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At last there is a growing movement in healthcare, in general, to rely less on goals and targets as a way of measuring success and to start asking about the patient experience. As dentists, we are more ‘in business’ than most of our medical colleagues and as such we have had to keep our patients happy in order to encourage them to come back, but we still have a lot to learn about providing healthcare in a commercial world. It is so easy to get lost somewhere between working with compassion for our patients and making a living. Solutions to this revolve around treating others as you would be treated, being responsible and caring practitioners and maintaining an integrity and honesty in our dealing with patients. A further solution is to think about the patient/practitioner relationship as a partnership.
The concept of ‘partnership working’ has been gaining ground in conventional business. This is where there is not a ‘customer’ nor a ‘supplier’ of goods or services but there is, instead, a partnership between contractor and contractee. It’s so brilliant because both parties have a stake in the outcome and shared responsibilities for the process.
However, partnership working has been noticeable by it’s absence in healthcare and particularly in dentistry. The provision of dental care is a process where the outcome depends not just on the skill of the healthcare professional but at least as much on patients making appropriate lifestyle choices, taking medication when required and turning up for appointments. On the face of it, this would be an ideal situation to make a partnership between the patient and practitioner in order that both parties understand their role in the process. We could then work within a relationship that is based on equality, commitment to an outcome and an understanding of responsibility. The following quote from ‘The National Review into Patient Safety in England, August 2013’ is relevant to the implied contract between dentist and patient and also sits comfortably with the new GDC standards:
“Patient involvement means more than simply engaging people in a discussion about services. Involvement means having the patient voice heard at every level of the service, even when that voice is a whisper. Evidence shows that patient safety improves when patients are more involved in their care and have more control. Patient involvement is crucial to the delivery of appropriate, meaningful and safe healthcare and is essential at every stage of the care cycle: at the front line, at the interface between patient and clinician; at the organisational level; at the community level; and at the national level. The patient voice should also be heard during the commissioning of healthcare, during the training of healthcare personnel, and in the regulation of healthcare services.
The goal is not for patients and carers to be the passive recipients of increased engagement, but rather to achieve a pervasive culture that welcomes authentic patient partnership – in their own care and in the processes of designing and delivering care. This should include participation in decision-making, goal-setting, care design, quality improvement, and the measuring and monitoring of patient safety. Patients and their carers should be involved in specific actions to improve the safety of the healthcare system and help the NHS to move from asking, - “What’s the matter?” to, -“What matters to you?” This will require the system to learn and practice partnering with patients, and to help patients acquire the skills to do so.”
So, how can we achieve this in dentistry?
A partnership, in this context, is an arrangement between two or more individuals to work together to achieve common aims. The term is now widely used in business, but has many different interpretations depending on the goods or services under negotiation. So what distinguishes a true partnership?
Partnerships usually have the following qualities -
- All the parties involved have some sort of personal stake in the partnership;
- All the partners are working towards a common aim;
- The partners have to work on developing a similar ethos or system of beliefs;
- The partners work together over a reasonable period of time;
- There is agreement amongst the partners that a partnership is necessary;
- There is an understanding of the value of what each partner can contribute;
- There is a growth in respect and trust between the different partners.
Partnerships are often more successful than contracts where one person pays another for services provided because one person isn’t laden with the responsibility of doing everything without cooperation from the other. Dentists could confidently tackle issues they had previously steered clear of, such as Preventative Care because the patient is also involved in the plan and is given tasks to complete as well – such as good Oral Hygiene techniques. Dentist/Patient Partnerships would also be successful because …
- They share information and feed-back results;
- Participants are able to feed off each other’s energy and enthusiasm;
- Paying patients better understand what they ar paying for;
- They highlight different issues, problems and solutions than just repair;
- Service delivery is often more effective;
- They offer support and diversity.
Planning is all important
However, for these partnerships to work, there must be an amount of high quality planning, flexibility, energy and commitment by all members of the team to become engaged in the process. A formal agreement will be required that has back-up plans in the event that one of the partners cannot fulfil all their responsibilities. It would have to be flexible enough to take into account all levels of ability from the patients’ end.
The important point about flexibility is that the partnership agreement should be tolerant enough to understand when a patient tries but fails to deliver their promises but rigorous enough to weed out those people who are not 100% committed to the partnership.
Other key ingredients to making a practitioner/patient partnership work are…
- Clear and targeted information – about costs, timings and responsibilities.
- A good initial examination – drive a clear plan of action;
- Discussion – to work out the best way of treating the problem;
- Acting together – to make sure each willing member of the partnership is involved in carrying it out.
Basis in trust
Trust is an essential ingredient for a successful partnership. When discussing the options with patients, it is important to do this from a firm position of trust and accountability first. To help establish trust, focus on the ways you can work together and actively seek out shared values. Once treatment gets underway, communication has to continue at the same high standard.
You can do this by…
- Seeing patients regularly and often
- Delivering what you promise
- Admitting to mistakes
- Checking that patients have no outstanding issues from previous contacts with the practice
- Informing and educating patients about treatment options and the course of care
- Being open and honest about the clinical situation and what is possible and about any problems or risks with treatments
- Sitting opposite the patient during conversation (not behind and out of sight!)
- Developing an understanding of the patient as an individual, not as a disease or a set of teeth
- Showing empathy and respect
- Listening actively
- Eliciting concerns and calming fears
- Answering any questions with understanding and not irritation
To begin designing a Partnership Agreement that suits your practice start by writing a list of what you can do as a practitioner and a list of what you expect from patients. Every practice will end up with a different standard agreement. No partnership will ever be perfect and if you spot any difficulties simply take a few steps back and review. If you decide this is for you, then I wish you well with it and please contact us to let us know how it goes.
Dr John Shapter – QCS Expert Dental Contributor