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Dealing with feedback and concerns

08 April, 2021
   

Dental treatment can sometimes go wrong, and may result in harm to patients, despite the professionals involved being suitably trained and competent. Employers and managers should seek to maintain an environment where treatment errors and patient feedback are understood and addressed, and acted upon to prevent such errors in the future. More information about how a dental professional is expected to communicate with a patient when an error is made can be found under duty of candour.

Human factors, including technology, equipment, workload and relationships with colleagues, can contribute to errors during treatment. It is important to understand how human factors can contribute to mistakes and errors in treatment and, just as importantly, how everyone involved can learn from any incidents.

We encourage you to incorporate an understanding of human factors into your work, and to make sure dental professionals understand factors that can contribute to error and to put safety mechanisms in place to help avoid error.

For more information on human factors, visit the National Advisory Board for Human Factors in Dentistry website

 

Patient feedback and complaints

Patients often want to give feedback about a dental professional or some aspect of the treatment they have received. Positive or negative, patient feedback can be useful for dental professionals and supporting colleagues to consider and reflect if and how their own practice could improve or otherwise evolve. As employers or managers you have a role in creating an environment that values patient feedback as part of professional development.

Negative feedback might amount to a complaint, or you might decide to treat it as such. Under the Standards, dental professionals have certain obligations to ensure a complaints procedure is in place and that it is accessible to patients. To assist in this, 28 organisations across the dental sector, including the GDC, have developed a set of universal principles for handling complaints about dental professionals. The six core principles provide a simple template for best practice, helping professionals, colleagues and patients to get the most from feedback and complaints. A poster and leaflet showing these core principles are available for display on walls and in waiting areas of dental practices. By using these materials, dental professionals and other members of the team can clearly demonstrate to patients that they follow a recognised complaint handling procedure.

It is important to be clear and upfront with patients who might want to make a complaint. Promptly managing complaints well at a local level is usually better for all concerned and can help avoid any unnecessary escalation, e.g. to the GDC, which has a duty to look into serious concerns about the ability, health or behaviour of a dental professional, and can take action if that professional’s fitness to practise is found to be impaired. When a patient escalates a concern to the GDC, it is sometimes because they have become dissatisfied with how a complaint has been handled, or were never clear about who they were “supposed” to complain to in the first place.

Such complaints usually do not need to come to the GDC at all, as they often could have been resolved early between the patient and practice or dental professional.

Patient concerns about private dental care can also be referred to the Dental Complaints Service, which is a free and impartial service funded by the GDC for resolving disputes about private treatment not serious enough to raise concerns about a dental professional’s fitness to practise.

A proactive and welcoming approach to patient concerns will signal that the practice wants to ensure it resolves these as fully and as quickly as it can. There may also be opportunities for learning and development. Such an approach should also help to prevent escalation.

If you work with a group of dental professionals and other team members, you may wish to discuss at a team meeting:

  • How feedback, from patients and colleagues, is gathered and considered.
  • How to collect and share both positive and negative feedback.
  • How easy it is for patients or colleagues to give feedback.
  • Whether the local procedure for raising concerns is clear, straightforward and easy to access, and meets the requirements of the GDC’s Standards for the Dental Team.
  • If, or how, feedback is being used to improve professional development or overall services.

In some serious cases, a patient’s feedback might identify issues that call into question a dental professional’s fitness to practise. Any serious concerns related to a dental professionals’ performance, health or professional conduct may need to be referred to the GDC.

Reflective practice

Dental professionals should feel able to reflect on their experiences to support their own development and learning. Reflection plays an important role in forming a professional development plan, to help professionals to gain insight into any gaps in their practice, skills or areas of development. The GDC’s enhanced CPD scheme encourages professionals to also reflect on CPD once complete, to make the link between the learning event and impact on everyday practice.

Reflection among dental professionals can also help to foster individual and business-wide improvements, and demonstrate how patient feedback and complaints are listened to and acted upon, in a spirit of continuous learning.

The healthcare regulators, including the GDC, have issued a joint statement on the benefits of becoming a reflective practitioner. Our website also covers the application of reflective practice to dentistry.

We encourage you to support dental professionals in reflective practice, whether at an individual or group level. At a practical level, that encouragement could mean making time for teams to reflect as a way of aiding development, improving well-being and deepening professional commitment. Fostering a culture where dental professionals feel able to speak openly and candidly with their colleagues is an important part of this.

Duty of candour

Dental professionals must be open and honest with patients if something goes wrong. Dental professionals have specific obligations relating to communication, consent and conduct, and at the heart of all of them is the need to build a strong relationship of honesty and trust with a patient. It is therefore important that practice colleagues and managers are able to fully support this process in order to put the interests of the patient first.

