WHENEVER you visit the dentist, do you know if you are getting value for money? Or better yet, how do you know that you are receiving the required treatment? 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 perception that a country is developing is the presence of a viable system of quality assurance for public services rendered.

During the last year, the State’s dental clinics provided the Guyanese population with close to 250,000 procedures. There has, in fact, never been an institutionalised strategy to analyse and account for the quality of service the public receives. Although the parameters of quality assurance are still evolving, the time is right for the first step in this direction, even if it is merely very serious consideration.

The economy, social values, and sense of distributive justice shape the philosophy underlying quality assurance. 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, this philosophy was an ethical principle—that healthcare, 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.”

Recently, however, the philosophy has 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 patient care. The responsibility for quality of care involves all aspects of the delivery system or organisation. Thus, the focus is on improving the system’s overall performance rather than identifying deficiencies in individual practitioners.

Another hallmark of the quality 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 those interventions.

Quality assessment consists of methods and tools used for measuring the quality of care. The specific tools used in assessing 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 assumes that patient care is achieved only through the interactions, collaboration, and interdependent functions of many people and departments. This means that if, say, the administration fails to provide an item for healthcare delivery, the practitioner shares the blame for the service deficiency—as they are 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 administrators, who are obligated to be very innovative for quality improvement to be a reality.