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Holloway JA, Chestnutt IG. It's not just about the money: recruitment and retention of clinical staff in general dental practice - part 1: dentists. Prim Dent J 2024; 13:38-54. [PMID: 38520198 DOI: 10.1177/20501684241232212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Increasing difficulties in recruitment and retention of dentists and dental care professionals in general dental practice in the UK is affecting delivery of NHS dental services. Reports of dissatisfaction among the general dental practice workforce indicate there is a significant risk to the future dental workforce supply which will affect access to dental care and worsen oral health inequalities. Understanding the factors related to job satisfaction and dissatisfaction of dental professionals would be useful in managing recruitment and retention issues and ensure a dental workforce exists which is able to meet the needs of the population. The aim of this literature review was to identify factors which contribute to job satisfaction and dissatisfaction of clinical staff in general dental practice. Database searching was conducted systematically through PubMed/Medline, Scopus, Ovid, and the National Grey Literature Collection. Part 1 of this two-part series discusses the factors relating to dentists. Twenty-two relevant articles were identified, which were qualitatively analysed using Herzberg's motivation-hygiene theory as an analysis tool. Target-driven and restrictive contractual arrangements are a major factor contributing to dissatisfaction of dentists, as well as time pressures, poor quality equipment, and unfair remuneration. Dental contract reform should aim to minimise factors contributing to dissatisfaction and increase factors which increase satisfaction, if sufficient numbers of dentists are to be persuaded to continue to provide state-funded dentistry.
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Affiliation(s)
- Jessica A Holloway
- Jessica A. Holloway MChD/BChD, MPH, PhD, FHEA Specialty Registrar in Dental Public Health, Public Health Wales, Cardiff, UK
- Ivor G. Chestnutt BDS, MPH, PhD, FDS(DPH)RCSEd, FDS RCSEng, FDS RCPSGlas, FFPH, DDPH RCS ENG, FHEA Professor and Honorary Consultant in Dental Public Health, Cardiff University, Cardiff, UK
| | - Ivor G Chestnutt
- Jessica A. Holloway MChD/BChD, MPH, PhD, FHEA Specialty Registrar in Dental Public Health, Public Health Wales, Cardiff, UK
- Ivor G. Chestnutt BDS, MPH, PhD, FDS(DPH)RCSEd, FDS RCSEng, FDS RCPSGlas, FFPH, DDPH RCS ENG, FHEA Professor and Honorary Consultant in Dental Public Health, Cardiff University, Cardiff, UK
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Abstract
Objectives Because of the heterogeneous nature of the evidence regarding dentists’ job satisfaction, an overview was necessary to examine dentists’ level of job satisfaction and to determine related work environmental factors. Materials and methods A literature search was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Electronic database searches of PubMed/MEDLINE, EMBASE, and Web of Science were performed until March 1, 2020. Two independent authors collected data and assessed the methodological quality of primary studies using the Newcastle Ottawa Scale. Results Nine studies were included from the 1987 initially retrieved. Among the included studies, 5 exhibited a neutral level of satisfaction and originated from China, South Korea, Egypt, and the United States, and 3 studies from Canada, Lithuania, and the United States showed a high level of satisfaction. Only 1 study did not report the mean job satisfaction score. According to bias evaluation, 9 studies were considered low risk. Conclusion The findings showed that dentists were satisfied with their jobs at a moderate to high level, and specialists were more satisfied than general dentists. Regarding work environmental factors, the 6 most satisfied factors were patient relationships, respect, delivery of care, staff, professional relationship, and professional environment. Five of the least satisfied factors were personal time, stress, income, practice management, and professional time. However, longitudinal studies would be required to identify changes in these factors. Further studies should be performed in middle- and low-income countries using the Dentist Satisfaction Survey, including stress evaluation.
