Quality of Care Report 2011

Oralhealth for Better HealthQuality Of Care repOrt 2011

Christi Malthouseanother reason to smile

Who’s who and what do they do? Meet the team at the dental hospital

healthy mothers and babies Oral health during pregnancy special

DhsV is now on twitter! Follow us at www.twitter.com/_dhsv

Competition

Win a double

pass to the movies!

Our number one priority at Dental Health Services Victoria (DHSV) is prevention.

As the head of DHSV I get really excited by the concept that, with the right knowledge and simple practises, these significant diseases can be prevented.

We want all children to have a life of no decay. With the right education, diet, cleaning and regular check-ups this is possible for every child.

This year’s magazine has a particular focus on new mothers and babies because that is where a life of good oral health begins.

Professor Mike Morgan gives advice on how to care for a child’s teeth and explains how to prevent tooth decay.

You will also read about our focus on quality services and care and how we are continually working – through research and your feedback – towards improving the services we provide to the Victorian community.

This magazine also includes important information about how we are accountable and how we provide our services. You’ll be able to read about the continuing improvements we make in delivering safe and high quality care.

Another highlight in this edition is our “cameo” appearance of the different members of the dental team working at The Royal Dental Hospital of Melbourne. From the dental assistant to the oral medicine specialist, we feature all the roles working to improve your oral health.

Welcome to this year’s edition of Oral Health for Better Health magazine. I hope you enjoy reading it.

Dr Deborah Cole Chief Executive Officer

We acknowledge the traditional owners of Australia and we welcome all Aboriginal and Torres Strait Islander people to our services.

Aboriginal Flag © Harold Thomas 1971

Dental Health Services Victoria delivers clinical dental services through The Royal Dental Hospital of Melbourne and purchases dental services on behalf of the State Government from over 50 community health agencies throughout Victoria. DHSV also delivers statewide oral health promotion programs designed to improve oral health in the community.

Cover image by Anna McCallum Photography (www.annamccallum.com.au)

Features 04 healthy mothers, healthy babies

Our Health Promotion team sends out a healthy message about oral health during pregnancy

05 No fillings! A new approach to dental care means less cavities and fillings

07 2011 review See how DHSV delivered services to you in 2011

16 Who’s who? A guide to who does what around the hospital

From the CEO

Oralhealth for Better HealthQuality Of Care repOrt 2011

Last year 86% of our readers found this magazine easy to read. Some of these readers were lucky enough to win movie tickets as thanks for their feedback.

This year we are distributing 6,000 magazines around Victoria. If you want to have your say, and be in the running to win some movie tickets, please fill out the blue form in the centre of this magazine.

tiCkets to be won

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MIT

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Gum disease, tooth decay and oral cancer are among the most preventable diseases in our community.

These oral diseases are common, can be quite serious and are strongly linked to other chronic diseases.

Regular features 18 Puzzle page

19 ask Professor Mike Your questions about good oral

health are answered

2 Quality of Care Report 2011

This busy reporter is committed to a healthy life

C hristi Malthouse has a busy life. As a mother of two, online presenter, sports journalist and author, she works hard

to make sure her life is as healthy as it can be.

She is known to Victorian audiences as the AFL boundary reporter for Channel 10, a presenter on 9am with David & Kim and appears on the Collingwood Football Club’s In Black and White Tonight online show.

This year the DHSV Community Advisory Committee (CAC) acknowledged her as a great role model for other mothers and awarded her Smile of the Year.

Chair of the CAC, Kellie-Ann Jolly, said Christi was chosen because she represents a positive role model to the community. Her high profile media career puts her in a great position to raise awareness of oral health.

Christi is firmly committed to bringing up her young son Zac and baby daughter Lillia in a healthy lifestyle.

As daughter of former Collingwood coach, Mick Malthouse, Christi grew up in a family that loved being active and eating well. And with husband Dean, a personal trainer, she wants her children to have the same great start to their lives.

“I don’t like fizzy drinks and I don’t even give my kids juice. They just have water and don’t miss the sugary drinks.

“We just didn’t grow up with soft drinks. Mum and Dad didn’t like them, so we only had them as treats when we went to parties,” she remembers.

“Dean and I are very conscious of the food we give Zac and Lillia.“Zac eats what we eat - fruit, vegetables, meat, pasta, noodles. He loves his fruit particularly mandarins, grapes, apples and bananas.

“For snacks he will have grapes, sultanas, carrots, celery or dairy free dips, such as hummus. For biscuits

he will have pizza Shapes. As he is intolerant to cow’s milk, he drinks a lot of water.”

“Lillia is still very young but I am already watching her diet. I don’t let her go to bed with a bottle in her mouth. She drinks her milk or water before she sleeps. I want her to get into good habits of eating now,” she says.

“I come from a close family and we all know the importance of living a healthy life.” Christi has two brothers and a sister who helped her write a book about their famous father called My Dad, The Coach. Christi was also involved in the writing of The Ox is Slow but the Earth is Patient, a book by her father Mick and David Buttifant about the leadership and management ideas that contributed to Collingwood’s recent success.

DHSV is very proud to have Christi Malthouse as our 2011 Smile of the Year winner.

Christi kiCks goals FOR HeR KIDS’ HeALTH

Smile of the Year

Christi

with her

baby daughter,

Lillia

Oralhealth for better health 3

Good oral health is achieved through education, prevention, early detection, intervention, health promotion and providing oral health resources.

This year DHSV helped the Department of education and early Childhood Development create a teaching manual for MCH nurses.

We also provided fact sheets for MCH nurses’ to give to families.

Tooth Tips fact sheets are given to parents, grandparents and carers. They provide information on how to look after children’s oral health and are available for children and babies from 0-12 months, 12-18 months and 18 months - 6 years.

The information included in the fact sheets is discussed with families at the 8 month (0-12 months fact sheet), 12 month (12-18 months fact sheet) and 18 month (18 months - 6 years fact sheet) visits.

Families get good Tooth Tips

Healthy mothers, healthy babies:

hoW We haVe MaDe a DiFFerenCe

good oral health is now an important part of Victoria’s Maternal and Child health (MCh) service - the main healthcare service for families with children from birth to school age.

