course objectives · themselves accountable for both the client care and business aspect of the...

ODHA Re-Energize Conference September 2016 Quality Assurance & Best Practice: Who is the RDH?

P o s i t i v e I m p a c t D H C o a c h i n g & m a x i l l P a g e 1 | 33

Slide 1

Quality Assurance & Best Practice: Who

is the RDH?

Michelle Aubé (Simmonds) RDH

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Slide 2 Course Objectives

• State the roles of the RDH

• Define the RDH as a leader

• Connect the RDH as a health coach

• View the role of the RDH in a transitioning profession

• Analyze leadership styles

• Address personal leadership style

• Access assessment and reading resources for leadership support

• Define professionalism

• Link professionalism and the roles of the RDH to leadership

• Identify DH Practice hurdles

• Examine decision making models

• Discuss the purpose of a morning huddle to resolve practice dilemmas

• Understand the responsibly of knowing the employment standards on Ontario

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Slide 3 Course Objectives

Continued …

• Access to the CDHO and RCDSO Practice Advisors

• Define team dynamics and listing good and bad dental office dynamics

• Comprehend the responsibility of a leader towards competency

• Review the notion of Best Practice and EBDM

• Learn how the professional portfolio QA process can create a team that fosters accountability

• Examine the question styles to the SMILE portal practice profile

• Use the questions for self-assessment as well as for reporting purposes

• Analyse the learning portfolio in the SMILE portal for quality learning and outcomes

• Review learning goals and view outcomes as a series of smaller changes, not always as one large impact to the practice

• Navigate in the SMILE portal to easily organize thoughts and data input.

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Slide 4 DEFINING THE RDH

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Slide 5 Role Primary Focus Secondary Focus Employment Example

Clinician ADPIE + D in direct preventive and therapeutic services

Any other role where clinician is not the main employment/ job title

Traditional dental officesIndependent DH officesDH clinic in educational setting

Educator Instructor in a dental hygiene program Clinician educating clients directly and /or participating in community educationCorporate education services

Faculty in DH Schools Education in: clinical practice,public health, corporate speakers

Researcher Testing theories and products and educational approaches for teaching DH theory

Clinician for their own QA of EBDM Research institutesClinical practice Oral health care industries

Administrator -Direct practice management in a dental office-Educational facility clinical and program directors-Professional Associations

Clinician participating in practice management for QA Day to day record keeping/documentationEntrepreneur DH owning a DH practice

Educational institutionsTraditional clinical practiceDH clinical practiceOral healthcare industry Public health programs

Promotor All roles advocate for best interest of client/public health

All roles All roles

Public Health Design/participate in programs to address unmet needs of the public

Any other role that participates in oral health community educational programs

Public health unitsAny other role advocating for public health

Corporate Use of DH practice expertise in partnership with oral health industries

Product researchers / trainersCorporate educators Sales representatives/managers

Entrepreneur Independent Dental Hygiene Practice owners and operators

Consulting services Coaching and consulting servicesDH cont. education providers

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Slide 6 Professionalism

A RDH is a Professional, what does that mean?

What Is Professionalism?

• Professionalism refers to the values of a profession that puts ethical and high quality services before the self-interest of the registrant. All codes of professionalism can be summarized in one phrase: “be competent, honest and fair”.

Competence: providing high quality services each and every day. Alistair Cooke said “A professional is a man (sic) who can do his best at a time when he doesn't particularly feel like it.”

Honesty: being truthful both in your statements and your omissions.

Fairness: appropriately balancing competing interests. CDHO Registrants Handbook Pg. 9

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Slide 7 The RDH is a Leader, Why?

• Do you view yourself as a leader?

• Ironically all the roles cannot exist without the RDH having leadership skills.

• QA cannot exist without the RDH being a team leader in a dental practice.

• Is the RDH always the leader?

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Slide 8 The RDH is a Coach, Why?

• Do you view yourself as a health coach?

• As the dental profession transitions forward, health professionals are assuming more and more of a ‘coaching’ role.

The ‘Health Coach’ is an emerging new role. o Recognized as a new way to help individuals

"manage" their illnesses and conditions, especially those of a chronic nature (1).

o The coach uses special techniques, personal experience, expertise and encouragement to assist the ‘coachee’ in bringing his/her behavioral changes about (1).

(1) https://en.wikipedia.org/wiki/Coaching#Health_and_wellness_coaching

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Slide 9 Leadership in the DH Profession

Reflect on leaders and coaches you know or have known …

What did they offer you? • Answer: education and motivation to strive for the best you can be

Who is the RDH leading/coaching? • Answer: client, team, peers

Why are we leading and coaching the client? • Answer: to accomplish best oral health possible

Why are we leading and coaching the team and peers? • Answer: to accomplish best practice in our direct practice as well as in our profession

R H

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Slide 10 What Is A Good Leader?

