A whole-team approach to optimising general dental practice teamwork: development of the Skills-optimisation Self-evaluation Toolkit (SOSET)

Introduction Studies across the health service reveal benefits of teamwork and barriers to its optimal use. Drawing upon the established Maturity Matrix Dentistry method, the Skills Optimisation Self-Evaluation Toolkit (SOSET) was developed to enable the whole dental team to critically review how they address skill-mix in delivery of patient-centred oral healthcare in their practice. This paper outlines the development of the SOSET and explores its usefulness to general dental practice teams. Methods Research literature and interview data from general dental practice teams were coded for high-level factors (positive and negative) influencing teamwork. We used this coding to identify skill-mix domains, and within each, define criteria. The SOSET process was refined following consultations with dental professionals and piloting. Results Eighty-four papers were coded and 38 dental team members were interviewed across six sites. The SOSET matrix was developed containing nine domains reflecting the use of skill-mix, each containing six development-level criteria. The domains addressed factors such as team beliefs on skill-mix and knowledge of team members' scope of practice, patient demand, the business case, staffing and training, and the practice premises. The process was piloted in 11 practices across South Wales, and feedback was received from 92 staff members. Results showed that the SOSET process was straightforward, that the whole team could contribute to discussion and that it would be used to improve practice. Following piloting, four domains were merged into two new domains, and the number of criteria within all domains was reduced and the wording simplified (seven domains, with four criteria each). Conclusion We used a systematic and rigorous process to develop the SOSET to support dental teams to progress their teamwork practices. Its usefulness was demonstrated in the pilot. The SOSET is now being offered to general dental practices across Wales

Skill-mix in the dental team: future directions and support mechanisms

It is a time of change: in patient demographics and treatment needs; in the composition of dental teams; and in NHS dental contracts and arrangements for Direct Access. Although studies across the health service reveal benefits from better use of skill-mix, there are significant barriers to the optimisation of skill-mix in dental practice. To help practices to optimise skill-mix, we developed and tested a whole-team self-evaluation tool. The Skills Optimiser Self-Evaluation Tool (SOSET) is a process that has a team meeting with a Quality Improvement (QI) tutor at its core. During the session, the team discusses the descriptions of four criteria or levels within each of the seven dimensions. The team celebrates areas where the practice is doing really well and agrees priorities for improvement. A ‘Sources of Help and Advice’ document is provided, and the QI Tutor may also offer further resources. The development of the SOSET was based on an analysis of existing evidence and its usefulness for setting objectives for optimising dental team skill-mix has been demonstrated in the pilot testing

Skill-mix in the dental team: future directions and support mechanisms

It is a time of change: in patient demographics and treatment needs; in the composition of dental teams; and in NHS dental contracts and arrangements for Direct Access. Although studies across the health service reveal benefits from better use of skill-mix, there are significant barriers to the optimisation of skill-mix in dental practice. To help practices to optimise skill-mix, we developed and tested a whole-team self-evaluation tool. The Skills Optimiser Self-Evaluation Tool (SOSET) is a process that has a team meeting with a Quality Improvement (QI) tutor at its core. During the session, the team discusses the descriptions of four criteria or levels within each of the seven dimensions. The team celebrates areas where the practice is doing really well and agrees priorities for improvement. A ‘Sources of Help and Advice’ document is provided, and the QI Tutor may also offer further resources. The development of the SOSET was based on an analysis of existing evidence and its usefulness for setting objectives for optimising dental team skill-mix has been demonstrated in the pilot testing

Setting the context for a complex dental intervention of role substitution in care homes: initial process evaluation findings

Background The oral health and quality-of-life of older adults residing in care homes is poorer than those in the community. Oral health care provision is often unavailable and a concern and challenge for managers. The use of Dental Therapists and Dental Nurses rather than dentists could potentially meet these needs. ObjectivesSENIOR (uSing rolE-substitutioN In care homes to improve oRal health) is a randomised controlled trial designed to determine whether role substitution could improve oral health for this population. A parallel process evaluation was undertaken to understand context. This paper reports on the first phase of the process evaluation.Materials and MethodsSemi-structured interviews were conducted with 21 key stakeholders who either worked or had experience of dependent care settings. Questions were theoretically informed by the: Promoting Action on Research Implementation in Health Services (PAHRIS) framework. The focus was on contextual factors that could influence adoption in practice and the pathway-to-impact. Interviews were fully transcribed and analysed thematically.ResultsThree themes (receptive context, culture, and leadership) and 11 codes were generated. Data shows the complexity of the setting and contextual factors that may work as barriers and facilitators to intervention delivery. Managers are aware of the issues regarding oral health and seek to provide best care, but face many challenges including staff turnover, time pressures, competing needs, access to services and financial constraints. Dental professionals recognise the need for improvement and view role substitution as a viable alternative to current practice. ConclusionAlthough role substitution could potentially meet the needs of this population, an in-depth understanding of contextual factors appeared important in understanding intervention delivery and implementation.<br/

