wheelchair tilter has been specifically engineered to improve dental treatment for wheelchair-bound patients. Its installation has been made possible by generous donations from the Anne and Eldon Foote Trust, the Helen Macpherson Smith Charitable Trust and the Lord Mayor s Charitable Fund. Quality of Care Report

6 Giving kids a reason to smile A new $30,000 facility is providing a safe and comfortable space for up to 90 children a day, bussed into the Royal Dental Hospital of Melbourne (RDHM) from surrounding schools for dental care. Completed in early 2006, the new children s waiting area is situated on level 2 of the Dental Hospital, and includes toys, games, DVDs, oral health promotion resources and two computers connected to DHSV s children s website The Defenders of the Tooth Adventure Playground. The new facilities are the result of a suggestion from consumers and community members on DHSV s Community Advisory Committee that the hospital investigate options for providing children with a special area where they could learn and play before receiving treatment. Thanks to a generous donation of $30,000 from the Collier Charitable Fund, the Collier Children s Corner was created. The Dental Hospital provides care to more than 14,000 children each year. The Collier Children s Corner is now giving our youngest patients a place where they can wait for care and learn how to protect their oral health, and most importantly all while having fun. Community and patient participation improves quality and safety DHSV s Community Advisory Committee (CAC) raises issues of consumer concern, and advises DHSV on how to ensure consumers are involved in the planning, delivery and evaluation of services. This year the CAC has been instrumental in developing a disability action plan for DHSV and providing consumer feedback on a range of initiatives. CAC members represent a range of community interests, including people with disabilities, families, youth, carers and regional patients. In 2006, two consumers were also appointed to DHSV s Board Quality Committee in order to ensure the patient s perspective was included in quality improvement initiatives. 4 Dental Health Services Victoria

7 Travelling team brings care to rural patients DHSV s Travelling Dental Team is using an innovative and successful service model to bring dental care to rural patients who would otherwise have little or no access to dental treatment. Established in November 2004, the travelling team includes a dental therapist and two dentists, recruited by DHSV s Health Purchasing & Provider Relations unit. The team visits regional public dental clinics without a full-time dentist, where they work to treat patients from the local community, assisted by local clinical and administrative support staff. Travelling to communities in need Dentist Charles Moatlhodi, a member of DHSV s travelling dental team, is currently treating patients at the Central Gippsland Health Service dental clinic in Sale where there is no permanent full-time dentist. Charles sees around 60 patients a week in need of both general and emergency care. While the work can be challenging at times, Charles says it is rewarding to bring care to an area that needs it more than many. It is good to know you are working where there is a real need. Before long we should start to see the difference in the waiting list here. Originally from Botswana, Charles did his dental training in Ireland. His longterm ambition is to study orthodontics. In the meantime, he hopes to continue his work in Sale until a permanent dentist is appointed, and then move on to another regional community where his help is needed. The team treats patients from the waiting list as well as those with emergencies. In addition, the team s dental therapist offers care through the Youth Dental Program to patients up to the age of 25 from surrounding areas. In the year, the travelling team treated 3,481 patients and continues to help reduce waiting times for general care. Members of the team have visited clinics at Moe, Warrnambool, Echuca, Sale, Wangaratta and Ballarat. The high quality of care provided by the team is evidenced by the many formal and informal compliments received. Due to its success, it is expected that an additional dentist and a prosthetist will be recruited to the travelling team this year. Quality of Care Report

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9 A lasting solution for young teeth Stainless steel crowns are recognised around the world as a long-lasting and cost-effective treatment for children who have extensive decay in their deciduous or baby molars. In 2006, we embarked on a program to make this treatment available to Victorian children under eight years of age. Stainless steel crowns are ready-made metallic caps which resemble the normal size and shape of a deciduous molar. Dentists use them to repair badly decayed deciduous teeth and protect them from further damage. DHSV s Clinical Director, Dr Hanny Calache, describes the introduction of stainless steel crowns as an important public oral health initiative. This is a durable and cost-effective treatment which will help reduce the burden of children s tooth decay on both the public dental system and on our young patients and their parents. Research has shown more than 90 per cent of stainless steel crowns will last more than four years without any problems, while less than 50 per cent of silver amalgam fillings last longer than four years, and tooth-coloured fillings have an even shorter lifespan. In most cases, the crowns are also a better option than extracting a badly decayed tooth as they maintain a space in a child s mouth allowing the permanent tooth to grow. Treatment is recommended for children aged eight years or younger with extensive decay in their deciduous molars, and in particular, for preschool children who usually require general anaesthesia to repair or remove extensive decay. We expect to see significant long-term benefits from the introduction of stainless steel crowns, including: significant reduction in the number of repeat general anaesthetics for preschool children; protection of remaining tooth surfaces; significant reduction in the need to repeat treatments and associated costs; reduction in the loss of productive time for school children and their working parents. Roll-out of the program will take two years. It includes a training program for dentists, dental therapists and dental assistants, developed in partnership with the University of Melbourne s School of Dental Science and private paediatric dentists. Quality of Care Report