I t is important that pregnant women look after their oral health because they have an increased risk of gum disease.

Advanced gum disease has been linked to premature labour and low birth weight babies. But many expectant mothers aren’t doing enough to look after their teeth and gums.

The State Government offers priority access to public dental services for pregnant women who hold valid concession cards. Pregnant women who are concession cardholders do not have to go on a waiting list to see a public dentist. They are given the next available appointment.

The Healthy Mothers, Healthy Babies Oral Health During Pregnancy project was funded by the Department of Health to support vulnerable pregnant women in communities across Melbourne.

The Department provided funding to increase the number of eligible pregnant women using DHSV services.

The Healthy Mothers, Healthy Babies project helps to make sure pregnant women understand the importance of looking after their oral health.

The project initially worked within eight communities. The communities were chosen because they had a high number of births and needed extra support because they couldn’t easily access information and services.

The project was so successful that it is now going to be rolled out to 12 more communities. After that, the project will go to the rest of the community dental programs across Victoria.

Manager Health Promotion, Sue Kearney said an internal project team and project steering group was set up to supervise the project.

“After we finished our project plan and received the necessary approval, we went out and talked to many people in the community dental clinics about how to get this information across – and get more pregnant women coming in to get their teeth and gums checked,” she said.

“We then revised all our guidelines for the dental management of pregnant women and produced a brochure and information card to promote the importance of oral health during pregnancy.

Dental risks greater in pregnancy, says our Health Promotion team


“We are particularly proud of our e-learning package on managing the dental needs of pregnant women that we gave to dentists. It was very well received.

“In the future we want to expand this course, taking in what we have learned so far.” “We also think we can use a lot of the information we received from our community consultations to develop more ways to encourage pregnant women to look after their teeth, and to come to our community clinics if they are eligible.”

DHSV is looking forward to working more closely with ante natal service providers to reach more women and get the message across about the risks of dental problems during pregnancy.

The Oral Health During Pregnancy Project Steering group included:

Manager Quality Improvement Projects (Agencies), DHSV, Marrianne Beaty; Director Clinical Leadership, education and Research, DHSV, Hanny Calache; Director Australian Population Health Improvement Research Strategy for Oral Health, DHSV, Andrea De Silva-Sanigorski; Director Maternity Services, Royal Women’s Hospital, Tanya Farrell; Manager

Smiles 4 Miles spreads for miles

If your child goes to a kindergarten or child care centre, you probably know about the DHSV Smiles 4 Miles program.

Smiles 4 Miles works with local organisations to improve the oral health of the youngest children in our community.

In 2010-11 the program was in 467 kindergartens and long day care centres, reaching about 24,000 children.

Services participating in the program have to make sure that their staff members complete the following tasks every year:

attend training

complete an early childhood survey

review their nutrition policy

conduct ‘eat Well’, ‘Drink Well’ surveys

organise activities to promote the ‘eat Well’, ‘Drink Well’ and ‘Clean Well’ messages

provide parents with information on good oral health and public dental services.

hoW We haVe MaDe a DiFFerenCe

Above: (from left) Manager Quality Improvement Projects (Agencies), Marrianne Beaty, Health Promotion Project Officer, DHSV, Allison Ridge and Manager Workforce Development, Deidre Mackechnie.

Are you pregnant and in need of a dental check-up? If you have a current concession card, please call 1300 360 054 to locate your nearest community dental clinic and book a priority appointment today.

Health Promotion, DHSV, Sue Kearney; Clinical Director – Dental, Plenty Valley Community Health Service, Sajeev Koshy; Manager Workforce Development, DHSV, Deidre Mackechnie; Dental Program Manager, Ranges Community Health Service, Andrea Nazareth and Health Promotion Project Officer, DHSV, Allison Ridge.


Want to go to the dentist and not need any work done on your teeth?

no Fillings! no extraCtions! Just gooD teeth

T here is now a new approach to oral healthcare that identifies dental decay before it becomes a problem. This

will avoid drilling teeth, using fillings or even removing teeth!

Called Minimal Intervention (MI) Dentistry, this new approach could help reduce the growing rate of dental disease among patients, save money and focus attention on those most at risk of oral disease.

According to Professor Hanny Calache, the traditional treatment for dental caries (also known as dental decay or cavities) is to repair the damaged structure of the tooth using a filling. Dental decay is caused by the bacteria in plaque on the teeth’s surface.

Although many patients think their problems are over once they have a filling to get rid of their toothache, the truth is, that the filled tooth will be a problem for the rest of their lives.

“Fillings are not permanent and need to be replaced once, twice, sometimes three times in a person’s

life, which is a costly exercise,” Hanny says.

“Each time a filling is removed, a part of the natural tooth is also removed, weakening the tooth and leaving it vulnerable to bigger problems in the future.

“This old approach to dentistry has treated the symptoms but not the cause of dental cavities,” he says.“If the cause of the dental disease is not dealt with, the patient will continue to experience cavities.”

Oral health professionals using the new MI approach:

• identify decay in its early stages

• delay fillings or extractions for as long as possible

• apply fluorides and other applications to help heal early signs of the disease

• improve plaque control and promote healthy eating

• put in fillings that save as much of the natural tooth as possible.

Hanny said that this approach is only possible when cavities, or the risk of cavities, are identified early in patients.

“We look at:

• the number and stage of development of any existing cavities or early signs of the disease

• the number of existing fillings and other dental work

• quality and quantity of saliva

• other health issues the patient has or whether they are on medications that may worsen oral health problems or affect flow of saliva

• the patient’s diet and oral hygiene practices.

“We can then identify patients as being at low, medium, high or extreme risk of dental decay. A patient’s risk category then affects the type and frequency of care needed to manage their problem.”

With an MI approach, patients would get a personal caries management plan. Treatment would include a range of preventive and repair strategies that they and their oral health professional can do.

Hanny said that one of the benefits of personalised risk assessments and treatment plans is that resources can be targeted to those most at risk and those most in need of dental services.

“We can now predict the chance of a patient developing dental caries in the next 12 months,” he said. “In the public dental sector, where resources are low, this service has the potential to improve long-term spending on public oral health, especially if it can be focused on preventive, early intervention and minimally invasive treatment.”