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Slide 11 Leadership Styles

• Based on the theories of Isabel Briggs Myers and C.G. Jung, there are 8 leadership styles

• A leadership profile is a mix of the personal preferences of the 8 styles (1)

• Some leaders use a combination of a few or all of the styles (1)

• When would each or combined styles best suit your organization

(1) Adapted from Team Technology UK: http://www.teamtechnology.co.uk/leadership/styles/

Leadership Styles

Participative

Ideological

Change Oriented

Visionary

Theorist

Executive

Action Oriented

Goal Oriented

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Slide 12 Determine YOUR Leadership Style

On line reading and assessments to determine your leadership style:

Reading Resource:

8 Dimensions of Leadership Overview Kristeen Bullwinkle & The Talent Gear Team. November 03, 2015. https://www.talentgear.com/learn/november-2015/8-dimensions-of-leadership-overview/

Talent Gear Slide Share Power Point: http://www.slideshare.net/TalentGear/lessons-from-each-of-the-8-dimensions-of-leadership

Disc Profile. Disc Personality Types Slide Share Power Point: http://www.slideshare.net/onlinedisc/disc-personality-styes

8 Dimensions of Leadership Book: http://www.8dimensionsofleadership.com/

Assessments:

• 8 Dimension of Leadership Assessment: https://www.talentgear.com/shop/8-dimensions-of-leadership-map/

• Team Technology Assessment: http://www.teamtechnology.co.uk/leadership/styles/

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Slide 13 Healthcare Leaders

Becker’s Hospital Review writes “Tomorrow's Top Healthcare Leaders: 5 Qualities of the Healthcare Leader of the Future.”

In the navigation of a changing environment and paralleling to dental practices, five qualities will define dynamic leadership in the future of healthcare:

1. Independent thinking to understand emerging client care needs.

Analysing what is not working and finding solutions for client centered care

2. Passionate about serving the needs of the client. Client centered care and making our clients happy. Legendary management consultant Peter Drucker states "Management is doing things right; leadership is doing the right things."

Tomorrow's Top Healthcare Leaders: 5 Qualities of the Healthcare Leader of the Future. Beckers Hospital Review September 25 2012. J. Stephen Lindsey, FACHE, Principal at Ivy Ventures, LLC, and John W. Mitchell, M.S., Hospital Advisor at Ivy Ventures, LLC. http://www.beckershospitalreview.com/hospital-management-administration/tomorrows-top-healthcare-leaders-5-qualities-of-the-healthcare-leader-of-the-future.html

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Slide 14 Healthcare Leaders

3. Act as a change agent for their organization/practice. Ethically aligning a business model to a client centered care model without sacrificing quality of care.

4. Motivate and inspire.In a transitioning profession with constant change a leader must be able to motivate and inspire others to achieve common goals.

5. Run a lean, high-quality organization.Create and manage lean, effective organizations without sacrificing quality. An inspired and empowered team will participate and hold themselves accountable for both the client care and business aspect of the practice.

Tomorrow's Top Healthcare Leaders: 5 Qualities of the Healthcare Leader of the Future. Beckers Hospital Review September 25 2012. J. Stephen Lindsey, FACHE, Principal at Ivy Ventures, LLC, and John W. Mitchell, M.S., Hospital Advisor at Ivy Ventures, LLC. http://www.beckershospitalreview.com/hospital-management-administration/tomorrows-top-healthcare-leaders-5-qualities-of-the-healthcare-leader-of-the-future.html

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Slide 15 Accountability

Definition of Accountability:

“the acknowledgment and assumption of responsibility for actions, decisions, and policies, including the administration and implementation within the scope of the role or employment position, and encompassing the obligation to report, explain, and be answerable for resulting consequences.” (1)

“Good leaders not only accept accountability but embrace its notion as a motivator to strive to do better”(2)

(1) Accountability in the dental office: the secret to an efficient, effective team. Dentristry IQ. Janice Keller. http://www.dentistryiq.com/articles/2011/09/accountability-in.html

(2) Michelle Aube Simmonds RDH

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Slide 16 AccountabilityAdapted from Dr. Ron Arndt Master (DDS MBA MAGD Master Certified Dental Coach)

Accountability is:

• Performance: It’s about holding yourself to a standard of performance—a performance level that you can feel proud about.

• Reliability: It’s about being constantly reliable and predictable in your reliability

• Action: It’s about doing what you say you will do.

• Commitment: It’s about living up to a commitment that you have made to yourself and others.

• Responsibility: It’s about accepting responsibility for your behavior.

• Respect: Its about respect for yourself, your team, your profession and your clients

• Humility: It’s about admitting you may not know something and gaining the necessary knowledge to change it

• Success: It’s about turning mediocrity into success

Adapted from: Dr. Ron The Dental Coach. Ron Arndt DDS MBA MAGD. Master Certified Dental Coach. http://drarndt.com/accountability-definition/

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Slide 17 Gaps in Knowledge

• Gaps in knowledge are boldly underlined as gaps in accountability

• New knowledge can be attained easily, how about accountability

• To function, all team members must be on the same page and share the same mission and vision

• All team members are professionals and require continued competency

• Too often gaps in knowledge prevent dental offices from functioning at an optimal level

• For the RDH who’s nature is indeed to lead, this causes frustration and decreased job satisfaction

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How does this impact the RDH?