10 Preventing oral decay in preschoolers Early intervention is critical in reducing the alarming incidence of oral disease among Victoria s youngest children. DHSV is working closely with maternal and child health nurses to identify children at risk and encourage preventive oral health habits. Oral disease is largely preventable, but many children still suffer from the complications of dental decay. School Dental Service data reveals more than 40 percent of five-year-old children experienced dental decay of which 75 per cent do not seek treatment until they start school (DHSV 2004). Unfortunately, by the time the child goes to school, it s too late for simple restorative treatment. Early intervention is vital. First teeth are important for young children in the development of their eating ability, speech patterns, facial appearance and, later, their adult teeth. Furthermore, healthy habits developed early form the basis of habits throughout life. We aim to equip Maternal and Child Health Nurses with the skills and confidence to provide parents and carers with information about adopting good oral health behaviours from an early age. These nurses are ideally placed not only to identify children at risk and provide appropriate referrals, but also to encourage parents to protect their children from oral disease through the development of three healthy habits Eat Well, Drink Well and Clean Well. Approximately 500 nurses received in-service training as part of DHSV s maternal and child health in-service program in , and a further 200 will receive training later this year. The training highlights key features of a new resource manual, Teeth: Oral Health Information for Maternal and Child Health Nurses, produced by DHSV to help the nurses incorporate oral heath into their daily work routine. Overwhelmingly, participants found the in-service opportunities useful, informative and well presented. Indeed, 96 per cent of participants said they were more confident in identifying a child at risk of oral health disease, and felt that they now had the knowledge required to conduct a mouth check. A major focus of DHSV s work in this area is on training practitioners in regional and rural areas to increase their skills and confidence when working with parents and carers, enabling them to adopt healthy behaviours and reinforce that oral health habits learned early will influence childhood and adulthood health. 8 Dental Health Services Victoria

11 Accreditation highlights improvements In December 2005, The Australian Council on Healthcare Standards (ACHS) conducted a periodic accreditation review of DHSV s service quality and safety measures. We received commendations in the areas of continuous quality improvement, risk management and post-operative care for day-surgery patients. It was evident DHSV had made significant improvements in all areas of the accreditation process an achievement made possible by our staff s commitment to the principles of continuous improvement. DHSV successfully achieved each of the 19 mandatory criteria and the 29 recommendations from the 2003 organisation-wide survey. The surveyors were aware of the extensive and diverse range of services provided by DHSV, as well as the significant effort required to ensure all the programs met the ACHS standards. DHSV was commended on these efforts, and as a result, did not receive any further recommendations for improvement. Surveyors were particularly impressed with a few unique areas, including: the planned roll-out of electronic patient records; the management of occupational health & safety matters; our new health promotion initiatives such as the inaugural National Oral Health Promotion Forum; and the credentialing and clinical privileges of clinical staff. The objective assessment of the ACHS accreditation review gave DHSV important feedback, informing future quality improvement initiatives. In we will concentrate on benchmarking our services, systems and processes against those of similar organisations. We see this as an important quality improvement initiative, set to provide us with new opportunities to learn from other organisations and share our own knowledge and expertise. Quality of Care Report

12 Measuring our performance The following charts measure the progress we have made during in improving the quality, accessibility and efficiency of our services. STATE-WIDE WAITING LIST Time to treatment STATE-WIDE WAITING LIST Number of people waiting ( 000) The average waiting time for general dental care decreased by 4.8 months, while the average waiting time for denture care has dropped by 5.7 months during The number of people waiting for general dental care decreased by 34 per cent throughout the year. We also saw a 26 per cent decrease in the number of people waiting for dentures. CHILDREN S ORAL HEALTH Decayed Missing and Filled Teeth (DMFT) NUMBER OF REPORTED ADVERSE EVENTS This graph illustrates the average number of teeth affected by decay in both 6 and 12 year olds who use the School Dental Service. The data reflects the current School Dental Service strategy to prioritise care and target Victorian children with highest needs. An adverse event is an incident that results in an undesirable outcome for a person receiving healthcare saw an increase in incident reporting. This is attributed to staff education and training programs, resulting in more conscientious staff reporting. Although there has been an increase in reporting, there has been a decrease in the number of incidents of a serious nature. 10 Dental Health Services Victoria