There are a number of reasons why treatment may not always produce the expected outcome. If a dental professional believes this to be the case they should draw this to the patient’s attention and discuss possible options for revision or alternative solutions including, where appropriate, referral to a colleague. Even if the treatment has already been provided, it is still possible, and advisable, to work with the patient towards a resolution. 

Our duty of candour guidance encourages professionals to apologise where a patient’s care has fallen below the standard they should expect. Saying sorry is not the same as admitting liability and the guidance is designed to emphasise this point. If something has gone wrong with a patient’s treatment or care, they should receive an apology and that apology in no way reflects poorly upon the professional offering it.

Significant event reporting and learning

It is equally important to be open and honest with patients in the event of more substantial or systemic errors. Patients need to be told what has gone wrong and how it can be put right and to receive an apology. Workplaces should also have systems in place to respond to significant events, and learn from them for the future, e.g. through a significant event analysis.

Part of an appropriate response to significant events is recording and reporting them when they happen. If you manage or employ dental professionals, you should have a clear and consistent policy to report incidents. You will need to be aware of what incidents must be reported, and to where—which will depend on the incident and where it took place. For instance, for NHS care in England, NHS Improvement’s data and policy on 'never events' (which must be reported) will be of interest, as well as NHS England’s National Safety Standards for Invasive Procedures, which are a national foundation for local guidance. As an example, the Royal College of Surgeons of England’s Faculty of Dental Surgery has developed local safety standards for wrong site tooth extraction..

The National Reporting and Learning System is a central database of patient safety incident reports for the NHS, and is intended to foster a culture of reporting incidents to improve safety in healthcare.

The Care Quality Commission’s series on  dental mythbusters covers where incident notification is required by regulation.

Raising concerns if others are at risk

Dental professionals must raise concerns if they think patients or other members of the dental team are at risk, whether that is due to:

  • the health, behaviour or professional performance of a colleague
  • any aspect of the environment where treatment is provided
  • someone asking them to do something they think conflicts with their duties to put patients’ interests first and act to protect them.

These concerns must be raised appropriately - which, in the first instance, should likely be within the workplace - even if the dental professional is not in a position to control or influence their working environment and irrespective of any personal or professional considerations.

If you are responsible for dental professionals, it is important to understand the nature of this professional duty and to have a practice procedure that encourages colleagues to raise concerns. In the event that a dental professional has a concern, it is likely that you will be the first person with whom they raise it. Concerns should be discussed, recorded and resolved in an open and supportive workplace environment, where they may become learning opportunities.

In support of this professional obligation, dental professionals must not enter into any contract or agreement that would prevent them from raising concerns about patient safety or restrict what they could say if raising a concern.

If taking action at a local level is not practical, or such action has failed to address the concern, or the concern is too severe, then it may be appropriate to escalate the matter to the relevant regulator.

Safeguarding

Dental professionals must also speak up if they think vulnerable patients are at risk of abuse outside the practice. Dental professionals should be aware of who to contact in such a situation, but again, if you contract, manage or employ that dental professional, it is likely they will come to you first. It is important, then, that you know where and how to refer concerns about possible neglect and abuse. The first point of contact may be different depending on where in the UK you are based or whether you are working in an NHS or private setting, but ultimately concerns should arrive at the relevant local authority.

While this duty to report concerns is a condition of dental professional’s registration, it can and should be shared across all members of the dental team. Reception staff, for instance, may be in a position to observe signs of possible abuse of vulnerable patients, where a dental professional is not present. If that happens, it is critical that those staff know it is appropriate to report such concerns, and that they know how to go about it.  

The Care Quality Commission’s series on dental mythbusters covers safeguarding, and may be of interest.

Fitness to practise

If you, or a colleague, consider that patients or the public need to be protected from a dental professional, then you should refer your concerns to the GDC.

Circumstances where a referral to the GDC may be appropriate include concerns that a dental professional is not fit to practise because of their health, professional performance or conduct. Additionally, where action taken at a local level has failed, is impractical or where the concern is too severe, then a referral to the GDC may also be warranted.

We often receive complaints involving disputes between dental professionals that do not necessarily raise broader concerns about a dental professional’s fitness to practise or pose a risk to patient safety. The fitness to practice process can be costly, protracted and stressful for all concerned and in such cases, other forums for addressing such disputes—for example, mediation or business resolution services—may provide a more suitable outcome.

A dental professional may be able to seek help from any professional association to which they belong, or independent advice through, from example, the Advisory, Conciliation and Arbitration Service (ACAS)..

Our website covers when it is appropriate to refer a concern to the GDC and what action may follow as a result. 

Reporting criminal proceedings

A dental professional is required to tell the GDC if they are subject to criminal proceeding anywhere in the world. This includes when cautioned or convicted of a criminal offence.

You can find guidance on reporting criminal convictions on our website.