• The RDH is responsible for the actions of the team that impact his/her clients and practice

• It is the role of the RDH to recognize and guide team members towards knowledge expansion

• However, team members must be willing to accept their own responsibility and accountability

• The role of the RDH is to lead not ‘babysit’

• If the RDH does not want to ‘babysit’ as a leader he/she must be very clear in their directions

• Unfortunately in scenarios of poor accountability, unenviably your teams actions have the potential to become a reflection of you

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• As the DH profession positively evolves, attention unfortunately must be drawn to an increasingly growing concern that may have negative impacts short and long term to dental offices

Business centered care VS Client centered care

• There is no surprise that the dental office or dental hygiene office has a business component

• However, the scales cannot tip only in favour of a business model of care

• It is a ‘delicate’ task to balance the models of business and client centered care

• A RDH has difficulty functioning in a model of care that is too heavily weighed on business as this model of care negates the DH Process of Care and has a tendency to jeopardize individualization of client centered care

• In the model of business centered care the clients quickly see the shift and the model becomes very transparent

• Dentistry should never be ‘sold’, the effective dental leader will educate with such quality and finesse that he/she will never have to sell

• An effective team where each member is supported and empowered in their role will generate the revenue needed to also be successful in the business aspect of a dental office

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Slide 20 DENTAL HYGIENE HURDLES

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Slide 21 Changing Times for a RDH

• Times have changed in our profession

• RDH are faced with new interesting practice management dilemmas

• Large impact on self and professional motivation

• Major influence on job satisfaction

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Slide 22 The RDH’s Hurdles

Hurdles, dilemmas, barriers within the modern day RDH practice:

• What stops the RDH from performing all the roles to their fullest, what are some common barriers? • Personal

• Ethical

• Practice Management

• Labour Standards

• Job Availability

• Job Competition

• Motivation

• Team Conflicts

• Procrastination

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Slide 23 Dental Office Dynamics

Definition of Team Dynamics

• The intangible, unconscious, psychological forces that influence the direction of a team’s behaviour and performance (1).

• Created by the nature of the team’s work, the personalities within the team, their working relationships with other people, and the environment in which the team works (1).

(1) http://www.teamtechnology.co.uk/team/dynamics/definition/

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Slide 24 Dental Office Dynamics

The Good• improve overall team performance

• motivate team

• support team in achieving goals

• share offices mission and vision

• reward good behaviour

• positive reinforcement

• mutual respect

• trust

• staff retention

• client centered care is first

• balanced revenue

• strong leadership

The Bad

• unproductive team performance

• demotivates

• no team support preventing team goals to be achieved

• no ‘big picture’

• no recognition

• conflict

• distrust

• loss of skilled staff

• business centered care is first

• poor revenue

• poor leadership

The Ugly

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Slide 25 Do Good Leaders Compromise?

Compromise when you can and don’t where you can’t!

• This parallel’s the saying ‘pick your battles’

• Ethics, morals, client safety and advocacy are never to be compromised, but feel free to compromise on prophy paste flavor (not abrasiveness though)!

• Determine what is necessary to change with a priority to conquer list

• How will your compromise impact you today, tomorrow, next week, next year? Decide based on the ethics of the compromise.

• Good leaders purposely choose where compromise can be allocated

• Good leaders purposely choose where compromise can not be allocated

• Compromise is not an act of weakness that you were defeated and you ‘backed down’

• Compromise is a tactic for leadership strength that displays integrity

• When and how you compromise as a leader will set the stage for your own respect as well as how you are perceived in respecting others

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Slide 26 Overcoming Barriers

Professionally CDHO has support for the RDH in assisting with overcoming barriers and lead to improving team dynamics, with the following tools/service:

1.CDHO’s Ethical Decision Making Model (see code of ethics)

2.Darby & Walsh Decision Making Model

3.Advice from CDHO Practice Advisors

4.Advice from RCDSO Practice Advisors

5.Mentorship Program

Other support:

1. Government of Ontario: Knowing the labour and employment laws of Ontario

2. Morning Team Huddles

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Slide 27 Decision Making Models

Purpose of decision making models :1. Guidance for the professional in the dilemma/conflict2. Confidence to step forward and do the ‘right’ thing3. Proof in an inquiry scenario that proper steps were followed to rectify the

issue

How to ‘act’ during conflict:• Always be respectful• Be solution oriented• Show willingness to negotiate• Ask a neutral party to mediate• Be willing to back down

Darby & Walsh 3rd Ed. Chap 60 Pg 1146

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Slide 28

CDHO Conflict Resolution Model 8 Steps

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Slide 29 Conflict Resolution Models

Darby & Walsh 6 Steps to conflict resolution:

• Darby and Walsh text book suggests for dental offices to have a dental ethics committee ‘DEC’

• A committee approach identifies and reviews issues of concerns to all office members

• Educates the entire team about ethical making decision process

• An education approach encourages an ethics based office philosophy

Darby & Walsh 3rd Ed. Chap 62 Pg 1190

Step Ethical Decision

1 Define the problem or conflict

2 Identify the ethical Issues

3 Gather relevant information

4 Identify the ethical alternatives

5 Establish and ethical position

6 Select, justify and defend the alternatives

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Slide 30 Professional Practice Advisors

RCDSO Practice Advice

CDHO Practice Advice

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CDHO States: “Mentorship is recognized as a viable strategy for professional growth and leadership in health professions.”

http://www.cdho.org/docs/default-source/pdfs/reference/mentorshippackage.pdf

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Know the Labour Laws of Ontario! The employment standards are YOUR RIGHTS in the labour field in Ontario.

• Employment Standards of Ontario: https://www.labour.gov.on.ca/english/es/

• Government of Ontario You Tube video: https://www.youtube.com/watch?v=YFfGZGJGO80

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Team Morning HuddlesPurpose: A method of quick structured guidance prior to the commencement of a day to review schedule and ensure exceptional client care in order to accomplish a smooth balanced work day.