Dental nurses' perception of CPD in Wales

Mandatory registration with the General Dental Council (GDC), introduced in July 2008, was intended to bring dental nurses (DNs) in line with other health personnel, increasing their standing and identifying them as a highly trained professional group

The introduction to practice (ItP) scheme for therapists in Wales: an evaluation of the first three years

Objectives: Introduction to Practice (ItP) is a foundation (vocational) training scheme for newly-qualified dental therapists. The purpose of this study was to evaluate the scheme with ‘current’ trainees and follow-up previous trainees to gather their retrospective views and career history. Methods: Following a group discussion, all current trainees (n=7) completed questionnaires. Portfolio extracts were gathered. Trainees (n=8; 67%) from the 2009/2010 intakes completed a postal/online questionnaire. Current and past trainers completed a postal questionnaire (n=12; 92%)

Dental nurses' perception of CPD in Wales

Mandatory registration with the General Dental Council (GDC), introduced in July 2008, was intended to bring dental nurses (DNs) in line with other health personnel, increasing their standing and identifying them as a highly trained professional group

Setting the context for a complex dental intervention of role substitution in care homes: initial process evaluation findings

ObjectivesSENIOR (uSing rolE-substitutioN In care homes to improve oRal health) is a randomised controlled trial designed to determine whether role substitution could improve oral health for this population. A parallel process evaluation was undertaken to understand context. This paper reports on the first phase of the process evaluation.BackgroundThe oral health and quality-of-life of older adults residing in care homes is poorer than those in the community. Oral health care provision is often unavailable and a concern and challenge for managers. The use of Dental Therapists and Dental Nurses rather than dentists could potentially meet these needs.Materials and MethodsSemi-structured interviews were conducted with 21 key stakeholders who either worked or had experience of dependent care settings. Questions were theoretically informed by the: Promoting Action on Research Implementation in Health Services (PAHRIS) framework. The focus was on contextual factors that could influence adoption in practice and the pathway-to-impact. Interviews were fully transcribed and analysed thematically.ResultsThree themes (receptive context, culture, and leadership) and 11 codes were generated. Data show the complexity of the setting and contextual factors that may work as barriers and facilitators to intervention delivery. Managers are aware of the issues regarding oral health and seek to provide best care, but face many challenges including staff turnover, time pressures, competing needs, access to services, and financial constraints. Dental professionals recognise the need for improvement and view role substitution as a viable alternative to current practice.ConclusionAlthough role substitution could potentially meet the needs of this population, an in-depth understanding of contextual factors appeared important in understanding intervention delivery and implementation.<br/

uSing rolE-substitutioN In care homes to improve ORal health (SENIOR): a study protocol

Background Dental service provision in the care home sector is poor, with little emphasis on prevention. Emerging evidence suggests that the use of Dental Care Professionals (dental therapists and dental nurses) as an alternative to dentists has the potential to improve preventive advice, the provision of care and access to services within care homes. However, robust empirical evidence from definitive trials on how to successfully implement and sustain these interventions within care homes is currently lacking. The aim of the study is to determine whether Dental Care Professionals could reduce plaque levels of dentate older adults (65 + years) residing in care homes. Methods This protocol describes a two-arm cluster-randomised controlled trial that will be undertaken in care homes across Wales, Northern Ireland and England. In the intervention arm, the dental therapists will visit the care homes every 6 months to assess and then treat eligible residents, where necessary. All treatment will be conducted within their Scope of Practice. Dental nurses will visit the care homes every month for the first 3 months and then three-monthly afterwards to promulgate advice to improve the day-to-day prevention offered to residents by carers. The control arm will be ‘treatment as usual’. Eligible care homes (n = 40) will be randomised based on a 1:1 ratio (20 intervention and 20 control), with an average of seven residents recruited in each home resulting in an estimated sample of 280. Assessments will be undertaken at baseline, 6 months and 12 months and will include a dental examination and quality of life questionnaires. Care home staff will collect weekly information on the residents’ oral health (e.g. episodes of pain and unscheduled care). The primary outcome will be a binary classification of the mean reduction in Silness-Löe Plaque Index at 6 months. A parallel process evaluation will be undertaken to explore the intervention’s acceptability and how it could be embedded in standard practice (described in a separate paper), whilst a cost-effectiveness analysis will examine the potential long-term costs and benefits of the intervention. Discussion This trial will provide evidence on how to successfully implement and sustain a Dental Care Professional-led intervention within care homes to promote access and prevention. Trial registration ISRCTN16332897. Registered on 3 December 2021