Trends in quality assurance in the dental profession.

I have dealt with three questions concerning trends in quality assurance. In summary, we must ask ourselves whether the profession can develop methods for dealing effectively with dentists whose performance is found to be continually unsatisfactory. This may be achieved by making available effective tools for others to use in developing quality assurance systems. These tools will involve criteria and standards for services, appropriateness of treatment, measuring outcomes of care, and methods for assessing dental practices. This may involve working closely with consumer representatives to assist in gaining the consumer's point of view and incorporating it into the technology of quality assurance. Berwick, in a recent article in the New England Journal of Medicine, called for the application of a "Theory of Continuous Improvement" rather than the "Theory of Bad Apples." His view is that we should examine the process itself and try to improve it rather than look for outliers or bad apples. His point of view is consistent with the concept of quality assurance I have been talking about. Quality assurance systems should assure quality by proper assessment, identifying strengths and weaknesses in the provision of care. The strengths should be reinforced and the weaknesses should be rectified. This necessitates positive communication between those who perform quality assurance and those who are being evaluated. It also assumes that the technology is appropriate, recommendations are reasonable and that, when changes are made, quality will improve. In order to make the theory of continuous improvement work, it should be consistent with financial incentives and professional values.(ABSTRACT TRUNCATED AT 250 WORDS)