Kettler Nele, Chenot Regine, Jordan A Rainer
Institut der Deutschen Zahnärzte (IDZ), Köln, Deutschland.
Zentrum Zahnärztliche Qualität (ZZQ), Berlin, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2015;109(9-10):695-703. doi: 10.1016/j.zefq.2015.10.015. Epub 2015 Nov 17.
Statutory health insurance dentists working in private practice have a duty to maintain and improve the quality of dental care. An individual practice's approach to quality management (QM) can be made to reflect the practice's philosophy on quality and standards and can be adapted to the specific requirements of the practice setting they are meant to serve. This study set out to collect data on the subjective perceptions of quality that exist among German dentists, and to canvass their views on the process and benefits of implementing QM systems. In doing so, this study aimed to identify the incentives and obstacles that currently exist in relation to the implementation and further development of practice-based QM systems.
As part of a nationally representative cross-sectional study, a random sample of 2,084 dentists was asked to complete a questionnaire on perceptions of quality and QM. The response rate was 40.3 % (n=838). The study's primary end point was defined as the surveyed dentists' interpretative description of quality. The study's secondary end point was defined as the dentists' subjective evaluations of the benefits of QM in the day-to-day management of their own practices. Responses to open-ended questions were analysed using content analysis, while quantitative questions were analysed using descriptive univariate analysis.
When analysing respondents' subjective perceptions of quality (primary end point), the following dimensions were revealed as highly significant: patient (mentioned by 31.4 % of the responders), quality of treatment (29.5 %) and staff (14.8 %). As far as the benefits of QM in the day-to-day management of the respondent's own practices (secondary end point) were concerned, these appeared to be linked to the ease of implementation of the organizational tools offered by QM systems: managing emergencies, team meetings and procedural check lists were ranked as "can be implemented to a reasonable degree" and "can be fully implemented" by 82.3 %, 80.2 % and 79.9 % of respondents, respectively. There appeared to be a disconnect between the respondents' subjective perceptions of quality and the benefits of QM as part of day-to-day practice management, with QM systems failing to reflect the respondents' subjective views on quality.
The perceptions of QM among German statutory health insurance dentists are generally positive but marked by a disconnect between aspects of quality currently measured by QM systems and the dentists' views on what is required in order to assess quality standards in relation to the dimensions "patient", "quality of treatment" and "staff". A targeted review of the tools offered by QM systems may lead to improved ease of implementation. If QM is to form an integral part of clinical practice, all future developments need to consider the dentists' subjective perceptions of quality and their attitudes towards QM.
在私人诊所工作的法定医疗保险牙医有责任维持并提高牙科护理质量。个体诊所的质量管理（QM）方法能够体现该诊所对质量和标准的理念，并可根据其服务的诊所环境的特定要求进行调整。本研究旨在收集德国牙医对质量的主观认知数据，并征求他们对实施质量管理体系的过程和益处的看法。在此过程中，本研究旨在确定目前在基于诊所的质量管理体系的实施和进一步发展方面存在的激励因素和障碍。
作为一项具有全国代表性的横断面研究的一部分，随机抽取了2084名牙医，要求他们填写一份关于质量认知和质量管理的问卷。回复率为40.3%（n = 838）。该研究的主要终点定义为接受调查的牙医对质量的解释性描述。该研究的次要终点定义为牙医对质量管理在其自身诊所日常管理中的益处的主观评价。对开放式问题的回答采用内容分析法进行分析，对定量问题采用描述性单变量分析法进行分析。
在分析受访者对质量的主观认知（主要终点）时，发现以下几个维度具有高度显著性：患者（31.4%的受访者提及）、治疗质量（29.5%）和员工（14.8%）。就质量管理在受访者自身诊所日常管理中的益处（次要终点）而言，这些益处似乎与质量管理体系提供的组织工具的实施便利性相关：管理紧急情况、团队会议和程序检查表分别被82.3%、80.2%和79.9%的受访者评为“可以在合理程度上实施”和“可以完全实施”。受访者对质量的主观认知与质量管理作为日常实践管理一部分的益处之间似乎存在脱节，质量管理体系未能反映受访者对质量的主观看法。
德国法定医疗保险牙医对质量管理的认知总体上是积极的，但质量管理体系目前衡量的质量方面与牙医对评估“患者”、“治疗质量”和“员工”维度的质量标准所需内容的看法之间存在脱节。对质量管理体系提供的工具进行有针对性的审查可能会提高实施的便利性。如果质量管理要成为临床实践的一个组成部分，未来所有的发展都需要考虑牙医对质量的主观认知及其对质量管理的态度。