The Team Huddle should:

• identify scheduling conflicts

• identify client’s specific needs

• direct team (who needs to be where and when)

• remind of systems and tasks

• motivate to build team

• identify staff changes and any training

• serve as a positive reinforcement (some teams repeat the offices mission and vision)

Most team huddles consist on one leader calling out a list to direct action

Some teams rotate the call out action list person

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You Define You!What happens when we are constantly faced with conflict?

• Even the most professional of professionals will begin to doubt their abilities

• A feeling of ‘isolation’ can emerge

• Go back to your mission and vision statement that allows you to focus on who you are and what your are here to do (no one can take or change your mission and vision statement, its yours!)

• Recognize when it is necessary to leave a work environment

• Recognize when it is necessary to obtain professional assistance via counselling (even leaders need leaders!)

• In unresolvable conflicts: Do not let your environment dictate who you are

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Slide 35 Maintaining Positive Thinking

The solution to any work environment and professions barriers is taking care of YOU!

• Typically this would involve a segment on ergonomics … what about our mental health as a RDH?

• The dental hygiene profession has its challenges, how does the RDH remain positive?• Importance of being positive vs. seeming positive• Staying focused as to our mission as a RDH • Mission and vision statements as a means of focusing• Pat yourself on the back: re-focusing on our strengths• There are no self ‘cheerleading’ courses for RDH but there is

peer support• Self help literature / counselling / coaching

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Slide 36 Mission & Vision Statements

Mission Statement• defines the purpose and primary objectives• explains your values / why you exist professionally, why are you here?• short clear and powerful• Example for RDH: Deliver ethical, individualized, quality dental hygiene care with compassion and integrity.

Vision Statement• defines purpose with focus on goals and aspirations• long-term desired change resulting from an organization or program’s work• Explains your direction, where are you going?• uplifting and inspiring• Example dental team: Working together to strive for the best quality client centered care for optimal client oral health and

overall wellness.

Both Statements:

o inspires and motivates

o purpose and belief to keep a person/team focused

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Slide 37 BEST PRACTICE

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Slide 38 Best Practice

“A method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark” (Business Dictionary)

• Best Practice is Evidence Based Practice that uses critical thinking and the notion that improvement is always possible

• Used to maintain quality

• Can be based on self-assessment and /or benchmarking

• It fosters consistent results and needs supportive evidence

• In DH Best Practice is based on the CDHO Standards of DH Practice

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Slide 39 EBDM – E vidence B ased D ecision M aking

Notion of EBDM Process

Appraising and applying current evidence from relevant research to link this knowledge to decisions made in clinical practice so that the knowledge is directly reflected in the care provided.

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Slide 40 Best Practice & EBDM

How to make Best Practice DecisionsAsk Yourself This …

Which decisions does the evidence suggest I should implement to help achieve health promotion/public health goals?

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Slide 41 Critical Thinking

The RDH needs to ‘think’ to connect EBDM to reach Best Practice decisions.

o Critical thinking is a cognitive process that requires disruptive patterns of thinking, ones that question the status quo of propositions and leads to the creation of alternative lines of reasoning. (1)

o Defining critical thinking as a process signifies by implication the presence of different elements, stages or steps that constitute and shapes its core. (1)

(1) Educational Technology and Mobile Learning. http://www.educatorstechnology.com/2014/04/the-8-elements-of-critical-thinking.html

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Slide 42 Critical Thinking

Knowledge

Comprehension

Application

Analysis

Synthesis

Evaluation

Identify information

Research and organize facts and ideas

Use and implement facts and principles

Separate whole ideas into smaller counterparts

Combine ideas to form a new whole

Develop judgement and conclude a decision

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Slide 43

QUALITY ASSURANCE

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Slide 44 Quality Assurance (QA)

Definition:

“a program for the systematic monitoring and evaluation of the various aspects of a project, service, or facility to ensure that standards of quality are being met”

Definition applied to RDH:

The CDHO in compliance with the Regulated Health Professions Act is required to have a system in place to evaluate RDH’s and their practice for knowledge and implementation of standards of care to monitor the quality and safety for the public of Ontario.

Linked to Best Practice, EBDM and Critical Thinking:

Practice Profile evaluates if RDH is following best practice.

Learning Profile evaluates if critical thinking is applied to practice.

http://www.merriam-webster.com/dictionary/quality%20assurance

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Slide 45 CDHO QA Resources

7 CDHO Resources

http://www.cdho.org/my-cdho/quality-assurance-program

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Slide 46 QA & Self Reflection

As a dental professional what tools and how many opportunities does the RDH have to self reflect?

• CDHO Self Assessment

• CDHO On-Site Practice Audit Form http://www.cdho.org/docs/default-source/pdfs/quality-assurance/qaprogram_guidelines.pdf?sfvrsn=2

• CDHO Practice Profile

• CDHO Learning Outcomes

• As a leader what tools does the RDH have to self-reflect?• Mind Tools SWOT Analysis https://www.mindtools.com/pages/article/newTMC_05.htm

• Mind Tools Leadership Skill Analysis https://www.mindtools.com/pages/article/newLDR_50.htm

• Tom Rath’s ‘Strengths Finder’ and ‘Strengths Based Leadership’ http://www.tomrath.org/

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Slide 47 Self Reflect as a Leader

W

TO

S

Weaknesses

Threats

Strengths

Opportunities

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Slide 48 Self Reflect: CDHO Self Assessment

• CDHO’s main self assessment tool for RDH’s

• Uses the standards of practice posed in question form with the RDH answering ethically and honestly.

