Vice President of Dental Services
Clinica Family Health Services, Denver
As a new year gets underway, it’s important to re-examine how we can best serve our communities. Specifically, I think it’s important to consider how we can continue to improve the ways we deliver healthcare.
Access & capacity
Despite our best efforts as a nation, we struggle to consistently provide access to routine dental care for many Americans. While many factors influence this, our current oral healthcare delivery system is limited in its capacity to equitably meet the preventive and routine care needs of many Americans.
These and other access issues are profoundly reflected in the underserved populations who receive care at Federally Qualified Health Centers (FQHCs). Currently, fewer than 20% of FQHC patients are able to receive dental care even with a federal requirement to offer oral health services (Healthy People 2020).
Healthcare complexity
With growing numbers of chronically comorbid and aging patients, evolving technologies and treatment options, and greater use of specialty services, caring for patients in the modern healthcare system has become more complex. For individual providers, there is greater demand on their time to coordinate care, stay abreast of clinical guidelines, and adopt practice innovations. As a result, there is less availability for direct patient care. Increased and competing demand on clinicians can be a source of provider burnout, which in an effort to create balance, pushes many clinicians to limit their patient panels (i.e., the number of patients for whom they provide care).
Time demands in primary care: based on data from: Yarnall KSH, Pollak KI, Østbye T, et al. Primary care: is there enough time for prevention? Am J Public Health. 2003 Apr;93:635-64; and Østbye T, Yarnall KSH, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005 May;3:209-14.
This presents a significant challenge to improving health outcomes at the population level. Because we belong to a profession that’s deeply rooted in serving others, we feel torn by the weight of working hard yet limited in our capacity to share our expertise with more people.
How solo clinician-centric care impacts outcomes. (Credit: Dr. Tom Bodenheimer, team-based healthcare researcher and advocate.)
A call for team-based care
I believe that applying team-based care in dentistry and oral health provides us with an opportunity to overcome some of these challenges and barriers.
For decades, dentistry has recognized the need for teams and that organizing ourselves in this way makes for more impactful and efficient procedure-based care for the individual patient. What would it look like if we broadly adopted this team approach and applied it to how we think about access and outcomes at the population level? How could we leverage a dental team to address the social imperatives that weigh so heavily on our profession?
If we’re open to redefining each role on our teams to better allocate responsibilities and close existing gaps, we have an opportunity to leverage our resources more efficiently and effectively [i.e., to build the capacity of the team to “share the care,” and to extend the reach of our care to more people (Bodenheimer 2012)].
For dentistry, that means letting go of the long-held idea that “only a dentist can” and transitioning to the question of “who else on the team can?” Such a paradigm shift can be transformative and could help us recognize the opportunities that exist in shifting ownership of patient care from the solo provider to a prepared and proactive team.
Indeed, high functioning team-based care holds the potential to enhance our ability to efficiently bring evidence-based care to more people in ways that drive greater satisfaction for everyone (i.e., fulfilling the core components of Quadruple Aim).
A call for transformation
If we’re open to envisioning what dentistry can and should look like, and if we’re willing to transform dentistry to actualize that vision, we can begin to positively bend the curve on access and outcomes in the communities we’ve vowed to serve.
The SMILES Dental Project is the beginning of this transformation. It has the capability to demonstrate the iterative impact of small-scale disruptions to the status quo, and show us the impact of putting real team-based care into practice.
Related resource:
ImplementingCare Teams (Agency for Healthcare Research & Quality)