The hospital became smoke free in 2010 to stop tobacco smoke affecting hospital staff, patients and visitors.

Smoking is not allowed in RDHM buildings, within the clearly marked hospital boundaries and is not allowed in DHSV vehicles. Since becoming a smoke

free hospital, RDHM has offered staff free nicotine replacement therapy and consultations with a Quit educator to help them give up smoking.

In 2011, staff celebrated World No Tobacco Day at RDHM by distributing posters, information and resources to patients.

sMokeFree @DhsVSmoking is banned at the royal Dental hospital of Melbourne (rDhM).


How well did we do? Dental health serViCes ViCtoria reVieWeD For 2010-11

In the next few pages we provide information that the Department of Health requires all health services to report on each year. This information must show what DHSV has done to improve its services and meet the needs of its communities.

We have worked hard in the past year to bring you the best services we can. This has involved teams of professionals at The Royal Dental Hospital of Melbourne (RDHM) in Carlton and in community health clinics all around Victoria.

If you can’t find the answers to your questions here, check out our website at www.dhsv.org.au or call us on 03 9341 1000 (within Melbourne) or 1800 833 039 (outside Melbourne).

ConsuMer, Carer anD CoMMunity PartiCiPation

At DHSV, we ensure that the community is involved in the decision-making process. It’s important to us that the community trusts the service we provide, so we constantly evaluate our actions in consultation with community representatives.

At DHSV, we employ the five standards outlined in the Doing it with us not for us Strategic direction 2010-13, a Victorian Government policy on consumer, carer and community participation in the healthcare system.

DHSV listens to the views of patients and community members via surveys, focus groups and our well established Community Advisory Committee (CAC). These processes were reviewed during our last organisation-wide accreditation survey and we achieved an extensive Achievement rating for our commitment to consumer participation in the last periodic Australian Council for Healthcare Standards (ACHS) review.

Our policies and plans keep us on track. We have a Community Participation Policy and a three-year Community Participation Plan 2010-2013.

We also have a Disability Action Plan 2010-2013 that adheres to the Disability Act 2006 and ensures that we respond to the rights and needs of people with disabilities.

All of these DHSV plans have been developed in consultation with consumers and are monitored by the CAC.

We make sure that consumers and carers are involved in the decision-making process throughout their treatment at RDHM. An interpreter service is used at RDHM for non-english speaking patients to ensure that they understand their dental treatment and are able to express their wishes and needs to staff.

DHSV has a dedicated Communications team, as well as a Health Promotion team. These teams produce a range of informative resources that are updated regularly to ensure that the community has all the information they need about available services and good oral health. Our website is monitored and updated daily so that people looking for reliable information online, can find it easily.

Because our CAC has the important role of monitoring and evaluating our services and programs, we think it’s important that we invest in their professional development. Two conferences and a training course were attended by CAC community members over the last year. We also welcomed three new CAC members who participated in our orientation activities for new committee members. CAC meetings include presentations by RDHM staff on clinical and service issues to enhance member’s understanding of oral health service provision.

We live in a very multicultural society and it’s important that we make everyone feel at home at DHSV. Our Cultural Responsiveness Plan 2010-2013 is based on the

six standards of the Cultural Responsiveness Framework and ensures that we respond to the needs of diverse communities.

Our CAC represents the diverse community that we service. Members are chosen for their knowledge and involvement with cultural and linguistically diverse communities, patients, carers, people with disabilities, Aboriginal and Torres Strait Islander communities, families and community agencies.

At DHSV, we are passionate about improving the oral health of Aboriginal and Torres Strait Islander people. We have actively adopted the Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program and have a dedicated Aboriginal Oral Heath Reference Group that develops and monitors the implementation of our Aboriginal Oral Health Plan.

Our Aboriginal Community Development Worker and Aboriginal Liaison Officer work with Aboriginal health organisations around Victoria to help ensure that Aboriginal people get the care they need. As a result, the number of patients identifying as Aboriginal and Torres Strait Islander at The Royal Dental Hospital of Melbourne has grown significantly from 339 in 2009-10 to 531 in 2010-11, an increase of 56.6%.

Quality anD saFety accreditation statusAccreditation is when a team from the Australian Council for Healthcare Standards (ACHS) visits the hospital to review our progress and achievements against set criteria. The surveyors make sure that we are providing a safe and high quality service. Accreditation provides a great opportunity for us to showcase the fantastic work we do at RDHM.

The hospital had a review in November 2009 and is due for its next accreditation organisation-wide survey in December 2011. Results of this survey will be in the next Quality of Care Report.


The last review found that RDHM met the required national healthcare standards. Areas for improvement included revising our patient feedback systems and linking incident reports into an organisation-wide system.

We have worked on all the recommendations from our last survey and will be reporting on them in December 2011 when the Accreditation team visits us again.

We welcome the opportunity to have our organisation reviewed.

Clinical effectiveness Clinical effectiveness is regularly monitored as part of our overall performance and is reported to our Quality Committee, Board and the State Government.

At DHSV, we ensure that the right care is provided to the right patients by the right clinician with the right skills in the right way. It’s also important to us that our patients are fully informed and involved in the care that they receive.

DHSV collects patient data and provides it to clinical staff to help them provide high quality care. We also regularly conduct peer reviews and audits in specific RDHM clinics.

Our clinical managers attend monthly meetings where they discuss strategy and business planning. Clinical staff are involved in the planning of all major projects and their feedback was incorporate into our Strategic Plan 2010-13.

Clinical innovation is supported through our Clinical Leadership Council (CLC). The CLC includes several DHSV staff members and is responsible for developing clinical guidelines and reviewing clinical practices and emerging research. The clinical guidelines developed by the CLC are available to all staff on the DHSV intranet, an internal website for employees.

In addition to the CLC, clinical staff are included on the Credentialling and Scope of Clinical Practice Committee, Population Health Committee, Quality Committee and on various working groups.

As part of our Business Improvement Program, we have started a Patient Flow Project at RDHM. The project is looking at how we can improve the experience of both staff and patients at the hospital. We look forward to reporting on the project’s achievements in next year’s Quality of Care Report.