• Will generate goal statements based on the needs from the self-assessment.

• View all the goal statements in the ‘Result’ tab

• Will list the goal statements in the learning profile

• CDHO does not view the answers, it is for the RDH only

• CDHO only sees that it was completed for QA participation and registration requirements

• Required (not optional) to be performed and submitted by all RDH every year regardless if being assessed or not.

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Slide 49 Self Reflect: On-Site Practice Review Audit Form

Be your own Practice Assessor!

Conduct your own audit!

• Based on the Standards of Practice

• Divided into two categories:

• Work Environment

• Chart Audit

• Perform this self assessment alone or as a team

• Structure the task as a yearly occurrence

• Performance review tool

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Slide 50 Self Reflect: Practice Profile Questions

The practice profile has two uses:

1. for you as a self reflection / assessment tool

2. for CDHO to evaluate your practice for ‘best practice’ and standards (will be discussed later)

o Practice profile questions serves as a ‘check-up’ to the practice.

o By reviewing each question early, should there be concerns / deficiencies or uncertainties the RDH has time to research, set goals and make appropriate changes to meet the standards.

o It’s not a surprise what CDHO expects in a practice setting, the questions are right there for ALL RDH to read.

o This is a task where procrastination is not a good choice, do not wait to the last minute, tackle the questions and understand the best practice rationale and CDHO Standards of Practice behind each question.

o Accomplish the learning goals and return to answer the practice profile questions

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Slide 51 Past to Present Forms and Profiles

Past ‘Forms’ Current ‘Profiles’

1,2,3 Employment Status and Practice Address

4 Practice Profile 43 Questions with 203 responses

5 Non Existent

6,7,8 Learning Profile

9 Non Existent

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Slide 52 Current Audit Statistics

How Did We Do?

CDHO Milestones2016 Issue 2 Page 15

http://www.cdho.org/docs/default-source/pdfs/milestones/milestones_201602.pdf

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Slide 53 Common QA Deficiencies

What Went Wrong?

CDHO’s Most Common Deficiencies for 2016 Audit Submission Year

o Missing, expired or unacceptable forms of CPR certification

o Insufficient time spent on Continuing Quality Improvement (CQI) activities

o Not providing enough information in the report on learning

o Submitting goals or activities listed as unacceptable in the Continuing Competency Guidelines

o Unacceptable evidence of the NDHCB QA test successful completion

o Missing information

CDHO Milestones 2016 Issue 2 Page 16

http://www.cdho.org/docs/default-source/pdfs/milestones/milestones_201602.pdf

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Slide 54 PRACTICE PROFILE

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Slide 55 Practice Profiles Choosing a Practice Setting:

The practice setting(s) selected in the personal data and employment tab will generate a practice profile with questions that match the practice type

• There are various profile types: general, educator, ortho or non-traditional.

• The educator and non-traditional profile is not the same as the general or ortho.

• The general and ortho do follow closely in the sequence with some variances.

• Public health utilizes the general practice

• Independent DH Clinic use general practice

• The non-traditional would be for the RDH practicing as a researcher, sales representative, etc.

The practice type and specifics to the practice determine how the questions will be answered as well if any modification are required to note within the opportunities given by CDHO in correspondence boxes

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Slide 56 Practice Profile Questions

• Answered based on the year of submission and only for the last year in the three year audit review.

• For example if submitting in 2017, the practice profile is answered for 2016 when submitting 2014-15-16. Years 2014-15 do not need a practice profile submitted.

• There are 205 questions numbered 1-43• There are limits to the characters of what can be entered, hinting that

CDHO does not require paragraphs of data but only what is being asked in the data entry questions

• Point form and abbreviations can be used• The questions need to be answered ethically and honestly• The RDH cannot answer the questions based on what the ‘best practice’

answer should be but rather what does happen in the practice

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Slide 57 Practice Profile Questions

Guide to Data Entry Questions

o16 Questions that require some data entry

o Indicate by a check mark to ensure you have entered the data

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Slide 58 Practice Profile

Possible Approach to Practice Profile

Understand CDHO

Standards of Practice

Understand Concepts of Best Practice

& EBDM

Review all Questions as

a Self Assessment

Tool

Gain Clarity on Questions

Decide if there are

Deficiencies

Correct Deficiencies

via Goal Setting

Implement Change Ethically

Re-Answer all Questions Honestly

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Slide 59 Practice Profile

Grasping the Practice Profile Questions

• As reviewed earlier, what are the practice questions based on?

• Standards of Practice• Process of Care ADPIE• Infection Prevention and Control• Record Keeping• Privacy• Workplace Health and Safety• Radiography• Professional Responsibility• Etc.

• What do you the RDH need to know for the above topics? The latest Best Practice approaches based evidence (EBDM).

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Slide 60 Wording of Practice Profile Questions

“By You Or Another Team Member”

• The RDH is asked ‘you’ or ‘another team member’? This differs from past portfolio data entry where the RDH was reporting on only what the RDH him/herself did in the practice.

