DO we in Guyana have an institution, laws or the means to evaluate the quality of dental treatment provided to the public? One factor that enhances the perspective that a country is developing is when there exists a viable system of quality assurance of public services rendered. Last year, the state’s dental clinics provided the Guyanese population with close to 200,000 procedures. There is not, in fact never has been, an institutionalised strategy to analyse and account for the quality of service the public receives. Although quality assurance parameters are still evolving, the time is right for the first step in this direction, even if it is merely very serious consideration.

The philosophy underlying quality assurances is shaped by the economy, social values and sense of distributive justice. All of these, over time, define the purpose of quality assurance. For many years, the philosophy was simply that healthcare professionals have a responsibility to provide care, in the patient’s best interests, and within the scope of scientific and clinical possibility. At its core, the philosophy was an ethical principle that health care, and the quality of it, was a somewhat private matter between the practitioner and the patient.

With time the practitioner’s responsibility extended to society as a whole rather than solely to individual patients. Given Guyana’s contemporary political history of close interaction between the State and the people, there is a real justification for and a duty to account more explicitly for services delivered. At first, such public accountability was often more punitive and commonly referred to as an effort to find the ‘bad apples in the barrel’.

The philosophy has recently shifted from quality assurance to quality improvement. This is a more educational, consultative and problem-solving approach. The philosophy of quality improvement emphasises the goal of improving care for the patient. The responsibility for the quality of care involves all aspects of delivery system or organisation. Thus, the focus is on improving the system’s overall performance rather than looking for deficiencies in individual practitioners.

Another hallmark of the quality of improvement philosophy is the persistent attention to identifying areas that need improvement, analysing data to discern the factors contributing to problems, planning interventions, and checking the results of the interventions.

Quality assessment consists of methods and tools used to measure care quality. The specific tools used in assessing the quality of care include performance indicators, review criteria and ratings, benchmarks, standards, clinical guidelines and practice parameters.

Issues regarding the quality of care are viewed within the context of the entire system. This is based on the assumption that patient care is achieved only through the interactions, collaboration and interdependent functions of many people and departments. This means that if the administration fails to provide an item for health care delivery, the practitioner shares the blame for the deficiency in the service as he/she forms part of the team, and vice versa.

One problem we face is that a major part of the philosophy originates in the United States, where there is no such person as a government dentist. In addition, financial constraints exert extra pressure on the administrators who are obligated to be very innovative in order for quality improvement to be a reality.