HBI Awards 2018: Quality control methodology for dentistry in India

Clove Dental is India’s largest dental chain of 218 clinics spread across 12 states.

India has many challenges when it comes to dental care including lack of infrastructure, poor quality treatment and follow-up care. To tackle these three areas, Clove has created a quality management methodology. To help improve treatment quality, Clove applies an anonymous peer review process for around 40% of the treatments in its clinics, this equates to 5,000 a month on average. For post-treatment care, it’s system divides the life cycle of each patient into stages which are tracked and monitored. Some outcomes from these processes include a 92% success rate in root canals compared to an 84% world average and a dental filling success rate at 97%.

Full application

1. Briefly describe the organisation giving number of facilities, staff, revenue numbers.
Clove Dental is India’s largest dental chain of 218 clinics spread across 12 states, offering entire gamut of oral healthcare services. Clove leverages best-in-class equipment, and utilizes the latest pain-management technology to provide affordable healthcare of the highest quality. We adhere to the highest standards in clinic safety and hygiene, patient service and recruiting, with a constant focus on ethics and transparency.

Clove clinics treat over 30,000 patients monthly and have an active patient list of more than half a million patients. Our 600 highly qualified dentists (65% of whom have advanced medical degrees and 70% are female doctors) adhere to highest standards for hygiene and use the most advanced dental technology and consumables, procured from the world’s best suppliers, to ensure the highest quality of care. Our priority towards infrastructure, integrity and training of doctors has established Clove Dental as a preferred and trusted dental network.

We have also entered a major expansion phase that will grow the network to 600 clinics in next 3-4 years. Year on year our revenue has been growing at more than 200% since 2012. 90% of Indians suffer from oral and gum diseases due to lack of awareness, or importance paid to dental hygiene. This makes India viable for a change in lifestyle and healthcare where dental treatment becomes preventive rather than pain-induced. It is well documented that there is an association of oral health with various systemic conditions such as diabetes, cardiovascular disorders, pregnancy, and its impact on quality of life. Most of these highly prevalent oral diseases are largely preventable and can be reduced through various health promotion and preventive measures. Our goal is to educate, motivate, and promote oral health in diverse populations, and induce the need to maintain oral hygiene.

2. Please briefly describe the medical service, which the organisation is delivering in which it has deployed the best quality data model
Measuring quality in healthcare is challenging and measuring quality in dentistry is even more challenging. Dental treatments are very intricate and involve both hard and soft surfaces of the oral cavity. Globally, dental awareness is poor and preventive focus is less. Combine this with a corporatized group like Clove, incentive structure and ownership of the dentists working in such a setup is also different.

Measuring quality in healthcare is challenging and measuring quality in dentistry is even more challenging. Dental treatments are very intricate and involve both hard and soft surfaces of the oral cavity. Globally, dental awareness is poor and preventive focus is less. Combine this with a corporatized group like Clove, incentive structure and ownership of the dentists working in such a setup is also different.

In India, the challenges are further exacerbated, and are present at three different levels:

  • Lack of infrastructure: Sterilization and hygiene, biomedical waste management, patient record keeping.
  • Quality of treatment: correct diagnosis, comprehensive treatment plan, right treatment done
  • Post treatment care and follow-up- treatments like Implants and braces continue for a long period of time, extending up to few years and require regular follow up care

Clove Dental has developed a unique methodology for Quality Management addressing all these three critical areas

3. Please describe the way the organisation has deployed and used the best quality data model.
Clove Dental has developed a unique methodology for Quality Management addressing all these three critical areas:

1. For lack of infrastructure: There are clear define protocols, state of the art equipment like autoclaves and ultrasonic cleaners, we have well defined training protocols to train doctors and Dental assistants, and also we carry out bi-monthly surprise In-Clinic reviews by an independent team to make sure that every clinic is following these protocols. The results of the reviews are tied to the doctors performance incentive

2. For Quality of treatment: We have developed along with our technology platform (PRM) which is proprietary and patent pending business processes, a review mechanism where about 30-40% of the cases done in clinics are reviewed by “peers” in a “Peer Review Process”. The patient record is taken from the PRM after removing the name of the clinic, patient name and doctor name making it unbiased and objective, and reviewed by a senior consultant doctor on diagnosis, treatment, billing and to ensure that the entire treatment was done according to protocol. As peers are reviewing the cases, it also brings in the self-learning and self-motivation factors and creates an environment where each doctor gets better in quality.

3. For Post treatment care and follow-up- Intelligent system where each treatment is divided into stages and track the life cycle of each patient. If by chance any appointment is missed, the system automatically creates a tentative appointment to remind the doctors to create an appointment in the system.

4. What new quality data has the organisation created?
Clove has created the following new data from the dental quality management process both from clinical and business perspective:-
1. 100% compliance on appropriate Biomedical waste management process across all clinics
2. 100% compliance on sterilization protocols across all clinics
3. Consistent 99.8% quality performance of all clove clinics
4. Root Canal Treatments success rate at 92% compared to the world average of 84%
5. Success rate of dental fillings being tracked across all clinics at 97%
6. Every month on an average 5000 cases are reviewed and a total of more than 50000 cases were reviewed in the year 2017
7. 97.4% compliance on billing and invoicing accuracy across all clinics

5. How has that new quality data been used to change the way that health care services are delivered?
Dental quality management has resulted in changes in healthcare services in many ways:-
1. Patients are aware that they are being treated in a hygienic environment with state of the art equipment
2. Doctors are aware that they are being measured and monitored on various parameters and that their Quality scores are linked to their performance incentive and growth in the organization
3. Doctors receive constant feedback on minor corrections and improvements that they need to make
So doing all this has uplifted the level of Quality in the organization, and this by far is not being done by any other dental chain or dental clinic across the world.

6. When did the quality data model start affecting service delivery?
Month : October
Year : 2012

7. What are the main key performance indicators? How does the organisation measure the success of the project?
Performance is based on 30 performance indicators measuring clinical and business overall performance:-
1. % of cases with inappropriate Access opening
2. % of cases with inappropriate obturation in RCT
3. Separation of instrument during RCT
4. % of Re-RCT done over one year
5. % of Re- fabrication of crown
6. Rate of retrieval of placed Implants before rehabilitation
7. Success rate of complete rehabilitation using implants over two years from completion
8. % of Restoration dislodgement in a year
9. Rate of retained root pieces post extraction
10. Success rate of dentures over two years from completion
11. Rate of Discount/Offers/invoicing discrepancies
12. Manpower utilization
13. Consumption v/s Treatment mapping
14. Adhoc requisition
15. ROL (Re-order Levels)
16. Turnaround time of Material
17. % of delivery discrepancies
18. No shows %
19. Total Footfalls
20. Training Need Analysis
21. Performance Rating
22. TAT met % for resolution of all complaints
23. % of PM Compliances done at the clinics
24. % of cases without/incomplete chief complaint
25. % of cases without/incomplete Oral exam
26. % of cases without /Incomplete treatment plan
27. % of cases without/incomplete work done notes
28. % of cases without/incomplete Images
29. % of cases without/incomplete X-rays
30. % of cases without/incomplete prescription

8. Additional documentation
Presentation

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