Credentialling DHSV makes sure that all clinicians providing oral healthcare have the right qualifications, skills and professional registration to do their job. Our staff know exactly what procedures they can and can’t do. You can be sure that only trained professionals will give you treatment and that DHSV only does the work that it is allowed to do under law.

During the last periodic ACHS review, DHSV was awarded an extensive Achievement rating for our performance in this area.

effective workforceWe make sure that all staff at DHSV are aware of their roles and responsibilities. each staff member has a detailed position description and their performance is managed through regular assessments and annual performance reviews.

DHSV provides support and training to staff to make sure that everyone has the right skills and knowledge to fulfil their role and responsibilities. All of our clinical staff report to a head of unit who is a registered dental practitioner. The heads of units make sure that their staff feel supported and confident with their day to day responsibilities.

Through the DHSV Continuing Professional Development Program, our staff can attend free educational training sessions. We also organise lunchtime clinical forums and professional development dinners for clinicians. Our staff are also supported to attend external training sessions.

We run two scholarship programs at DHSV. Our Oral Health Therapy Undergraduate Scholarship Program offers dental students hands-on experience in public dental clinics under the supervision of experienced

dental professionals. Our Graduate Certificate in Clinical Dentistry Scholarship Program is for overseas-trained dentists who want to work in Australia. Once they have completed their studies and registered with the Dental Board of Australia, scholarship recipients are contracted to work in public dental clinics throughout Victoria.

The effectiveness of our workforce is monitored through various committees and working groups, including the DHSV Board of Directors, the Quality Committee, Community Advisory Committee and our Workforce Advisory Group. These groups review complaints, incidents, recruitment, turnover, productivity and clinical indicators.

Risk management DHSV is committed to providing quality oral healthcare and a safe, supportive environment for staff and patients.

Staff are taught about our policies and procedures on clinical risk management when they join the hospital and then can check them out later on the DHSV intranet.

Clinical risk management is the organised approach to investigating and managing potential clinical problems so we can improve how we care for our patients and make sure they are safe.

All clinical incidents are recorded in an online incident reporting management system. Staff use the system to log clinical incidents, record consumer feedback and log OH&S incidents.

All clinical incidents are investigated to identify why they occurred. Where necessary, we change our processes to prevent the incident from occurring again.

Dental health serViCes ViCtoria reVieWeD For 2010-11

Did you know?Defining the scope of clinical practice involves describing the extent to which an individual clinician can work within DHSV. It is based on the person’s education, competence, performance and professional suitability as well as the ability of DHSV to support them in this work.

Clinical practice is governed by a committee within DHSV.


Complaints per financial year

Complaints by category

Jul 05 - Jun 06 Jul 06 - Jun 07 Jul 07 - Jun 08 Jul 08 - Jun 09 Jul 09 - Jun 10 Jul 10 - Jun 11

500

450

400

350

300

250

200

150

100

50

0

291282

470

339317

264

Patient feedbackDHSV welcomes feedback from patients and consumers via the telephone, in person, in writing or online via the feedback section on the DHSV website.

Consumers can be certain that, where possible, action is taken to prevent the same or similar complaint happening again.

DHSV has a responsibility to be responsive and sensitive towards the rights, needs, concerns or complaints expressed by consumers (or someone on their behalf) and all responses are managed in a timely and sympathetic manner.

If you have a problem with how you are treated, we want to hear about it.

Please put your complaint in writing and address it to the manager of your dental service or contact us directly by phone on (03) 9341 1200. You can also fill out the Tell us what you think form, which can be found at The Royal Dental Hospital of Melbourne or go to the Give Feedback page on our website, www.dhsv.org.au.

We also love to hear about what we are doing well and we get letters from patients thanking us for looking after them. Thanks to everyone who has told us what they liked – and thank you to those who told us how we could do better.

infection controlClinical instruments used in the hospital are sterilised by our central sterilising services department.

Sterilising equipment is tested daily and comprehensive checks on the department are carried out regularly.

The department is required to meet the relevant Australian standards if we are to pass our Accreditation.

Infection control procedures are reviewed regularly and any weaknesses are identified through audits. Our Infection Control Nurse runs training programs at the hospital to make sure all clinical staff meet infection control requirements.

Did you read our magazine last year? Last year 86% of our readers who responded to our survey found this magazine easy to read.

The good news is that around 85% of the same people learned something new about oral health, including how overseas doctors are trained and skilled, how tooth whitening works, how to choose a toothbrush and that we only need a “pea-sized” amount of toothpaste.

Around 61% wanted more information on how to look after their teeth and there were some great suggestions on how to improve future issues.

We have taken a lot on board this year, including increasing the size of the type and the number of pictures.

Some people asked for us to use ‘oral health’ instead of ‘dental health’, which we would love to do, as it

better describes our work. Surveys have found that our readers find ‘dental health’ easier to read, so we have tried to use both terms.

The most popular articles in last year’s magazine were:

• ‘Dentists in the Park’ about RDHM staff giving free mouth-checks at the Where the Heart is…Festival for homeless people and people at risk of homelessness

• ‘Top Tips’, Professor Mike Morgan’s oral health advice column

• The profile on our 2010 Smile of the Year winner, Wayne Quilliam.

Readers who wanted more information on maternal and child oral health will be pleased. Our issue this year focuses on this topic.

Thanks to the DHSV Community Advisory Committee for their feedback on this publication.

access Waiting times, delays in treatment

Customer service Attitude of staff, inadequate or conflicting information

treatment Perception of inadequate or unexpected treatment

Cost Cost of treatment

administration Clerical error

Facilities Amenities and car parking

Patient rights Confidentiality and access to personal information

102

98

84

18

15

4

18


CliniCal inDiCators

DHSV collects data on the number of patients we treat and the results of their treatment. We also look at whether patients have to come back unexpectedly for further treatment and try and find out why this is happening. This helps us improve the quality of the services we provide.

In most cases, we judge our results against targets set by the Department of Health.

teeth retreated within six months of restoration

We keep records on the number of teeth that need refilling less than six months after we put the filling in. DHSV provided fillings to 19,013 teeth in 2010 but only 1,502 needed to be replaced.

