Getting the measure of quality

What does quality assurance mean to you? If you are reading this journal, as I have been since a dental student, you are aware of what this unique journal offers, which explains why Colgate's partnership with Dental Update goes back to well before continuing professional development (CPD) was mandatory in the UK. There are many definitions of quality, ‘The standard of something as measured against other things of a similar kind; the degree of excellence of something.’¹ If we reflect what quality means to us as clinicians the definition broadens also to include conformance to requirements, fitness for use, fitness for purpose and, of course, meeting patient needs and expectations.

A key measurement of quality in healthcare provision is ultimately clinical outcome, but this can be challenging when defining what success looks like. So let us consider what evidence we use to inform and update ourselves when considering our clinical choices and decision-making in practice.

Can we link quality with reliability? Reliability comes from quality standards, whereby the level of quality is linked to reliability. In other words, reliability is ‘The probability an item/service will function correctly when needed, for the period required, in the specified environment’. An all-encompassing definition for reliability is ‘the chance of success’. As a reader and subscriber to Dental Update, you have access to peer reviewed articles covering new and established clinical practices. This provides you with a level of quality and reliability, but how do you measure this?

The General Dental Council states that ‘CPD for dentists and DCPs is defined in law as activity which contributes to their professional development and is relevant to their practice or intended practice’. The GDC also makes reference to the quality of CPD activity we all undertake, stating that ‘The quality of CPD supports you to meet the GDC Standards and, as consumers of CPD, dental professionals should make careful choices when investing time and money in CPD products and services.’²

The Committee of Postgraduate Dental Deans and Directors UK (COPDEND) has recently commissioned a Quality Assurance Framework to support both providers of continuing professional development (CPD) for dental professionals and for dentists and dental care professionals themselves.³ It is informed by evidence and designed to be a practical tool for CPD providers. It also helps dental professionals to make informed choices about their continuing professional development. This framework encompasses different types of CPD provision (face to face, ‘hands-on’, online, journal and conference formats), from a range of different providers (private/commercial providers, academic institutions and postgraduate deaneries). It is structured around four principal areas vital to quality CPD: planning and development, delivery, evaluation and administration.

As a Dental Update subscriber, you are aware of recent format changes in terms of answering and scoring your CPD element. This is in response to this new quality framework and therefore further supports you to meet GDC standards. How do you measure the quality of other CPD providers for you and your team? Commercial companies offering CPD in any format have a choice: either to embrace the new framework and deliver quality CPD or, until this framework scheme is piloted in the near future, carry on as before. This is your chance to judge their efforts in respect of products and courses they offer to review which ones will benefit your patients.

How do you measure the quality of products you use in practice? By linking quality with reliability or the chance of success when using or recommending specific products, you need to review your quality measures for the product in question. This could be linked to the number and quality of any clinical trials. There is a hierarchy of clinical evidence, with the most compelling and independent being a systematic review of multiple, well-designed randomized control trial/s. The Cochrane Collaboration gathers and summarizes the best evidence from research to help you make informed choices about treatments.⁴ Their work is recognized as representing an international gold standard for high quality, trusted information. These are complex reviews and readers are encouraged to see them in their entirety.

Any product claiming to improve or relieve a clinical condition has to have a medical licence. The medicinal licence gives specific and relevant indications for when it should be used, based on the clinical evidence provided when the product obtained the licence to show it does the job, and also a quality assurance measure in its production to ensure that every individual pack delivers the clinical benefit stated. An MHRA licence is, in effect, an independently verified quality seal to ensure that the product meets applicable standards of safety, quality and effectiveness.⁵ The NHS Choices website informs patients that ‘licences are only granted if high standards of safety and quality are met during the whole development and manufacture of a medicine and the product must also work for the purpose it is intended for if it is to be licensed’.⁶

Evidence-based practice requires a discipline of lifelong learning in which recent and relevant scientific evidence are translated into practical clinical applications. ‘Delivering Better Oral Health: An Evidence-based Toolkit for Prevention’, now in its third edition and published by Public Health England,⁷ brought experts together to provide a practical, evidence-based guidance to help clinical teams to promote oral health and prevent oral disease in their patients. Each piece of advice or clinical intervention is presented with an evidence grade. This represents the highest grade of evidence that currently exists for the advice or intervention listed in the model.

So let's acknowledge those that do deliver quality in our professional development, and set the bar as high as our patients deserve.