managing dispersed outreach: is it worth it? michael smith
TRANSCRIPT
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Managing Dispersed Outreach: Is it worth it?
Michael Smith
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Spectrum of Outreach
Clinical activity
outsourced (piggybacked)
Hospital Annexe with
the same procedures
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High Green
Fairlawns
Taptonville House
Rotherham
The Mount, Hemsworth 25km
Chesterfield
Dearne Valley DAC
Southey Green, Firth
Park & Wheata Place
Genesis Lynton House
Salaried ServicesDental Practices
Sheffield
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Content
• Brief Description
• Development
• Operation
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Sheffield’s Outreach Aims
• Professional Responsibility
• Public Health Dentistry
• Practice Environment
• Clinical Skills
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The Outreach Year
Year 2 H&T
Introduction to Primary Care
TeamTraining
Outreach Project
Audit Project
Teamwork Project
Work 4+ days a week for 20+ weeks
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Content
• Brief Description
• Development
• Operation
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Development
2005 Decision to adopt outreach
2006 Funding HEFCE £0.8M, SHA £1,5MIncreased undergraduate intake3 years to develop a 6 month prog.
2009 38 chairs across 12 locations 64 supervisors + dental nurses
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Selection of Practices
~250 dental practices notified▼
~24 expressions of interest▼
15 costed outline bids▼
6 bids selected▼
6 delivered
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Management Structure
Executive Committee
Teaching Committee
Outreach Programme Steering Group
Outreach Working Party
Dental Service Managers Group
Independent Outreach Locations
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Quality Management
• Shared understanding
• Contract
• Monitoring of outcomes• Activity
• Perception
• Training days
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Enhancements
• Outreach Project link two case studies to local health data
• Audit Project design, conduct and report an audit
• Teamwork Project help develop dental therapy students, assess progress
• Visits other healthcare services, sedation, GPs, domiciliary
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Content
• Brief Description
• Development
• Operation
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Preparation
• Handbook• Lecture Programme
Introduction / Epidemiology Methods / Project work / Quality of Dental Care / Structure of NHS Dentistry / Health Promotion + Managing expectations
• Allocations• Meet Hosts
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Boundary Crossing…
• Students initially nervous
• Soon settle
• Needlestick injuries
Cope et al. J Adv Nursing 2000; 31:850-856Wilcox et al. J Hosp Dent Pract 1977; 11:13-17
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2008 after 2 blocks
n=62
Prediction from Three Block Model
Restorations- simple plastic
118(10)
188(24 in children)
Dentures 6 14
Endodontics 7 15
Extractions - simple
44(4)
66(4 in children)
Fissure sealants
18 20
Pt appointments
280 410
Sheffield Outreach
Recently published *
requirements
Restorations- simple plastic
195(29 in children)
~70
Dentures 14 ~2 to ~8
Endodontics 13 ~ 6 or ~8
Extractions - simple
67(7 in children)
Fissure sealants
26
Pt appointments
461
Clinical Activity * Lynch & Allen 2007 Br Dent J, Youngson et al. 2007 Br Dent J
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Communication
• Formal channels
• Informal
• Time consuming…
… but vital
Holloway & Dixon, BDJ 1977; 143: 146-150.
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Integration
• Some staff both Outreach and hospital
• Academics present at development days
• Students carry (mis)information
• Visits by the Dean and L&T Advocate
• Annual Review visits
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Managing students
• Want the practical skills and ‘real’ world
• Increase competence
• ‘Stand out’ among applicants
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Managing - hosts
• Altruistic innovators seeking a challenge
• Initially uncertain - reassurance
• Wide variation between students
• Encouraging assessments objective
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Managing Recurrent Costs• For: supervision, close
dental nursing support, additional materials / wear, time for induction, feedback, coaching, local admin and staff training
• £1m pa – paid monthly • BDS travel allowances• H&T Bursary awards• Training events• Office salaries
Placements Travel allowances
Administration Meetings
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Summary
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Is it worth it?
Small and dispersed• Variation / scattered• Admin complex• Service ethos• ‘Real’ and broad• Boundaries to be
crossed – Integration more complex
• Feel ready for VT and practice
Single large• Standardised• Admin eased• School’s ethos• School-like• Smother transitions
within course – Easier integration
• Less familiar with typical practice
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Wider benefits• Partnerships developed• Partners’ reputations’ enhanced inc. outreach
staff CVs • Outreach staff want ‘teacher’ training• Students better informed re employment
(but then make comparisons) • University logo seen in new communities• Learning kept up-to-date – feedback on currency
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Unintended outcomes
• Partners flexible and innovative
• School increasingly reliant on outreach
• Some School staff resistant
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Dispersed Outreach:
Is it worth it? No!Yes!
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