All restoration retreatments are investigated. For 2010, 50% were true restoration failures, the other half needed to be replaced for other reasons. In 2009, 62% of all restoration retreatments were true restoration failures, so the increase in teeth retreated within six months of initial restoration (from 7.2% in 2009 to 7.9% in 2010) was due to reasons other than true restoration failures.

unplanned return within seven days after extraction

Less than one in every hundred patients we see have to unexpectedly come back and see us after their tooth is taken out.

Repeat emergency care within 28 days

Less than one person out of every 100 patients who comes to us for emergency care needed to return for the same problem within 28 days.

repeat endodontic treatment within six months

Less than one in 100 teeth that had endodontic (root canal) treatment needed to have this treatment redone within six months.

Dentures remade within 12 months

This year, we made 1,239 dentures for our patients. Of these, only 2.4% needed to be remade within 12 months to improve their comfort or effectiveness.

200714,495

200815,670

200915,891

201019,013

8%

7%

6%

5%

4%

3%

2%

1%

0%

2007-08 15,494

2008-0916,496

2009-1015,938

2010-1115,784

8%

7%

6%

5%

4%

3%

2%

1%

0%

2006-07 1,776

2007-081,849

2008-091,531

2009-101,239

8%

7%

6%

5%

4%

3%

2%

1%

0%

2007-08 15,643

2008-0914,918

2009-1014,236

2010-1115,540

8%

7%

6%

5%

4%

3%

2%

1%

0%

2007 198

2008121

2009132

2010405

8%

7%

6%

5%

4%

3%

2%

1%

0%



extractions within 12 months of endodontic treatment

This graph shows the number of teeth that had endodontic (root canal) treatment. Only three in every 100 people had to come back to have these teeth extracted.

Fissure sealants needing to be resealed within two years

Fissure sealants are plastic coatings applied to the grooves or fissures of the teeth to help prevent tooth decay. In 2008-09, 2,113 teeth were sealed with less than three people in every hundred needing to come back and have them done again in the next two years.

Fissure-sealed teeth treated by restoration or extraction within two years

Of the 2,113 teeth that were fissure-sealed during 2008-09, less than three in every hundred needed to be filled or taken out within two years.

teeth extracted within six months after pulpotomy treatment

A pulpotomy is the removal of the diseased part of the tooth nerve. Last year we did 319 pulpotomy treatments, with less than 1% of teeth treated needing to be taken out within six months.

2007-08 6,310

2008-092,113

8%

7%

6%

5%

4%

3%

2%

1%

0%

2007-08 6,310

2008-092,113

8%

7%

6%

5%

4%

3%

2%

1%

0%

2009 255

2010319

8%

7%

6%

5%

4%

3%

2%

1%

0%

2006-07 217

2007-08154

2008-09115

2009-10227

8%

7%

6%

5%

4%

3%

2%

1%

0%

The winners were

• Professor Hanny Calache, Director of Clinical Leadership, education and Research at Dental Health Services Victoria and Adjunct Professor, La Trobe University School of Dentistry and Oral Health • Dr Sajeev Koshy. Dental Director, Plenty Valley Community Health and Boort Public Dental Clinic, Dental specialist, The Royal Dental Hospital of Melbourne

• Ms Pearl Dias, Dental Assistant, The Royal Dental Hospital of Melbourne, Carlton

Dr Ramini Shankumar from Southern Health Oral Health Services, Dandenong and Dr James Newby from Goulburn Valley Health, Shepparton were highly commended.

The awards marked the 120th anniversary of The Royal Dental Hospital of Melbourne.

Winners were judged on their contribution to the delivery of high quality public oral health services in Victoria, their contribution to improving the capacity of Victoria’s public oral health workforce, and whether they had gone above and beyond what is expected of someone in their role.

For those Who go that extra Mile Three dedicated public dental professionals have won Victoria’s first Public Oral Healthcare Awards.

Top Prizes


Improving our accessIt’s not just our care that we are trying to improve. We also want to bring down the number of people waiting for our help, and the time people have to wait.

From July 2010 to June 2011, the length of time people waited for non-urgent general care, specialist care and dentures decreased in Victoria.

Statewide waiting list 2010-11 General, denture and specialist care (average months waited)

Waiting time (mths)

General Denture Specialist

2007-08 17.68 13.21 9.81

2008-09 19.7 18.99 8.19

2009-10 18.64 19.64 6.84

2010-11 16.6 17.13 5.49

emergency and priority patients at The Royal Dental Hospital of Melbourne were usually seen at the next available appointment with 92.4% of the most urgent patients offered care within 24 hours.

Statewide waiting list 2010-11 General, denture and specialist care (number waiting)

People waiting

General Denture Specialist

2007-08 101,407 12,028 3,059

2008-09 114,921 17,497 6,202

2009-10 113,090 14,722 4,564

2010-11 101,148 11,918 5,029

The number of people who waited for non-urgent dental care and dentures dropped although there was a slight increase in the number of people waiting for specialist care.

Falls preventionThe Royal Dental Hospital of Melbourne has a very low number of patient falls each year.

The hospital uses a falls risk assessment tool, based on the Falls Prevention Project by the Victorian Quality Council, to assess patients who may be at risk of suffering a fall.


Clean traCk reCorD For hosPital

The Royal Dental Hospital is one of the cleanest in Victoria.We achieved a cleanliness score of 95.8%, well above the agreed statewide target of 90%.

DhsV keeps the hospital infection-free by:

• cleaning and sterilising equipment and instruments

• vaccinating staff against viruses and germs

• cleaning walls, floors and furniture

• wearing masks, gowns and glasses.

Manager Infrastructure Services, Paul Horsington said he was very pleased.

“We have had our ups and downs but now are getting consistently great results. All the staff involved should be congratulated for their efforts”.

overall hospital score

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AQL 90% Acceptable Quality Level (Benchmark) for Very High Risk Areas

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DentureGeneral

Specialist


Although all staff use gloves when treating patients, international guidelines state that alcoholic hand rubs must also used in clinical areas.

“In the last two years, we have seen students increasingly remember to use the rubs. At the beginning of our campaign, only 22 % would regularly remember. Now it is more like 63%,” she says.