13 NUMBER OF PATIENT COMPLAINTS AND COMPLIMENTS FOCUS AREAS FOR IMPROVEMENT Patient complaints Patient feedback is important to us. It helps us identify ways in which we can improve our services. This graph shows the percentage of feedback, both compliments and complaints, received from patients treated by DHSV during In response to these patient complaints we have:» increased the number of chairs available at the Dental Hospital to treat emergency patients;» improved communication between DHSV staff and patients through a number of specialised communication and training workshops;» improved the processes for referring patients to the Dental Hospital. Infection control An infection control audit conducted in revealed significant improvement in compliance with infection control standards. Some important improvements included: 100 per cent compliance in batch labelling and tracking of instruments allowing efficient monitoring and isolation of instruments in the event of any infection control breaches; A staff education campaign resulted in a 15 per cent increase in reporting of sharps and splash incidents, ensuring higher levels of protection against transmittable diseases. Quality of Care Report

14 About DHSV Oral Health for Better Health Established in 1996, DHSV is the leading public dental agency in Victoria. In , with a budget of over $120 million, we provided clinical services directly to 132,468 patients, and purchased services from public and private providers across Victoria for 167,806 patients. Committed to quality DHSV s 850 staff share a commitment to ensuring the dental care provided to our patients is of a safe and high standard. Our patients receive that care through the Royal Dental Hospital of Melbourne, the School Dental Service, our Adult Dental Clinics and numerous community dental clinics across Victoria. Consultation and collaboration Our vision is Oral Health for Better Health and we aim to improve the oral health of Victorians by working in partnership with the community. We have close relationships with the Department of Human Services, our Community Advisory Committee, consumer bodies such as the Health Issues Centre, leading tertiary education institutions, the Australian Dental Association, and many private companies and philanthropic organisations who generously sponsor our activities. Your feedback In preparing this Quality of Care Report, we interviewed consumers from around Victoria and surveyed members of our Community Advisory Committee to find out what quality in dental care means to them, and how they would like to see DHSV report on its quality and safety measures and improvements. This is what they said: Good quality dental care is... Being told what you need to know without you asking. Getting a good job done. Someone taking the time to explain the treatment. Not having to wait too long. Feeling safe and confident. Being listened to and respected. Seeing staff take good care of my son. This report aims to respond to your requests for more real-life stories and more information about accessing and using DHSV services, while providing you with a concise report on how we ensure and measure the quality and safety of our services. You also told us you would like the report to be smaller than last year s. While some people said they might read it on the internet, the majority of people said they would be most likely to read the report in hard copy in clinic waiting rooms, or if it was mailed to their homes. Your feedback told us you wanted us to regularly inform you about our quality improvement initiatives in many different ways. During the next 12 months we will focus on improving the way and the means through which we communicate with our community. Currently, this report is widely distributed throughout Victoria. It is also available upon request by calling DHSV on (03) , and via our website at Hanny Calache Clinical Director Lloyd O Brien Chair, Board Quality Committee 12 Dental Health Services Victoria

15 ictoria s Public Dental Services Victoria s public dental services Type of service Who is eligible? Where is it available? How much do I pay? Early Childhood Oral Health Program All preschool aged children Community dental clinics in rural and metropolitan Victoria Free to dependants of health care card holders $27.50 for other families School Dental Service All primary school children Dependants of health care card holders in years 7 and 8 Mobile dental vans and fixed clinics in rural and metropolitan Victoria Free for dependants of health care card holders $27.50 per child, capped at $110 per family, per year Youth Dental Program Dependants or holders of a health care card aged under 18 or in school years 9 12 Community dental clinics in rural and metropolitan Victoria Free General dental care (including emergency care) Victorian health care card holders and their dependants Community dental clinics in rural and metropolitan Victoria $22 per visit capped at $88 for a course of care for health care card holders All Victorians are eligible for emergency care at the Royal Dental Hospital of Melbourne $100 pre payment for non-health care card holders, with cost based on treatment need Denture care Victorian health care card holders and their dependants Community dental clinics in rural and metropolitan Victoria Up to $ for a full acrylic denture Specialist care Victorian health care card holders and their dependants (by referral only) The Royal Dental Hospital of Melbourne Dependent on treatment needs. This will be discussed at your appointment. To find your nearest clinic visit or call

16 We value your feedback. Please contact us to tell us what you think of this report and how it could be improved. Dental Health Services Victoria PO Box 1273L, Melbourne, VIC, 3001 Telephone: Facsimile: Dental Health Services Victoria is the State s leading public dental agency, promoting oral health, purchasing services and providing care to Victorians.