Indicators of quality in NSW public dental services: Enablers and barriers to implementation

Abstract

Quality measures are essential instruments for evaluating healthcare by providing actionable data to assess care delivery, identify strengths and weaknesses, and monitor various aspects of healthcare performance. Traditionally classified into process, structure, and outcome measures based on Donabedian's framework, these metrics have evolved to encompass seven quality domains, offering a more detailed framework for assessing oral healthcare quality.

This thesis critically examines the status of quality measure implementation and enablers and barriers to the implementation within New South Wales (NSW) public dental services, providing insights into how these factors impact service delivery and overall care quality. The study employs stakeholder interviews to explore the status of implementation as well as enablers and barriers of the quality measures across various quality domains such as accessibility, effectiveness, efficiency, equity, patient-centredness, safety, and timeliness.

The findings highlight several significant enablers that facilitate the implementation of quality measures across multiple domains. These include the Centralised Healthcare Contact Centre, the Priority Oral Health Program (POHP), and the Oral Health Fee for Service Scheme (OHFFSS). Additionally, continuous professional development, mentoring programs, and the Incident Management System+ (IMS+) play a critical role in supporting the effective implementation of quality measures to enhance care delivery and patient outcomes.

The research also highlights several persistent barriers, including limited funding, high staff turnover, resource constraints, and geographic challenges that limit timely and effective services, particularly in rural areas. Cultural and linguistic barriers, combined with low oral health literacy among patients, further complicate the delivery of patient-centred care. Addressing these barriers is essential for improving the quality of public dental services in NSW.