When asked how she has achieved such a great improvement, she laughs and admits she nags them. “I am very persistent. I explain to them one-on-one what they must do and why. I talk to every student

in every year. I stress the importance of hand hygiene and how the hand rub allows them to clean their hands on the move.”

The hospital is part of the Hand Hygiene Australia initiative which ensures that hospital staff use correct hand hygiene procedures.

Wendy carries out three hand hygiene reviews each year in all our clinical areas. The results of these audits are sent to the national coordinating centre and the Victorian Department of Health.

you Can’t Wash your hanDs oF WenDyWendy Bacalja is on a mission. As Infection Control Nurse, she makes sure all staff remember to wash their hands.

O ver the past year, Toothpicks Café at The Royal Dental Hospital

of Melbourne, has made some positive changes to its menu.

There are now more healthy foods available and these tasty and nutritious options have become popular with staff and visitors.

The changes are part of the Victorian Department of Health’s Healthy Choices program. These food and drink guidelines have been developed for all Victorian public hospitals.

The guidelines help hospitals to increase the availability of healthier food and drink choices in their canteens, retail shops and vending machines.

S ometimes, using an interpreter is the only way patients and DHSV staff can be sure that they have understood each other.

Recently the hospital changed the way it makes bookings for interpreters.

With the new system all bookings are made via an Interpreter Bookings Officer.

Interpreters, patients and staff all like the new system because they know who to contact and where to go for any interpreter issues. It saves everyone time and money.

Interpreter Bookings Officer Mona Shaarani was congratulated by the DHSV Quality Committee for her help in starting the new system.

The bookings office is at ground floor reception and can be contacted on (03) 9341 1394.

If you want to know more about how the hospital responds to different cultures and their needs, check out the DHSV Cultural Responsiveness Plan 2010-13 on our website.

It makes sure:

• translated material is available on our website

• our Community Advisory Committee monitors the plan

• the Community Advisory Committee has representatives from ethnic, Aboriginal and other communities

• Diversity Champions are chosen to organise activities at DHSV.

The Top 10The top ten languages spoken at home by patients of The Royal Dental Hospital of Melbourne are

languages ARe PLANNeD TO MAKe SeNSeIt’s easier to book translators for appointments

• English• Italian• Arabic• Vietnamese• Greek

• Mandarin• Turkish• Cantonese• Somali• Spanish

These are the same top ten languages as the last two years but Cantonese and Somali have both climbed up one step in the ladder.

toothPiCks oPts For

eating Well


J ennifer Lumley, a patient at The Royal Dental Hospital of Melbourne, felt like that when, at 42, she saw herself in a mirror for

the first time after four crowns had been fitted to her front teeth.

According to Dr Ian Steele, the prosthodontist who fitted the crowns, Jennifer’s story was very rewarding.

“We see Jennifer’s problem in about one in every 8,000 people. In this genetic condition people usually lose their teeth by the time they are 30. Their teeth are very short and wear down quickly so we usually fix this when they are teenagers by adding crowns to lengthen them.

“For various reasons, Jennifer did not have this treatment at that time but luckily managed to keep her teeth until she was referred to us from a community dental clinic.

“She is a pretty lady and the new crowns looked wonderful. It completely changed her appearance,” he remembers.

“It is not just an oral health issue, it’s also psychological.“Jennifer received treatment in both the Fixed Prosthodontics and Periodontics Departments at the hospital.

“When my mother saw me after receiving my upper arch, she cried. She said she had never seen me look so good,” Jennifer says.

look Who’s laughing noW!When you have had poor teeth all your life, having a perfect smile may seem like a miracle.

Did you know?This report is distributed to patients and visitors at The Royal Dental Hospital of Melbourne and to all community dental clinics in Victoria.

We also mail it to around 400 people and organisations including all Victorian migrant resource centres.

It is available online at www.dhsv.org.au.

We measure our success by the number of readers who fill in the feedback forms and send them back to us – and the number of copies that are picked up by visitors at the hospital and community dental clinics.

Anastasia Perri (above) hates waiting and she really hates other people waiting.

In her job as Administrative Support Officer, she tackles the problem of children waiting a long time for dental check-ups.

“DHSV really tries to get children back every couple of years for a dental check-up so that we can give them the best chance for a healthy mouth and good teeth in adulthood,” Anastasia says.

“My job is to contact parents with children on long waiting lists and see if we can see their children some other way, such as going to another clinic nearby or coming to one of The Royal Dental Hospital’s after hours clinics.”

According to Manager Quality Improvement Projects (Agencies), DHSV, Marrianne Beaty, many clinics with long waiting list times across the state had focused on adult waiting times.

“Unfortunately, by trying to see as many adults as possible they can inadvertently let the recall visits for children slow down,” she says.

“In May 2010, we found that just over 33,500 children across the state were overdue for a dental check-up. We had to do something and the Department of Health agreed. The Department identified that children were a priority for dental care in Victoria.

“We can happily report that one year later this number had dropped to just over 4,500 children, a fantastic result!”

The DHSV Agency Relations Team worked with the dental clinics across the state to help them fix the problem. What started as a pilot was later extended into a two year program.

DHSV will continue to work on this project until no children are overdue for a dental check-up across the state.

Anastasia gets kids to come back for more

Jennifer’s treatment is not finished. Although she was referred in 2009, pregnancy and other personal issues meant that her treatment has been delayed. eventually all her teeth will be fixed.

“There is a real difference in morale. The work is not unreasonable to do and the improvement in her appearance and wellbeing is very rewarding,” says Dr Steele.

Jennifer said she had been hesitant in the past to see dentists but Dr Steele put her at ease immediately.

“He is a lovely man and made me feel immediately at ease. He explained everything really well,” she says.

Dr Ian Steele congratulates Jennifer Lumley on her progress.


What Do they Do?The team at The Royal Dental Hospital of Melbourne all have a special role in helping you get the best possible care. A few of our staff explain what they do, and why they love doing it!

Who’s who andTraining needed to become

a specialist Dentist

• Bachelor of Dentistry

(five years)

• Postgraduate degree

(three years)

• Specialist dentists can work in

various fields as oral pathologists,

periodontists, paediatric dentists,

endodontists, orthodontists and

oral surgeons.

role

• Treats diseases of the lips,

cheeks, tongue and jaw

• Helps people with painful

skin rashes, sore jaw joints,

neuralgia, mouth ulcers,

mouth cancer and infections.

