Article
The recent release of the General Dental Council's framework of behaviours and outcomes for dental professional education discusses the concept of a safe practitioner on qualifying.1 As with this document's predecessor, ‘Preparing for practice’, the importance of leadership in dentistry and across the whole dental team is recognized, with each registrant group having leadership highlighted as an increasingly important professional domain.
For example, in the case of dentists the following domains are suggested:
Behaviours
- Where appropriate lead, manage and take professional responsibility for the actions of colleagues and other members of the team involved in patient care.
Learning outcomes
- Describe the differences between management and leadership
- Describe own management and leadership role and the range of skills and knowledge required to do this effectively
- Describe how to take responsibility for the quality of services and devices provided to the patient as relevant to your scope of practice.
Googling the term ‘leadership’ results in a substantial number and diverse range of definitions. Ultimately, leadership tends to mean different things to different people, with concepts shaped by experience, peer groups, education, training and the working environment. Over the years, we have heard it defined as: ‘motivating individuals, achieving objectives, bringing people together, building progress, bettering the team’, and commonly, ‘encouraging others to share the leader's vision.’ None of these answers is necessarily wrong, and most are applicable to the clinical environment.
While good clinical leadership is often unrecognized, when organizational healthcare flounders, the spotlight commonly falls upon failures of leadership. One such example was the catastrophic impact of leadership failing to unite the objectives of meeting key performance indicators with quality of patient experience described in the Francis report.2 Such reports have supported the need for ‘good leadership’ in dentistry, with the College of General Dentistry defining leadership skills and qualities at different career stages, from the safe to the enhanced practitioner. Fortunately, it is increasingly recognized that leadership is not limited to those with an innate aptitude, but it can be taught and developed, much as our regulator highlights. Leadership now frequently features as a component of both undergraduate and specialty curriculums. Many healthcare providers, recognizing the value of developing good leaders within their organizations, also offer internal courses and mentorship. Hospitals, in particular, provide an environment that is conducive to leadership development, with an organizational structure that supports both small- and large-team leadership, and the resources to enable formalized training. Developing clinical leadership across dentistry is more challenging, given that the vast majority of dental care is provided in small, disparate practices. Dentistry is a fundamentally hard profession; high demands for service, ever-increasing patient expectations, and litigation, have to be balanced against the challenges of running a financially sustainable business. In such environments, it is easy for clinical teams to retreat into a zone of routine dentistry, which, although safe, quickly reduces professional stimulation and ultimately confidence to try new techniques. The professional risk is that, when it is difficult to separate one week from the next, the fortress of independence that a surgery can offer, transitions to a metaphorical prison. Effective clinical leadership not only improves the working environment, but can also help clinicians balance the tight rope between ‘rust out,’ when we fail to find stimulation from our workplace, and ‘burn out,’ when we are overloaded.
So, what can clinical leadership look like in general dental practice? There are rafts of ideas on this, but generally, the foundation relies upon the setting of team goals, both within and outwith clinical delivery. While such goals will be varied, they will only really be valid if they are achievable, and specifically directed to the immediate working environment. Team involvement in projects or teaching sessions can help whole team development while also improving individual ownership of care provision. With regards to the former, projects don't need to be complex, with often a simple audit of practice process or outcomes being sufficient to give the team a directive. An example of establishing individual team member goals may be to adopt a mantra that aspires for 10% of the clinical workload to be professionally challenging and be outwith simple ‘routine care.’ Encouraging teams to try this 90/10 approach can be achieved, not just by formalized courses, but by simpler departmental activities, such as case discussions, intelligent use of PDPs, or team participation in study/journal clubs. Such activities provide forums to both improve communication and also stimulate practitioners to try new materials or procedures. Similarly, mentoring can also act a means for team members to expand skillsets beyond their routine practice, while also helping to breakdown inter-surgery barriers.
Ultimately, there is no ‘one size fits all’ approach to leadership in general dental practice, but recognition of its importance, and perseverance with establishing a leadership model that works, can transform your own clinical environment.
When it comes to transforming your own clinical environment and adopting the 90/10 approach, Dental Update is not only essential reading for the 90, but also ideally placed to inform all members of the dental team in embracing the 10. The British Society of Periodontology special issue in May's Dental Update, had articles relevant for all the dental team, and as undergraduate team members approached finals, it was a most welcome resource. The June issue has a range of articles including areas that increasingly fall in the remit of primary care, relating to the increasing number of bariatric patients rising year on year, leading to increased numbers of these patients presenting in the community. As dental teams and their leaders consider challenging themselves in order to optimise patient care, Dental Update remains at the heart of this community of practice, essential reading for dental leaders and followers alike.