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The November 2017 publication of ‘Lessons for dentistry from the flightdeck’1 has stimulated thought, as evidenced by the Dental Update Study Day into how dentistry can learn from the aviation industry. In aviation, a pilot's continued professional competence is formally assessed every six months during simulator checks and, alongside that, targeted training aims to develop competencies. Outside formal assessments, aviation aims to create a culture that encourages the open reporting and sharing of information in a way that identifies where mistakes have been made but, more importantly, focuses on how that information can be used to learn lessons and strive for continuous improvements in safety and standards.
UK dentistry has been in a spiral of increased litigation against dentists, with the General Dental Council, until recently, joining in by virtue of its increased case load of cases against supposedly miscreant dentists. This is in stark contrast to the ‘Just Culture’ that is promoted within aviation, where the aim is to encourage open reporting without fear of unfair retribution. Of course, the situations are different. In aviation, a mistake by a pilot could cost many lives, whereas in dentistry a mistake by a dentist could cost a tooth, with the patient suing the dentist as a result or, in situations reported in our November 2017 ‘Risk Issue’, death. Apart from the, thankfully, relatively rare significant incidents in aviation though, there are many more much less significant ‘near misses’ or situations where things might have gone wrong had actions, procedures, equipment performance or circumstances been different.
Older clinicians (such as one of the co-authors) and younger clinicians (perhaps as a result of inexperience) will reflect on the many near misses in which a disaster affecting a tooth/teeth and patient was narrowly avoided. This could be the result of using the wrong material for a given clinical situation or, frankly, the incorrect/inappropriate treatment. So, how can dentistry learn from these near misses using the benefit of aviation's experience?
In aviation, the concept is ‘Open Reporting’, where people feel comfortable to share reports of what went well and what didn't, without fear of unfair retribution. Pilots are required to report significant incidents to the regulatory bodies through formal reporting mechanisms, but also share information on a peer to peer basis. Many large aviation organizations publish regular safety publications, within which pilots are encouraged to share their experiences of when something went wrong, nearly went wrong, or equally valuably, when something went very right. This creates an effective feedback loop and feeds the industry-wide sharing of information that contributes towards a continuous improvement in safety and standards. A frequently used generic title for this peer to peer communication is ‘I learnt about flying from that’. The reports may be anonymous, but equally frequently, flightcrew are happy to be identified with what they write.
Dental Update proposes to commence an additional feature in which subscribers will be encouraged to report on their clinical experiences (emphasis on clinical – we are not diving into the political arena), anonymously or not, with a view to helping other clinicians avoid adverse situations or, on the contrary, to describe what went well in their experience. It will be called ‘I learnt about dentistry from that’ and a paragraph or two is all that is needed. This can be submitted to a secure email address, away from prying eyes (for the reporting of adverse incidents). If the same subject is reported more than once, its importance will be emphasized and this may act as an effective catalyst to focus on areas of concern in future issues of Dental Update.
This proposed new initiative was discussed at a recent meeting of the Editorial Board of Dental Update and opinions were delicately balanced. We therefore ask subscribers to consider whether they feel that this concept is a good one by writing to Trevor Burke at tburke@georgewarman.co.uk if readers agree, we will put this into action, either in print, or on the Dental Update website. It is our view that this initiative will not only help in the provision of care for patients (our primary consideration) but also reduce the number of adverse medico-legal situations in which dentists find themselves, as well as leading to a greater awareness, by bodies like the General Dental Council, of the difficulties which dentists find themselves in on a daily basis while treating patients. If these objectives can be achieved, then this new initiative will have been worthwhile. Please let us know!
Postscript from the Editorial Director: In this issue, we report two different uses of ‘selfies’ in patient care. In one, ‘selfies’ are used as a patient instruction tool, while in the second, it was an aide to the dentist when treating a trauma case: without the ‘selfie’, the traumatized teeth might not have been returned to their optimal position. Something new for us all to think about in 2019!