• Read the questions with all the details asked to ensure it is answered based on the entire practice even if the task is not performed by yourself the RDH.

• There are 4 questions in the profile that are based on ‘you or another team member’; #1,7,9 & 17.

• Example: A RDH may or may not fabricate mouth guards but the dental assistant does, therefore if asked if mouth guards are part of your services, the answer is yes based on the question being asked “you or another team member”.

• Some RDH are not reading the question fully and answering ‘not applicable’ on many as they directly do not perform the task/service … however, question states you or another team member

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Slide 61 Wording of Practice Profile Questions

“When Applicable”

• Note that in question #12 above, the RDH is asked ‘when applicable’? Read the selections of what is being asked if it is applicable or not. A good rule of thumb is to swap out the word ‘following procedures’ for the actual list of specific procedures to ensure you are answering the question properly. As well think of applicable as ‘when needed’.

Example: How often are the following procedures used for your clients when applicable?

How often is local anesthetic used for your clients when needed?

The next decision is the choice of: 1.Routinely/always 2.Usually 3.Occasionally 4.Very rarely/never

• The question is actually asking when a client needs local anesthetic for pain management do they receive local anesthetic? We should hope so! So the answer is yes, which translates to routinely /always.

• There are 3 questions in the profile using this approach of ‘when applicable’: #12,14 & 15.

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Slide 62 Examining Practice Profile Questions

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Is this a conflict?

What’s missing?

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How would the following practice types answer these series of questions?

• General

• Independent

• Public Health

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• What happens if you do not have certain technology in the practice?

• Is it a red flag?

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Slide 66 Examining Practice Profile Quesitons

• Overall, how frequently do you achieve the treatment goals specified in a client’s care plan?

• Interpretations?

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o All three questions are based on equipment maintenance and health and safetyo If RDH is not performing the actual task but someone else is, the RDH is still responsible

to know the details o #26 is sometimes a quality assurance issue in dental practices in older buildings

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Slide 68 Examining Practice Profile Quesitons

Does your office have a ‘Washer’ verses an ultrasonic cleaner?

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What knowledge do you need to answer #29?

There are three means to sterilization monitoring:1. Chemical (every load)2. Biological (CDC=weekly/RCDSO=daily)3. Mechanical (every load)

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The ‘math’ from #37 needs to match what was answered here in #36It’s a common mistake to not relate the two questions

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Should you ‘volunteer’ additional information?What information should you include?

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Should you ‘volunteer’ additional information?What information should you include?

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Slide 74 ON-SITE PRACTICE REVIEW

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Slide 75 Preparing for the Practice Review

In the streams of QA cycle if the RDH choose a Practice Review CDHO is very transparent with offering on the website a ‘Practice Checkup” the Practice Review (On-Site) QA Practice Assessment Tool

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Slide 76 QA EXAMINATION

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Slide 77 Preparing for a Written Examination

o The written exam is administered by the National Dental Hygiene Certification Board

o Instructions are sent via email to the RDH from NDHCB

o In 2015 58 RDH chose the written exam (Milestone 2015 Issue 3)

oA fee of $125.00 plus taxes is paid to NDHCB for the administration of each attempt

oUpon successful completion a copy of the exam is submitted to CDHO via SMILE Portal

oMaximum of 3 attempts

oPost 3 attempts the RDH is referred to QA Committee for decision pending remediation

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Slide 78 QA Examination Resources

Resources to prepare for the written examination stream:

• Darby, M.L., Mosby’s Comprehensive Review of Dental Hygiene, 6th ed. Mosby Book Company. 2006. ISBN 0-323-0371-35 (www.elsevier.ca)

• DeBiase, Christina, B. Dental Hygiene Board Review. Lippincott, Williams and Wilkins. 2001. ISBN 0-683-30669-3- Purchase from Lippincott

• Nelson McKelvey, D. Saunders Review of Dental Hygiene. W.B. Saunders 2000 ISBN 0-7216-7576-X- Purchase from Harcourt

• NDHCB Preparatory Tests: http://www.ndhcb.ca/#!prep-test/c12u2

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Slide 79 LEARNING PORTFOLIO

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Slide 80 Learning Portfolio

Set Learning Goals

Find Resources for Learning

Gain New Knowledge

Implement New Knowledge

Conclude Outcomes of

Implementation

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Slide 81 Learning Portfolio = Critical Thinking

Knowledge

Comprehension

Application

Analysis

Synthesis

Evaluation

Identify information

Research and organize facts and ideas

Use and implement facts and principles

Separate whole ideas into smaller counterparts

Combine ideas to form a new whole

Develop judgement and conclude a decision

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Slide 82 Responsibility In Learning

• Regardless of the practice environment and in any profession, the responsibility of a professional and leader is maintaining competency

• In order to ‘lead’ and ‘coach’ effectively and accurately the leader/coach need to be knowledgeable in their specific area of expertise

• Responsibility lies on the leader to gain new knowledge

• Accountability is also required to ensure new knowledge is not only being learned but as well applied

• It is not acceptable to gain new knowledge and ‘park it’, it must be implemented!

