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News Bulletin : ADA News Bulletin December 2010
20 DECEMBER 2010 PRACTICE ACCREDITATION and the Early Adopters Pilot Scheme As mentioned in the Federal Council report published on page 5 of this issue of the News Bulletin, Practice Accreditation (PA) and how best to progress the Early Adopters Scheme (EAS) was discussed in detail at the recent Federal Council meeting. BACKGROUND Readers are referred to articles published in the October and November issues of the ADA News Bulletin on PA. These have provided perspectives from both the ADA and the Australian Commission for Safety and Quality in Healthcare (ACSQHC). Significant uncertainty continues as to exactly how PA will be applied to dental practice settings. At the moment ACSQHC is recommending to the Australian Ministerial Advisory Council (AMAC) that PA in dentistry be implemented through a voluntary process. This contrasts with earlier proposals that recommended the creation of a mandatory scheme that would occur through amendment of Private Health Insurance Rules or through State/ Territory licensing regulations. If the Scheme is to be implemented on a voluntary basis the ACSQHC is suggesting that the ADA adopt a 'regulator/facilitator' role. This would occur through a phased approach. The 'regulator/facilitator' in this model would mandate the Standards and participation in the accreditation scheme; oversee accreditation program content; receive relevant accreditation data and be responsible for escalating a response (guiding a practice) where the need arises.* The ADA, through the Federal Office and Branches, would support practices in participating in the accreditation process. This process would be undertaken by an accrediting agency (independent of the ADA) to assess the practice against the Standards and then award accreditation. Adoption of this 'regulator/facilitator' model would avoid the punitive nature of a mandatory scheme and is consistent with ADA Policy (See Policy 5.10 -- Dental Practice Accreditation at www.ada.org.au/about/policies.aspx). What has concerned the ADA from the outset is if there is a real need for PA. In its submission in response to the Commission's discussion paper on National Safety and Quality Accreditation Standards as early as March 2007, the ADA stated: "Existing registration and other regulatory measures imposed on dentists and their surgeries already adequately protect public health and safety in relation to the delivery of dental services and treatments. There are already comprehensive standards in existence and the addition of a further layer is not necessary. Further, there is no need to impose any further costly and time consuming "red tape" administrative standards on practitioners who are running office-based practices that are ultra-small businesses, where patient's critical and irreversible treatment almost always involves a single practitioner only." When the onset of PA seemed inevitable, the ADA felt that if this process was to be followed then the creation of Standards that were realistic and reflected the actual practice of dentistry should be created. The ADA recognized some potential positives in a quality improvement process. Therefore the ADA created a Special Purpose Committee (SPC) and worked with ACSQHC by providing dental practices to be involved with Pilot programs to help settle the standards. The ADA could see that large institutional settings may benefit from an accreditation model. However, it saw that 'dentistry is different' from these settings in that: • Most dentistry is practised from one or two practitioner settings. • Unlike many large institutionalised settings, dentistry has been practised safely through existing regulatory requirements. • Compliance costs for office-based practices in dentistry will represent a significant percentage of overhead costs. Previously, dental boards and now the Dental Board of Australia (DBA) impose standards, codes and guidelines for dental practitioners.† These codes and guidelines provide the regulatory framework within which dental practitioners are required to conduct the practice of dentistry. The ADA has seen the PA process as now having the potential for dentistry having three layers of regulation imposed, such as: i. Federal and State Regulation governing equipment, premises, and occupational health and safety. * ACSQHC-Draft Report on National Safety and Quality Health Service Standards and their use in a model national accreditation scheme -- July 2010. † The codes and guidelines created include a Dental Code of Conduct; Guidelines for Mandatory Notifications; Guidelines on Continuing Professional Development; Guidelines on Dental Records; Guidelines on Infection Control; Guidelines for Advertising and Guidelines for Conscious Sedation.
ADA News Bulletin November 2010
ADA News Bulletin February 2011