Best part of her job

“I love helping people by

diagnosing their conditions,

especially when these have

been difficult to identify

before. It’s very rewarding

to work out what the

problem is and fix it so that

patients get some pain relief

and hope.”

Dr Nicole Heaphy

Specialist Dentist, Head of Oral

Medicine Department

Training needed to become a Nurse

• Three year Bachelor of Nursing degree at university

• Post graduate degrees in nursing specialties,

such as peri operative (theatre)

role

• Oversees the day to day running of the Day

Surgery Unit

• Nurses meet the patients before the operation, help

the anaesthetist look after the patients when they

are unconscious and look after the patients when

they are recovering after theatre.

Best part of her job:

“We receive some really positive feedback

from patients which lets us know we have

succeeded in providing effective care.

I work with a great team in the unit.”

Eileen Wilton

Nurse Unit Manager, Day Surgery Unit

Training needed to become an Anaesthetist

• Bachelor degree in Medicine and Surgery (six years)

• Prevocational Medical education and Training

(two years)

• Australian and New Zealand College of Anaesthetists

Training (five years).

role

• Assesses the medical condition of the patient

before surgery to ensure they are well enough

for the anaesthetic

• Determines whether it is safe to have a

local anaesthetic, sedation of a general

anaesthetic

• Gives the anaesthetic, so the person

is unconscious

• Looks after the patient all the way

through the operation, adjusting

medication when it is needed

• Wakes the patient up and looks after

them until they are safe in recovery.

Best part of his job

“everyone is different. Things

can happen quickly and

we have to fix problems

quickly. You can’t wait.

It is like practicing

emergency medicine.

It’s challenging and

satisfying at the

same time.”

Dr Tony Bajurnow

Director of Anaesthesia,

Day Surgery Unit’

Training needed to become a Dental assistant • Certificate III in Dental Assisting (One year traineeship)

role• Assists and supports the dentist

• Prepares patient, sterilises and disinfects instruments• Sets up the clinic

• Takes the dentist’s notes and puts them into the patient’s chart.Best part of her job “I love caring and helping people. I get a satisfaction when seeing the end result which may be a beautiful smile or just getting someone out of pain. It’s rewarding when you have gone that extra mile for someone. I work with a fantastic team who have the same working standards as I do. “

Liz Ristevski Dental Assistant Team Leader, Day Surgery Unit, Oral Maxillofacial Surgery Department


You may need to see a dentist who focuses on one area:

• orthodontics: alignment of teeth

• oral Medicine: treatment of disease of the lips, cheeks, tongue and jaw

• Periodontics: treatment of severe gum disease

• Prosthodontics: dentures, crowns, bridges

• Paediatric Dentistry: treatment for children with complex dental, medical and other needs

• endodontic: root canal treatment

• special needs Dentistry: for patients with intellectual or physical disabilities and complex medical histories

What are our specialist services?

Training needed to become an Hygienist

• Bachelor of Oral Health Therapy / Bachelor of Oral

Health Science (three years)

role

• examines and assess tissues around teeth

• Plans treatment and care to treat diseases

• Treats, teaches and counsels patients in good

oral health, such as plaque control, nutrition,

diet, and lifestyle

• Ongoing check-ups after treatment

because caring for the tissues

around teeth cannot be ‘cured’ by one

treatment.


“I love the various challenges involved

in bringing each patient to full oral

health, and then maintaining them. It’s

great to see the benefits the patient

experiences in doing so. I meet a

wide variety of interesting people,

particularly at RDHM.”

Georgina Lobb Dental Hygienist, Periodontics

Who’s who and

Training needed to become a Dental Technician

• Apprenticeship in Dental Technology (four years)

• Advanced Dental Prosthetists course allows

technicians to treat their own patients and make dentures

role

• Makes and repairs dentures (false teeth) and other dental

appliances including crowns and plates to replace missing

teeth or to help the mouth work properly

• Works with dental prosthetists and dentists to

construct, modify and repair dental appliances

• Uses the latest technology

• Always training


“I love seeing a job well done, seeing the

mouth look really good and working well. You

need both technical understanding to cast

metals and make the teeth but also an artistic

flair so that these false teeth will match the

ones still in the mouth.”

Sian Elise Healy

Dental Technician Team Leader, Dental Laboratory

Training needed to become a Dentist• Bachelor of Dentistry (five years) • Post graduate degrees for oral health specialities

role

• Cares for the mouth and lips, looks after the tissues in the mouth as well as the teeth• Improves chewing• Fixes broken teeth, puts in fillings• Fits dentures

Best part of his job“I love my job. It’s a constant challenge. each

person is different with different problems and expectations. It is

also enjoyable working with people and making some

sort of difference in their life. I like to think I help, especially those who are scared before they come to me, but leave smiling.”

Demetrios Karakitsos Senior Dentist, Officer in Charge, Primary Care

Sharon Richardson Dental Therapist, Undergraduate

Teaching Clinic, Paediatrics

Training needed to become a Dental

therapist

• Bachelor of Oral Health Therapy / Bachelor

of Oral Health Science (three years)

• Further study allows dental therapists

to treat adults under certain circumstances

role

• Works under the supervision of a dentist

• Sees people up to 26 years of age for general

dental work, such as fillings, cleaning,

extractions and x-rays

• Plans treatment programs and

provides oral health promotion

advice

• Different from a dentist in that

she doesn’t write prescriptions,

or do surgery and doesn’t work

on crowns and bridges, dentures

or implants

• Refers more complex cases

to a dentist

• Has a strong focus on stopping

oral health problems before they

get bad.


“I love helping children to stop

being scared of going to

a dentist.”


Wired Up Which child eats what to improve their health

Shade in every fragment that contains a dot. What have you got?Shade

Challenge your mind

PUZZLESHave FUN with our variety puzzles

Wired Up Shade

Can you find all 10 differences?

