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LifesmilesGOLD: Making oral health Care more accessible for more people

Murrumbidgee Local Health DistrictSouthern NSW Local Health District
Project Added:
20 August 2015
Last updated:
1 November 2017

LifesmilesGOLD: Making oral health care more accessible for more people

Summary

LifesmilesGOLD for Oral Health has introduced a change in our appointment scheduling. Appointment books are customised for each clinic to match demand. Urgent patients receive quicker access for their urgent treatment. There are more appointments available for patients who have less urgent oral health needs.

Phase two of the project will see initiatives implemented that will focus on prevention. An oral health risk / motivation assessment tool will be applied for those who are waiting for care. This will provide an optional pathway for patients to receive education and clinical assistance to improve their long term oral health outcomes as well as simply having dental treatment completed.

Download a poster from the Centre for Healthcare Redesign graduation, August 2015.

Aim

To ensure oral health services are delivered in a fair and equitable manner to the eligible adult population who request public dental care in Southern NSW and Murrumbidgee Local Health Districts (SNSWLHD and MLHD).

Benefits

  • More patients are getting dental treatment with fairer, more consistent process for allocating appointments.
  • More appointments available for patients with less urgent treatment needs.
  • Reduced waiting times, and fewer patients on waiting list.
  • Leaner process to access oral health care with less potential contact points with patient before attending appointment.
  • Positive feedback from patients around timely appointments and consistent and clearer information received.
  • Reduced cost of care per capita.
  • Improved communication between clinics and management with consistent processes and messaging and improved documentation.
  • Clear, transparent and more consistent processes for staff.
  • Clear decision making process for clinicians.
  • Increased staff satisfaction.
  • Clinicians better able to predict demand and plan rosters and report feeling more in control of the workload.
  • Better understanding of how to provide services to meet demand.
  • Clinicians report that they are able to provide a broader range of services.

Project status

Project started: 21 July 2014.

Project status: Implementation.

Background

Dental clinics belonging to oral health services SNSWLHD and MLHD have limited appointments available to provide care each week. Diagnostic analysis showed that, patients who request access to the service under a high triage priority receive treatment for their urgent condition and also receive an average of five additional appointments for non-urgent care.

When urgent patients have extra appointments for lesser conditions this prevents patients with similar non-urgent needs from accessing the service.

Before redesign was implemented, 65% of all patients waiting on lower priority oral health waiting lists in SNSWLHD and MLHD waited longer than the NSW recommended waiting time and much longer than the state average.

Patient stories revealed frustration at the lack of information about expected waiting times for dental treatment and a perception of lack of fairness of the system. One patient felt she was going "backwards" on the "never, never-ending waiting list" due to the high volume of emergency cases that she perceived "jump the queue" and push everyone else backwards.

Clinicians reported: feeling that they could “Never get our heads above water”, “I have a tidal wave of toothaches and can never get to see the lower priority patients” and “We as clinicians do not have any control over our appointment books or waiting lists, so we just do all that we can for the patient in front of us.”

Implementation

Phase one

  • All patients with high priority triage codes are now given an appointment at first contact without any wait list time.
  • Less urgent conditions are prioritised and appointments allocated according to a standard process.
  • Processes have been changed and are consistent across all clinics across the LHDs and intake service.
  • Customised appointment book templates for clinics ensures demand for appointments of various priorities is matched to capacity to provide timely clinical services.

Phase two

Phase two of the project will see initiatives implemented that will focus on prevention. An oral health risk / motivation assessment tool will be applied for those who are waiting for care. This will provide an optional pathway for patients to receive education and clinical assistance to improve their long term oral health outcomes as well as simply having dental treatment completed.

Implementation sites

Trial clinics Wagga and Queanbeyan. All other dental clinics across SNSWLHD and MLHD are at various stages of implementation.

Partnership

Murrumbidgee Local Health District and Southern NSW Local Health District shared oral health service.

Evaluation

Trial Clinic Wagga

  • 100% of clinicians consistently complying with policy and new processes at trial clinic and most other clinics across the LHDs.
  • Number of appointments for high priority courses of care reduced from average of 5 appointments to average of 1.5 appointments.
  • Increased number of patients accessing the service.
  • Increased number of patients triaged as lower priority receiving treatment.
  • Increased range of services being provided.

Review of waiting list data

  • Total Waiting lists reduced from 659 to 271 after redesign implementation.
  • High priority patients now appointed at first contact, no waiting list. In June 2014, 191 patients were waiting for an appointment, some waiting in excess of two years. Post redesign zero on waiting list and this result has been sustained for four months.

Awards

Lessons learnt

  • Challenges include measuring results when you are not starting with a greenfield site.
  • We were not only implementing a new way to progress patients through the system but also patients who are undergoing a course of care from the old system requiring completion.
  • Did not predict the transition stage for the management of legacy waiting lists created prior to the change would be as long as it has been.
  • Many positive impacts of the change can be disguised or obscured by the crossover of old and new.
  • When setting a goal as a percentage, you have to be sure that the denominator does not change! My goal was to reduce the % of those waiting longer than recommended waiting time from 65%-15%. We reduced the overall number and therefore we could no longer compare percentages.

Contact

Anne PritchardClinical Leader Oral Health
Southern NSW and Murrumbidgee Local Health Districts
Phone: 0407 061 902
anne.pritchard@gsahs.health.nsw.gov.au

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