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Slide 83 Setting Learning Goals

• Gaining new knowledge is initiated by setting professional goals

• Goals all have somewhat of a performance attached but cannot be performance based, all goals must be learning goals

• CDHO offers written goal statements generated from the Self-Assessment

• See CDHO QA Program Guidelines page 4 (http://www.cdho.org/docs/default-source/pdfs/quality-assurance/qaprogram_guidelines.pdf?sfvrsn=2)

• RDH can derive own goal statements for goals that are not generated from self assessment

• Goals generated from practice profile, on-site audit and milestone article review need to be stated in proper goal stating format

• Set a goal and start it, do not procrastinate

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Slide 84 Quality & Quantity of Learning Goals

o If a goal is too large it must be broken down into smaller components or be made very specific to

give it the direction it needs to have a successful end result.

o Quote from CDHO “ A large goal that would span more than one year to complete should be divided

into yearly achievable milestones.” (QA Program Guidelines Con’t Competency

http://www.cdho.org/docs/default-source/pdfs/quality-

assurance/qaprogram_guidelines.pdf?sfvrsn=2)

o Goals on broader topics can be broken down to their sub counterparts. The same topic can be

repeated in the several or all years as long as the same resources are not used, there is a different

approach to the goal and that the learning has achieved something new and different for each goal.

o There is no set # of goals as long as the tally is 75 hours with 60 goal related and 15 non- goal (5

hours per year max for non-goal related)

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Slide 85 Learning Profile Goal Statement

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Slide 86 Learning Profile Activities

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Slide 87 Gaining New Knowledge

• New knowledge will be gained via Continuing Quality Improvement Activities (CQIA)

• CDHO lists CQIA’s that are acceptable for both non- goal and goal related learning in the QA Program Guidelines page 5 & 6 (http://www.cdho.org/docs/default-source/pdfs/quality-assurance/qaprogram_guidelines.pdf?sfvrsn=2)

• All CQIA’s must be evidence based and from reliable resources suited to the profession

• Resources from other countries can be used if suited for the research (example journal articles from the American Dental Hygiene Association (ADHA))

• Not all knowledge gained will be ‘new’ some knowledge is also ‘review’

• Reporting of CQIA’s must be in bibliography format with sufficient detail to allow assessor to locate the data (page 6 of QA Program Guidelines)

• Minimal time allowed is 15 mins with time being counted in decimal system

• Create as many activity ‘panels’ as needed for the CQIA you completed using the add new activity bar

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Slide 88 Reporting New Knowledge Gained

o In #3 the amount of data entered needs to ‘match’ how many CQIA are listed

o Example: a goal with 8 CQIA’s cannot only have 3 or 4 points of data

o It is a summary of all the learning o The RDH does not need to write

everything from the CQIA but rather the highlights and important points to YOUR learning

o Point form reportingo If copying must quote source

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Slide 89 Implementation of new Knowledge

• Goals have been set, researched and the knowledge is reported, what now?

• Implementation of the knowledge is required as with responsibility and accountability knowledge cannot just be parked

• The challenge of implementation is how to bridging the gap between theory and practical application

• The learning is never the difficulty, however, the implementation of new knowledge is typically where struggles can occur in ensuring the team shares the same view- points, especially in a traditional setting where the RDH is not the owner.

• Appreciate that the RDH has a dual educator’s role in not just educating clients but as well team members.

• Understand how a RDH functions as a leader and oral health coach within the DH scope of practice and standards of practice to constantly strive for a high quality of care.

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Slide 90 Reporting Outcomes to Goals

• Reporting an outcome is often where RDH’s struggle, why?

• As a RDH within our leadership characteristics we often migrate towards thinking an outcome has to be grand

• Often times it’s the smaller components of the outcome of the goal tied into other goals that make up the ‘grand finale’

• Do not dismiss small outcomes as being too trivial or ridiculous as they all count in the big picture

• Realize that the outcome of a goal can be composed of a series of smaller changes not necessarily always one large impact to the practice.

• Does the outcome ‘Match’ the goal statement? Go back and restate your goal statement in a question and determine is what you entered in #4 answers the question

• Use critical thinking skills to focus on the outcome of the knowledge

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Slide 91 Re-Evaluating Learning Outcomes

• A goal outcome should not only be attached to its purpose of being stated in the SMILE Portal

• Outcomes to goals need review and re-evaluation to ensure the original research and evidence is still supportive of the goal

• As theories and products change the RDH needs to revisited all aspects of knowledge past and current implemented in practice to ensure it still holds its evidence base validity

• And then the entire ‘cycle’ of goal stating to learning to implementation commences again

• Re-Evaluation is part of continuing competency

• Re-Evaluation is part of the responsibility and accountability in leadership

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Slide 92 Submitting the Portfolio

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Slide 93 Saving and Sending in SMILE Portal

Just as with any computer data entry ‘save’ as you go along

A message stating saved successfully appears post saving

CDHO has an automatic built in saving however it is still cautious to save

Do not enter large volumes of data continuously without saving

There are two save buttons in the practice profile pages located at both the top and bottom of the pages

In the year of submission the screen set up will allocate a button that states you are completed

When submitting the practice profile ensure all questions are reviewed before selecting ‘I’m all done’ button. Once selected the profile cannot be altered.

