Indian Journal of Dental Research

: 2014  |  Volume : 25  |  Issue : 2  |  Page : 139--141

Patient safety and quality assurance and improvement

Nermin Yamalik 
 Member, Council, FDI - World Dental Federation, Member, Finance and Renumeration committe, FDI Council, Department of Periodontology, Faculty of Dentistry, University of Hacettepe, Sihhiye 06100, Ankara, Turkey

Correspondence Address:
Nermin Yamalik
Member, Council, FDI - World Dental Federation, Member, Finance and Renumeration committe, FDI Council, Department of Periodontology, Faculty of Dentistry, University of Hacettepe, Sihhiye 06100, Ankara, Turkey

How to cite this article:
Yamalik N. Patient safety and quality assurance and improvement.Indian J Dent Res 2014;25:139-141

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Yamalik N. Patient safety and quality assurance and improvement. Indian J Dent Res [serial online] 2014 [cited 2020 Aug 4 ];25:139-141
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Patient safety and risk management together with quality and standards of oral healthcare are among important professional issues for dentistry. It can easily be seen that more and more emphasis is placed on these issues each year. Thus, dentists and their team members are expected to have a considerable amount of awareness, knowledge and concern for patient safety and risk management and the broad context of quality assurance/improvement (QA/I) in healthcare. Further, they are expected to fully implement the basic patient safety and quality measures into daily dental practice.

As not many practitioners have a clear understanding of the broad context of patent safety and not all health care providers practice it on a daily basis, it is of utmost importance that organized dentistry is actively involved in this process and encourage and support individual dental professionals and the dental team members for the effective implementation of the basic measures of patient safety, and QA/I into dental practice. At this point, determination of individual dentists' specific needs and demands regarding QA/I and patient safety, more efforts to improve the knowledge, understanding and awareness of dental practitioners regarding the broad context of patient safety and the relatively "new" patient safety culture, and simple measures to avoid preventable errors all seems to be important.

 What is Patient Safety and Quality Assurance/Improvement and Why They are (Becoming More) Important ?


Patient safety is a relatively "new" discipline aiming at improving the quality of care, minimizing treatment errors, and improving safety of patients. Its main objective is to avoid preventable adverse events (accidents, errors, or complications) associated with healthcare and/or limit the impact of inevitable adverse events. Despite the simple definitions, patient safety is multifaceted and quite complex in nature and it includes many key elements. Thus, it cannot be simply defined as provision of safe healthcare or protection of the patients from harm by the healthcare providers, as there are economical, fiscal, social, cultural, and organizational aspects of a patient safety climate [1] although patient safety generates knowledge by itself (accidents and complications associated with the use of materials, general procedures and clinical facilities), this discipline can be defined as a cross-sectional area that benefits from the well-established knowledge in other areas. [2]

General principles of patient safety (e.g. learning from errors, checklists to reduce errors, etc.) apply to all health professions; however, its implementation of patient safety or improving the standards of care seems to be interpreted as 'difficult' by the individual practitioners. In fact, this may not be the case as the outcome of many specific patient safety methods is usually recommendations. Thus, most clinical expert recommendations about patient safety are very similar to the things, which common sense tells us. The problem may be that during the daily practice, time pressure, hurry, acquired habits, fatigue, and inertia sometimes may end up deleting this common sense. [1] The various peculiarities of patient safety in dentistry (e.g. widely dispersed dental healthcare settings, care to be mostly performed by solo-practicing dentists not closely connected to each other - unstructured and not institutionalized (hospitals) nature of dental care-, limited reporting and analysis of adverse events and/or errors, dental patients mostly being ambulatory) may need a particular interest when encouraging dental practitioners for effective implementation of patient safety, risk management, and QA/I measures into daily practice. [1]

On the other hand, patient safety is closely linked to the concept of quality care and similar to patient safety more emphasis is placed on QA/I in health care, including oral health care services. This process is even interpreted by the practitioners as a "pressure" for quality in daily practice. QA/I models/systems and their implementation in the health care arena share some common goals such as focusing on process, to uncover weaknesses and problems, to reduce mistakes in care, to encourage transparency, to improve service excellence, teamwork, patient safety and satisfaction, to save money and to ensure the standard of care. [3]

It seems that both dental education and dental practice are affected by the increasing "pressure" for QA/I in health care and the dental profession is expected to take more responsibility for the maintenance and improvement of quality of oral health care and service delivery. Where QA/I efforts are concerned it can be seen that various QA/I organizations and systems or models are available. Dental professionals are expected to be familiar with these various QA/I systems or tools that are available and that have implications for dentistry and the crucial importance of their ethical implementation in the health care arena, [4] together with a clear understanding of the new driving forces behind this increasing "pressure" for quality to be able to meet the demands for the continuous QA/I.

Although, there seems to be distinct differences in definition of QA/I and quality in general, systems and tools and their implementation in health care together with the national and international differences in health care delivery and QA/I laws and regulations still it is particularly important to have a correct understanding of the QA/I process, the shared values, goals, and potential benefits of the different QA/I systems and tools. [5]

It is important for the dental profession, especially the organized dentistry to promote a culture of patient safety and effective implementation of QA/I into practice as this is also an ethical obligation in any health profession. [1]


More efforts seem to be needed for including topics such as implementation of patient safety and risk management, and QA/I topics into both the undergraduate dental curriculum and continuing dental education programs. Development of educational materials aiming at improving knowledge and awareness of dental practitioners and the entire dental team about these topics is needed. Working together for clinical guidelines and national laws/regulations to improve patient safety and adopting a widely accepted culture where patient safety is concerned is recommended. [6],[5] Devising protocols to make maneuvers and activities potentially less dangerous and establishing "safety instructions" would also be beneficial.

Fundamentally, patient safety culture needs to be acknowledged as a culture that compels us to share our experiences and data, good or bad, with our colleagues so that everyone can learn from them. One important feature of patient safety - its "nonpunitive" character- needs a further emphasis. As the basic goal is to prevent the adverse events that may recur (or at least be prepared for them) patient safety does not seek to punish the guilty. In fact, it is intended that the adverse event reporting is completely anonymous. [1]

Improving patient safety may provide economic benefits and also may imply better legal security for dental practitioners. By complying with the basic guidelines and protocols pertaining to patient safety, practitioners may reduce the possibility of errors and adverse events and thus, diminish the occurrence of subsequent claims. [1] However, the objectives must be reasonable, and the measures taken to achieve them effective.

Although, there is considerable progress, still much needs to be done including policy makers taking the necessary measures to improve the culture of safety and academicians making more efforts to incorporate patient safety culture principles into educational curriculums and organizations promoting patient safety as a strategic priority around which the entire efforts of the organization needs to be focused and evaluating their systems for this purpose [2],[6],[7] Dental professionals also need to take into account the positive impact of benefiting from evidence-based dentistry, keeping up-to-date in the field of dental science and technology and not ignoring the close relationship between or the inseparable nature of, patient safety, risk management, and QA/I.

Patient safety should not be limited to individual practitioners, rather should be accepted as everyone's responsibility. All parties involved in provision of oral healthcare either directly or indirectly (e.g. dental educators, national, regional and international dental organizations, specialty groups, decision-makers, insurance agencies, dental industry, patient organizations, etc.) need to acknowledge they all can play significant roles in achieving an improved patient safety and QA/I and such efforts clearly benefit the individual patients and the public at large.


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