Since changes were introduced on 1 July 2020 relating to Scope of Practice, Dental Protection has been mindful of the implications for individual practitioners, as well as teams. There are many potential pitfalls that can cause practitioners to come unstuck when providing patient care in a team environment. 

It is important to consider what can we do to make sure our patients don’t experience a “Swiss cheese” moment, where all the holes line up, and they fall through the cracks. With this in mind, we look at the tools available, to helps us seamlessly deliver safe and cohesive patient-centred care. 

Code of Conduct 

As with most situations, there are several factors to consider, depending on an individual practitioner’s circumstances, such as whether they work alone, in a team, or remotely. What does not change, however, are the expectations placed on practitioners, outlined in the Code of Conduct. This includes the expectations for practitioners’ professional conduct in all aspects, such as working as a team. The Code recognises that comprehensive dental care requires an organised and plannedapproach to patient treatment. By respecting each other's roles and expertise, teamwork or collaborative care ultimately enhances the quality of treatment, and we can provide to our patients. 

The Code outlines the following principles which the Dental Board of Australia believe are essential for effective shared care: 

• Communication: Timely and accurate sharing of information. 

• Teamwork: Collaboration across different dental specialties and healthcare fields. 

• Patient-centred care: Involving patients in decision-making processes. 

• Continuity of care: Seamless transitions between different levels of care. 

• Professional respect and trust: Valuing contributions from all team members. 

• Documentation: Comprehensive records to support coordinated care1. 

Oral Health Therapists, Therapists and Hygienists, have historically worked in a team environment. Consequently, it is commonplace for them to intuitively adopt a collaborative approach to care. Being ‘independent’ has not changed this. It is also important to note that the Code of Conduct clearly states that working collaboratively does not alter a practitioner’s personal accountability for their professional conduct or the care they provide. Similarly, it stipulates the importance of delegation, referral and handover where appropriate.

Ultimately, being aware of these six key areas, and proactively working to hold these central, provides a core foundation for practitioners. Similarly, these form the cornerstone to assisting you in times where things have not gone to plan – both in navigating complaints processes and protocol, and in self-reflection and self-awareness, which contributes to learning and growth throughout your career.

Know your scope 

As outlined in the Dental Boards guidance, it is the expectation that all practitioners know their own scope. Considering the evolution of the Division, as well as the breadth and nuance of undergraduate training across Australia within the Division, the Board is live to the potential for confusion when determining Scope. Consequently, when the changes to Scope were introduced in 2020, the Dental Board created additional supporting resources, fact sheets and FAQs, along with a Reflective Practice Tool, to help practitioner’s consider their knowledge, skills, and abilities, and how their overall competence relates to their area of practice. Practitioners are responsible for assessing their own scope, within their Division, based on education, training and competencies. Continuing Professional Development (CPD) also plays a role in this, with the benefits of CPD to maintaining and improving skills and experience, as well as broaden a practitioner’s scope of practice, though only within their Division.

The Board is very clear however, that no amount of CPD will enable a practitioner to move from one Division to another.

The Board’s Reflective Practice Tool can assist you to reflect on your individual knowledge and skills and how these relate to your current practice2. Additionally, if practitioners are managing patients collaboratively, this applies even within practices. If each Practitioner’s scope is different, the use of the Reflective Practice Tool can prove invaluable to a team. This can help ensure that the scope of each individual within the team are crystallised for other members (be that OHTs, Therapists, Hygienists, Dentists or even Dental Assistants) participating in the delivery of patient care.

Communication 

Communication matters. This has been found to be true many times over, in all aspects of everyday life, and holds true in practice too. Practitioners need to communicate with each other, as colleagues and professionals, with patients and with teammates. It is one thing to be communicating effectively with patients and colleagues when treatment is going well, though it can be an entirely different course to navigate in instances where situations are not be progressing as expected. Nevertheless, it is imperative that practitioners consider how to keep the channels of communication open in these difficult times, to prevent unnecessary escalation.

Dental Protection has a raft of valuable resources available on its eLearning platform, to assist you navigate these interactions, such as difficult conversations, saying no, navigating adverse events in practice, or supporting colleagues who may be navigating these situations themselves. Dental Protection would strongly recommend that all practitioners review these resources and consider which to incorporate in their CPD plan.

The Code of Conduct and the Scope of Practice Guidelines set out clear expectations for all dental practitioners and recognises the important role effective communication plays. Providing comprehensive dental care in a shared model of care can be extremely rewarding, however consideration must be given toward the issues that can arise if a clear, concise and coordinated plan is not established from the outset.

Essentially, if practitioners are unable to talk to each other, how can they expect to work cohesively as a team. Additionally, if practitioners are unable to collaborate and communicate with one another effectively, it can sadly end with the patient ultimately paying the price, when the holes line up and they are at risk of falling through the cracks. 

Each individual practitioners’ practice of dentistry often differs based on their life experiences, locations and the teams they work in. In this new era of independent practice, this still holds true, with practitioners’ realities differing greatly. What does not change, however, is our professional obligation and the expectation that we take the time to meaningfully consider and understand: 

• “What is my scope and what is the scope of my colleague and team?”

• “How do we work in this space together, to ensure our patients are central to all we do?” 

• “How do we communicate effectively, so that there is a clear understanding by both the team and patient, on what is going on, what treatment needs to be provided, when, and where, and who is ultimately the driver, and responsible for making sure things stay on course?”

As without the consideration of these questions, and a collaborative team approach, there can be a risk that should treatment steer off course, it is found that there was a multitude of passengers, yet no one was driving the bus. 

References 

1 Ahpra Code shared Code of Conduct. Found at: Australian Health Practitioner Regulation Agency - Shared Code of conduct https://www.ahpra.gov.au/Resources/Code-of-conduct/Shared-Code-of-conduct.aspx 
2 Dental Board of Australia - Reflective practice tool. https://www.dentalboard.gov.au/Codes-Guidelines/Know-your-scope/Reflective-practice-tool.aspx