The same will unfold with the learning portfolio with no return once ‘I’m all done’ is selected

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Slide 94 Submitting to CDHO

Official dashboard view for submitting portfolio to CDHO

Common navigation submission errors:

o Believing choosing ‘I’m all Done’ button in practice profile was submitting the practice profile to CDHO

o Believing choosing ‘Submit Goals’ in learning portfolio was final step to submission

o Not scrolling down past the Goal Related Learning to reach the Non-Goal Related Learning section to submit

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Slide 95 Challenges

1. ’Determine your leadership style and start viewing yourself as a leader and coach to bring a higher level of motivation to both your clients and your team’

2. ‘Once a month pick one concept of DH practice to share with one of your team members or peers to assist them with their learning. ’

3. ‘Write a mission and vision statement and post it where you can see it, keep it handy and read it when you need to re-balance your focus!’

4. ‘Use the Current Audit Common Deficiencies from Milestones 2016 Issue 2 Pg. 16 as a check list for your own portfolio. Are you making the same errors?’

5. ‘Amongst all the goals you set, make at least one professional goal per year that creates a positive challenge’

6. ‘Consider a broader approach and reflect how YOU can use all the information today not just to improve yourself as a RDH but the profession itself. Together we can strengthen our profession!’

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Slide 96 Resources & Support

[email protected]@maxill.com

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Slide 97 Resources

• Dental Hygiene Theory and Practice. Darby, Leonardi Michele BSDH, MS; Walsh, M. Margaret RDH MS EdD Elsevier Saunders, St. Louis Missouri, 4th Edition, 2015.

• Dental Hygiene Theory and Practice. Darby, Leonardi Michele BSDH, MS; Walsh, M. Margaret RDH MS EdD Elsevier Saunders, St. Louis Missouri, 3rd Edition, 2010.

• College of Dental Hygienist of Ontario (CDHO). 2012 Standards of Practice. http://www.cdho.org/docs/default-source/pdfs/standards-of-practice/standardsofpractice2012.pdf

• CDHO Registrants Handbook. http://www.cdho.org/docs/default-source/pdfs/reference/registrantshandbook.pdf

• CDHO Code of Ethics. http://www.cdho.org/docs/default-source/pdfs/reference/code-of-ethics/codeofethics.pdf

• CDHO SMILE Portal. www.cdho.org.

• Requirements of the Quality Assurance Program and Guidelines for Continuing Competency http://www.cdho.org/docs/default-source/pdfs/quality-assurance/qaprogram_guidelines.pdf?sfvrsn=2

• CDHO SMILE Portal Guide

• CDHO Self Assessment Guide

• CDHO Peer Mentorship Program. http://www.cdho.org/docs/default-source/pdfs/reference/mentorshippackage.pdf

• CDHO Milestones: 2015 Issue 3. 2016 Issue 1 & 2. www.cdho.org

• Tomorrow's Top Healthcare Leaders: 5 Qualities of the Healthcare Leader of the Future. Beckers Hospital Review September 25 2012. J. Stephen Lindsey, FACHE, Principal at Ivy Ventures, LLC, and John W. Mitchell, M.S., Hospital Advisor at Ivy Ventures, LLC. http://www.beckershospitalreview.com/hospital-management-administration/tomorrows-top-healthcare-leaders-5-qualities-of-the-healthcare-leader-of-the-future.html

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Slide 98 Resources

• Critical Thinking. RDH Mag. http://www.rdhmag.com/articles/print/volume-26/issue-6/feature/critical-thinnking.html

• Critical Thinking Definition. The Critical Thinking Community. http://www.criticalthinking.org/pages/our-concept-of-critical-thinking/411

• Team Dynamics. http://www.teamtechnology.co.uk/team/dynamics/definition/

o 8 Dimensions of Leadership Overview. Kristeen Bullwinkle & The Talent Gear Team. November 03, 2015. https://www.talentgear.com/learn/november-2015/8-dimensions-of-leadership-overview/

o Talent Gear Leadership Types. Slide Share Power Point. http://www.slideshare.net/TalentGear/lessons-from-each-of-the-8-dimensions-of-leadership

o Disc Profile. Disc Personality Types Slide Share Power Point. http://www.slideshare.net/onlinedisc/disc-personality-styes

o 8 Dimension of Leadership Assessment. https://www.talentgear.com/shop/8-dimensions-of-leadership-map/

o Team Technology Leadership Assessment. http://www.teamtechnology.co.uk/leadership/styles/

o Employment Standards of Ontario. https://www.labour.gov.on.ca/english/es/

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Slide 99 Resources

• Critical Thinking. Educational Technology and Mobile Learning. http://www.educatorstechnology.com/2014/04/the-8-elements-of-critical-thinking.html

• The Critical Thinking Community. https://www.criticalthinking.org/pages/defining-critical-thinking/766

• Accountability in the dental office: the secret to an efficient, effective team. Dentristry IQ. Janice Keller. http://www.dentistryiq.com/articles/2011/09/accountability-in.html

• “The Problem of Many Hands” in Restoring Responsibility: Ethics in Government, Business and Healthcare. Thompson, Dennis (2005). Cambridge University Press. pp. 33-49. ISBN 978-0521547222. Google Quick View: http://www.worldcat.org/title/restoring-responsibility-ethics-in-government-business-and-healthcare/oclc/54007138/viewport

• Dr. Ron The Dental Coach. Ron Arndt DDS MBA MAGD Master Certified Dental Coach. http://drarndt.com/accountability-definition/

• Images: Yahoo Images. Microsoft Word Online Pictures.

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