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Affiliation(s)
- Van Nhat Thang Le
- Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea; Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Minh-Huy Dang
- Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Jae-Gon Kim
- Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yeon-Mi Yang
- Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Dae-Woo Lee
- Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
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Collin V, Toon M, O'Selmo E, Reynolds L, Whitehead P. A survey of stress, burnout and well-being in UK dentists. Br Dent J 2019; 226:40-49. [DOI: 10.1038/sj.bdj.2019.6] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 11/09/2022]
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Chenot R. [Pay for performance in dental care: A systematic narrative review of quality P4P models in dental care]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2017; 127-128:42-55. [PMID: 28838794 DOI: 10.1016/j.zefq.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Pay for performance (P4P) links reimbursement to the achievement of quality objectives. Experiences with P4P instruments and studies on their effects are available for the inpatient sector. A systematic narrative review brings together findings concerning the use and the effects of P4P, especially in dental care. METHODS A systematic literature search in PubMed and the Cochrane Library for reimbursement models using quality indicators provided 77 publications. Inclusion criteria were: year of publication not older than 2007, dental sector, models of quality-oriented remuneration, quality of care, quality indicators. 27 publications met the inclusion criteria and were evaluated with regard to the instruments and effects of P4P. The database search was supplemented by a free search on the Internet as well as a search in indicator databases and portals. The results of the included studies were extracted and summarized narratively. RESULTS 27 studies were included in the review. Performance-oriented remuneration is an instrument of quality competition. In principle, P4P is embedded in an existing remuneration system, i.e., it does not occur in isolation. In the United States, England and Scandinavia, models are currently being tested for quality-oriented remuneration in dental care, based on quality indicators. The studies identified by the literature search are very heterogeneous and do not yield comparable endpoints. Difficulties are seen in the reproducibility of the quality of dental care with regard to certain characteristics which still have to be defined as quality-promoting properties. Risk selection cannot be ruled out, which may have an impact on structural quality (access to care, coordination). CONCLUSION There were no long-term effects of P4P on the quality of care. In the short and medium term, adverse effects on the participants' motivation as well as shifting effects towards the private sector are described. A prerequisite for the functioning of P4P is the definition of clear targets and measuring parameters. Furthermore, evidence-based quality indicators have to be developed that validly depict quality differences. It is yet unknown whether P4P will have long-term effects or whether the quality of dental care will increase.
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Affiliation(s)
- Regine Chenot
- Zentrum Zahnärztliche Qualität (ZZQ), Berlin, Deutschland.
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Berthelsen H, Westerlund H, Hakanen JJ, Kristensen TS. It is not just about occupation, but also about where you work. Community Dent Oral Epidemiol 2017; 45:372-379. [PMID: 28421641 DOI: 10.1111/cdoe.12300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/04/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dentistry is characterized by a meaningful but also stressful psychosocial working environment. Job satisfaction varies among staff working under different organizational forms. The aim of this study was to identify (i) to what extent crucial psychosocial work environment characteristics differ among occupations in general public dental clinics in Sweden, and (ii) how much of the variation within each occupation is attributable to the organizational level. METHODS All staff (N=1782) employed in four public dental organizations received an email with personal log-in to an electronic questionnaire based on the Copenhagen Psychosocial Questionnaire. After two reminders, a response rate of 75% was obtained. Responses from 880 nonmanagerial dentists, dental hygienists and dental nurses working in general practices were included in our analyses. RESULTS First, we compared the three dental occupations. We found that job demands, task resources (eg influence, possibilities for development and role clarity), strain symptoms and attitudes to work differed among occupations, dentists having the least favourable situation. Next, we compared the four organizations for each occupational group, separately. For dentists, a significant and relevant amount of variance (P<.05 and ICC >.05) was explained by the organizational level for 15 of 26 subscales, least pronounced for task resources. By contrast, for dental nurses and hygienists, the corresponding number was 2 subscales of 26. The psychosocial working environment of people working at the organization with the highest levels of strain indicators and the least positive work-related attitudes differed systematically from the organization with the most favourable profile, in particular regarding job demands and leadership aspects. CONCLUSION In conclusion, the psychosocial working environment depended to a large degree on occupation and, for dentists in particular, also on their organizational affiliation. The findings suggest a potential for designing interventions at organizational level for improvements of the psychosocial working environment for dentists.