1. One of the star is yellow 2.Waterboy cape is red 3.Red star missing on Brush boy face 4.Circle missing on Brushboy shoe 5.One star missing 6.Red triangles are not the same height 7.One of Munchgirl’s juggling ball missing 8.Munchgirl wheels have changed colour 9.Munchgirl eyes - looking down 10. Elephant’s tusks

SPOT the DifferenceSPOT the Difference


Pregnancy hormones cause changes in your mouth that may cause gum disease. It is important for pregnant women to brush their teeth twice a day and have a dental check-up before and during pregnancy. Flossing can also be good but check with your dental professional.

Executive Director, Oral Health Leadership at Dental Health Services Victoria, Professor Mike Morgan, answers questions on good oral health for mothers, babies and children

Put your child on your lap facing away from you, or stand behind your child. Cup their chin with one hand and brush the teeth in a circular motion. Use a small, soft toothbrush and let your child hold the toothbrush so they feel like they are brushing their own teeth. Only use water on the toothbrush up to 18 months of age (unless a dental professional says otherwise). From then on, use a fluoride toothpaste that your dental professional suggests.

How do I brush my child’s teeth?

How do I look after my teeth and gums during pregnancy?

I recommend that children have a professional dental check-up by two years of age.

When should my baby have its first dental check up?Your children will need your

help and supervision until they are about six or seven years of age.

What age can my children brush their teeth by themselves?

Ask ProFessor Mike

Yes, soft drinks can lead to tooth decay. If sweet drinks are offered it is best to only do so once in a while and give them as part of a meal rather than as a snack. It is best to give your children water (especially fluoridated tap water) if they are thirsty.

Can soft drink damage my children’s teeth?

Yes, you can gently wipe the new tooth with a damp cloth or face washer.

Can I brush my baby’s new tooth?

Yes. It is not good to let your baby sleep with a bottle of milk in its mouth, because this can lead to early tooth decay. Usually our saliva breaks down the natural sugars in the milk and helps stop the bacteria in our mouth converting these sugars to acids. Acids can dissolve the enamel which covers the tooth.

But when your baby is asleep, its saliva flow slows down. This means that when the milk pools in your baby’s mouth, there is really very little to stop the bacteria turning the sugars into acid.

Babies under six months only need breast milk or formula. When babies are old enough to drink something other than milk, water is best.

Does putting my baby to bed with a bottle hurt my baby’s teeth?

toothbrushes sent around Victoria In 2011, more than 9,000 toothbrushes were sent around Victoria as part of a world wide drive to improve dental health.

According to our Aboriginal Community Development Worker Jacqueline Watkins (pictured), DHSV sent 9,250 toothpacks to 10 Koori Maternity Services and eight Aboriginal Health Organisations throughout the year.

“This is a large increase. In 2008, we sent out 4,625 toothpacks.

The number has really grown,” she said.

The Global Child Oral Health Taskforce was established in 2006 to raise the profile of oral health and to bring it in line with understanding about general health.

The project is supported by the UK government and its mission is endorsed by the World Health Organisation. The toothpacks were donated by Colgate Palmolive. Jacqui said the communities who received the brushes were very pleased.

“We had a lot of good feedback. People said that the brushes taught their kids to be healthy, and that the children were very excited to be brushing their teeth at the centre during the day and talked

about how they also did it at home in the evening.

“People told me that the program helped them to get their kids to brush their teeth,” she said.


Service directory

www.dhsv.org.au

Type of service Who can use iT? Where? hoW much do i pay?

AdultsCheck-ups and adviceCleaningFillingsExtractions

Healthcare and pensioner concession cardholders

Community dental clinicsand The Royal Dental Hospital of Melbourne

$25 per visit up to a maximum of $100 for a general course of care

Children and youth Check-ups and advice every 1-2 yearsDental sealants to prevent decayCleaning Fillings

All children aged 12 years and under.

Children and adolescents between 12 years and 17 years if they or their parents hold a current healthcare or pensioner concession card.

Community dental clinics and The Royal Dental Hospital of Melbourne

Free for children and adolescents if they or their parents hold a current healthcare or pensioner concession card Children aged 12 years and under whose parents don’t hold a concession card pay a flat fee of $30 per child (maximum of $116 per family) for a general course of care Children and adolescents without a concession card may be eligible for free treatment in some circumstances. Visit www.dhsv.org.au or ring 1300 360 054 to check eligibility

Emergencies Healthcare and pensioner concession cardholders

Victorians without a concession card


The Royal Dental Hospital of Melbourne

Flat fee of $25 for an emergency course of care

Pre-payment of $100 with total cost based on dental need

Dentures Healthcare and pensioner concession cardholders


Fees for dentures are dependant on the type of dentures required, up to $120 for a full upper and lower acrylic denture

Specialist careOrthodonticsOral and maxillofacial surgeryEndodonticsPeriodontics Prosthodontics Paediatric dentistry Oral medicine

Healthcare and pensioner concession cardholders and their dependants who have been referred by their dentist.


Depends on treatment needs, up to a maximum of $300 per course of care

Special needs Care is available to children and adults with special needs. Talk to your local clinic for more details.

The Royal Dental Hospital of Melbourne and some community dental clinics

Depends on treatment needs. Cost will be discussed at your first appointment

Student clinic You may be eligible for treatment by a dental student under the supervision of a senior dental professional.

To make an appointment to assess your suitability call (03) 9341 1168.


Free for healthcare and pensioner concession cardholders

Free for children aged 12 years and under

locations• To find your closest community dental clinic call 1300 360 054 or go to www.dhsv.org.au• The Royal Dental Hospital of Melbourne 720 Swanston Street, Carlton | Phone: (03) 9341 1200 Disabled parking spaces are available on Lynch Street (a one-way lane off Cardigan Street) in Carlton. enter the lane from Cardigan Street and the disabled parking bays are on the left.

hoursthe royal Dental hospital of Melbourne Appointments: Mon-Fri, 8.30am-4.45pm emergencies: Mon-Fri, 8.30am-9.15pm Weekends and public holidays, 9.00am-9.15pm

Community dental clinics Check with your clinic.

Note: These are 2011 fees and are subject to change.

in an emergency call 1300 360 054

Quality of Care Report 2011

Documents

Transcript of Quality of Care Report 2011