What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

We experience high levels of referrals for dental treatment involving General Anaesthetic (GA). Non-attendance for appointments can be linked to barriers to communication with services, poor understanding of the treatment required and what alternative treatment options are available.

The level of non-attendance has a negative impact on waiting times. Improvements in communication and engagement with supported, informed decision making will have a positive impact on service experience for vulnerable patients and families. This includes children offered alternative treatments to GA.  This will help reduce delays in accessing care and the prioritisation of GA waiting lists.

A test of change involving a random sample of ten patients was used to develop a communication support pathway to:

• adopt a whole family approach
• prepare the family giving an overview of the treatments options
• maintain contact with the family to reduce likelihood of non-attendance.

Six patients went on to have alternative treatment to GA.

What does your project aim to achieve?

The project would look to up-scale the findings of the original test of change. The overall aim is to improve attendance and increase the number of patients utilising treatment options alternative to GA – thus reducing waiting lists.

This will be achieved by developing a training package to be delivered by Dental Health Support Workers. This will provide education to young people and families at the earliest opportunity to support informed decision making on treatment options.

The anticipated Outcomes are:

(Quantitative Data)

• To reduce the time for vulnerable families to engage with dental services
• To reduce the number of ‘failed’ appointments with vulnerable families
• To increase the number of vulnerable children who have alternative dental treatment to a General Anaesthetic

(Qualitative Data)

• Improved patient experience and engagement
• Improved staff experience

How will the project be delivered?

In order to upscale this project, we require dedicated training support provided by training officer to Dental Health Support Workers.   The costs set out would allow us to deliver the training to 8 members of staff over a 3 month period.  This training will include practical elements (e.g. alternative treatment options) as well as enhancing key transferable skills (active listening, collaborative decision making, involvement of patients and families, motivational interviewing)

We also require administrative support which will:

• Identify suitable families and link them to a Dental Health Support Worker
• Ensure effective communications between families and dental teams
• Supporting data gathering and evaluation

This fund will provide a legacy to provide sustained support to families and be a mechanism to deliver key Board Child Protection policies.

We will evaluate this project against the outcomes set out above, and with the aim of demonstrating value for money to secure ongoing funding and expansion.

How is your project going to share learning?

Further expansion of the project would utilise peer support across other areas of the Health Board, and further to other health professionals e.g. general dental practices, dental health nurses.

Our wider aim is to inspire progressive change within national policy to ensure early engagement and prevention; therefore success in this project would be shared across Q community, Healthcare Improvement Scotland, Child Smile, and other national networks and community partners and community group networks.

The team will also look at opportunities to share learning via national conferences and journals.

On a wider scale however, the principles of patient and family involvement in decision making, collaboration and realistic medicine are important in all services.  The measurement of our qualitative outcomes (patient, family and staff experience) combined with our quantitative outcomes could very clearly demonstrate a correlation between informed decision making and reduced waiting times and costs.