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Affiliation(s)
- Hanne Berthelsen
- Centre for Work Life and Evaluation Studies & the Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Hugo Westerlund
- The Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Jari J Hakanen
- Finnish Institute of Occupational Health, Helsinki, Finland
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Lo Sasso AT, Starkel RL, Warren MN, Guay AH, Vujicic M. Practice settings and dentists’ job satisfaction. J Am Dent Assoc 2015; 146:600-609. [DOI: 10.1016/j.adaj.2015.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/25/2015] [Accepted: 03/05/2015] [Indexed: 11/30/2022]
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Holmes RD, Steele JG, Donaldson C, Exley C. Learning from contract change in primary care dentistry: A qualitative study of stakeholders in the north of England. Health Policy 2015; 119:1218-25. [PMID: 25765782 PMCID: PMC4561527 DOI: 10.1016/j.healthpol.2015.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 12/01/2022]
Abstract
Commissioners’ ability to reallocate resources between contracts is constrained. Patients are unclear about the costs of dental treatment and the NHS charge bands. Dentists dislike the target-based approach involving units of dental activity. Disease prevention is not adequately rewarded under the current dental contract. The quality of dental care provided by dentists should be measured and rewarded.
The aim of this research was to explore and synthesise learning from stakeholders (NHS dentists, commissioners and patients) approximately five years on from the introduction of a new NHS dental contract in England. The case study involved a purposive sample of stakeholders associated with a former NHS Primary Care Trust (PCT) in the north of England. Semi-structured interviews were conducted with 8 commissioners of NHS dental services and 5 NHS general dental practitioners. Three focus group meetings were held with 14 NHS dental patients. All focus groups and interviews were audio recorded and transcribed verbatim. The data were analysed using a framework approach. Four themes were identified: ‘commissioners’ views of managing local NHS dental services’; ‘the risks of commissioning for patient access’; ‘costs, contract currency and commissioning constraints’; and ‘local decision-making and future priorities’. Commissioners reported that much of their time was spent managing existing contracts rather than commissioning services. Patients were unclear about the NHS dental charge bands and dentists strongly criticised the contract's target-driven approach which was centred upon them generating ‘units of dental activity’. NHS commissioners remained relatively constrained in their abilities to reallocate dental resources amongst contracts. The national focus upon practitioners achieving their units of dental activity appeared to outweigh interest in the quality of dental care provided.
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Affiliation(s)
- Richard D Holmes
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4BW, UK.
| | - Jimmy G Steele
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4BW, UK.
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Level 3-Buchanan House, 58 Port Dundas Road, Glasgow G4 0BA, UK.
| | - Catherine Exley
- Institute of Health & Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
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Tickle M. Revolution in the provision of dental services in the UK. Community Dent Oral Epidemiol 2012; 40 Suppl 2:110-6. [DOI: 10.1111/j.1600-0528.2012.00729.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Martin Tickle
- Dental Public Health and Primary Care, School of Dentistry; The University of Manchester; Manchester; UK
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Mcdonald R, Cheraghi-Sohi S, Sanders C, Tickle M. Changes to financial incentives in English dentistry 2006-2009: a qualitative study. Community Dent Oral Epidemiol 2012; 40:468-73. [DOI: 10.1111/j.1600-0528.2012.00687.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 02/12/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Martin Tickle
- School of Dentistry, University of Manchester; Manchester; UK
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Tickle M, McDonald R, Franklin J, Aggarwal VR, Milsom K, Reeves D. Paying for the wrong kind of performance? Financial incentives and behaviour changes in National Health Service dentistry 1992-2009. Community Dent Oral Epidemiol 2011; 39:465-73. [DOI: 10.1111/j.1600-0528.2011.00622.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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