The safety and wellbeing of patients is every clinician’s first priority. Dental professionals do all they can to optimise conditions for successful treatment, free of complications or harm of any kind. Despite this, the fear of litigation weighs heavily. In a recent survey of dentists, it was revealed that 98% believe that society has become increasingly litigious, and 79% are concerned about the impact this is having on their welfare and the way they practise. 77% of respondents have experienced stress or anxiety connected to fear of being sued.[i]
This fear does little to improve the quality of care. Anxiety leads to practitioners feeling less clinically confident, affects the decision-making process, and leads to professionals feeling less able to form a diagnosis.[ii]
The World Health Organization (WHO)[iii] and the NHS[iv] have developed recommendations and protocols to contribute to an environment that promotes patient safety. A positive patient safety culture should not just address risk management around treatments, but should also support the safety and wellbeing of clinicians, allowing them to practice and learn without fear.
Safety in practice
According to guidelines, patient safety is about maximising the things that go right and minimising the things that go wrong for people experiencing healthcare.[v] A safe environment adopts procedures, systems and culture that reduce the occurrence of avoidable harm, making error less likely and reducing its impact when it does occur.[vi] This is achieved by building competency through continual learning, while adopting a supportive approach to teamwork. Alongside patient engagement, an emphasis on organisational strategy and systems that support excellent communication, and effective, coordinated treatment is advised.[vii]
Only a tiny fraction of patient safety incidents occurs in primary care, but the report lists a number of factors that could potentially threaten the safety of patients in these settings. These include risks to electronic health records, communication breakdown between practitioners and other team members, limited patient health literacy, a lack of patient engagement or adherence, and the effects of clinician burnout.[viii]
The report notes that dental work historically done in secondary care, such as minor oral surgery, can increasingly be offered in a primary and community care setting, potentially increasing risk. Clinicians are advised to apply additional risk management protocols when conducting more complex procedures,[ix] but surveys have revealed 64% of respondents feel that the fear of being sued has resulted in them making more referrals rather than attempting procedures that hold greater risk.[x] This caution prevents clinicians from honing or developing new skills, fuelling a sense of frustration, as well as closing off potential areas of development for their business. It’s clear that further mitigation is needed to allay fears.
Safety through documentation and engagement
To protect dental professionals from the anxiety of litigation, and to maximise patient safety, the GDC – as well as the NHS – have emphasised the importance of excellent documentation and record keeping, by every clinician at every stage of treatment. Doing so builds a body of evidence to support the clinician’s approach to decision-making, and demonstrates that patients were clearly made aware of any risks as well as the benefits of all options around treatments before consenting.[xi] [xii]
WHO recommends investment in the means to promote patient engagement, which, if done well, can increase the safety of patients by up to 15%.[xiii] Studies show the value of clear communication in promoting trust between patients and dental professionals. When patients feel more engaged and informed, they are more likely to display autonomy in adopting healthier behaviours, and will engage more proactively in decision-making around their care, optimising outcomes.[xiv] Patient-centred care – treating patients as individuals and equal partners in the business of healing[xv] – leads to greater patient satisfaction, improved outcomes, enhanced health status, and reduced utilisation of care.[xvi]
Investing in a system that boosts patient engagement as well as providing the best in contemporaneous note-taking, that can be translated into documentation instantly and effortlessly, is a game-changer in creating a safer environment for patients and clinicians. Kiroku believes clinicians can spend less time writing records with intelligent machine-learning systems, all while enhancing legal protections and patient safety. Kiroku Docs seamlessly takes information input in consultations via AI-powered, one-click notes, and converts them to any documentation clinicians need for records, referrals, treatment plans, patient-friendly information and consent forms. Now Kiroku Practice adds new features such as smart prompts and AI audits to ensure the whole team follows best practice all the time.
Maintaining a positive culture of patient safety is helped by systems that protect the wellbeing of practitioners as well as patients. Relaxed, confident clinicians feel more able to develop new skills that could open up new horizons, as well as cater to the more complex needs of their patients. When systems are improved, everybody wins.
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[i] Dental Protection survey reveals 9 in 10 dentists fear being sued by patients. Dental Protection. October 2018. Available at: https://www.dentalprotection.org/uk/articles/dental-protection-survey-reveals-9-in-10-dentists-fear-being-sued-by-patients Accessed May 2024.
[ii] Mental Health and Wellbeing in Dentistry: A Rapid Evidence Assessment. General Dental Council. June 2021. Available at: https://www.gdc-uk.org/docs/default-source/research/mental-health-and-wellbeing-in-dentistry27973e06-eb0f-4ee2-b92f-7fee3d2baf5b.pdf?sfvrsn=511f2ef9_5 Accessed May 2024
[iii] Global action on patient safety. 72nd World Health Assembly Agenda Item. WHO. May 2019. Available at: https://iris.who.int/bitstream/handle/10665/329284/A72_R6-en.pdf. Accessed May 2024
[iv] The NHS Patient Safety Strategy. NHS England. July 2019. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/08/190708_Patient_Safety_Strategy_for_website_v4.pdf Accessed May 2024
[v] The NHS Patient Safety Strategy. NHS England. July 2019. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/08/190708_Patient_Safety_Strategy_for_website_v4.pdf Accessed May 2024
[vi] Patient Safety. World Health Organisation. September 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/patient-safety Accessed May 2024
[vii] Patient Safety. World Health Organisation. September 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/patient-safety Accessed May 2024
[viii] Patient Safety. World Health Organisation. September 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/patient-safety Accessed May 2024
[ix] The NHS Patient Safety Strategy. NHS England. July 2019. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/08/190708_Patient_Safety_Strategy_for_website_v4.pdf Accessed May 2024
[x] Dental Protection survey reveals 9 in 10 dentists fear being sued by patients. Dental Protection. October 2018. Available at: https://www.dentalprotection.org/uk/articles/dental-protection-survey-reveals-9-in-10-dentists-fear-being-sued-by-patients Accessed May 2024.
[xi] The NHS Patient Safety Strategy. NHS England. July 2019. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/08/190708_Patient_Safety_Strategy_for_website_v4.pdf Accessed May 2024
[xii] Standards for the Dental Team. www.gdc-uk.org. September 2013. Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team Accessed May 2024
[xiii] Patient Safety. World Health Organisation. September 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/patient-safety Accessed May 2024
[xiv] Benecke M, Kasper J, Heesen C, Schäffler N, Reissmann DR. Patient autonomy in dentistry: demonstrating the role for shared decision making. BMC Med Inform Decis Mak. 2020 Dec 2;20(1):318. doi: 10.1186/s12911-020-01317-5. PMID: 33267847; PMCID: PMC7709219.
[xv] Coulter A, Oldham J. Person-centred care: what is it and how do we get there? Future Hosp J. 2016 Jun;3(2):114-116. doi: 10.7861/futurehosp.3-2-114. PMID: 31098200; PMCID: PMC6465833.
[xvi] Mills, I., Frost, J., Cooper, C. et al. Patient-centred care in general dental practice – a systematic review of the literature. BMC Oral Health 14, 64 (2014). https://doi.org/10.1186/1472-6831-14-64
