Creating a Job

Dental hygiene must respond to changesin how care isdelivered, including areas outside ofprivate practice. The catch? You have to come up with the blueprint.

by Christine Nathe, RDH, MS

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Although dental hygiene initially began as a profession focused on public health initiatives, the profession has been positioned in the private dental office. In fact, the first dental hygienists worked in a variety of settings such as elementary schools, industry, the military, and hospitals. Dr. Alfred C. Fones, the founder of dental hygiene, actually emphasized the use of dental hygienists as outreach workers who brought patients in need of restorative dental care to private dental offices.

Health care delivery is changing, and health care professionals, including dental hygienists, must adapt to these changes. The authors of Dental Hygiene Theory and Practice (1995) said that the future of health care will place emphasis on cost containment, access, quality, and accountability, and there will be an increased focus upon professional autonomy among health care providers (other than the physician). Although most states experience difficulties in containing costs while delivering quality care to all members of the population, access to preventive health care should undoubtedly improve costs by decreasing the prevalence of dental diseases.

Today, the majority of dental hygienists work in private practices, providing care to approximately 50 percent of the population. It is readily apparent that not all in society are able to visit a dentist's office for a variety of reasons. Some of these reasons involve disabilities, chronic illnesses, lack of funds, or rural locations. The populations frequently in need of dental hygiene services include:

Homebound
Institutionalized
Potential patients who have disabilities
Residents in rural areas
Potential patients who have dental phobia
Inmates
Patients without financing
Patients who face language or cultural barriers

Because society demands a more appropriate delivery system for dental hygiene services, hygienists may initiate programs in settings other than the private office in most states. Legislative initiatives to change the supervisory requirements may be a necessity in states that require dentists to directly supervise dental hygienists.

The paradigm for planning a dental hygiene program utilizes process of care theory while incorporating various concepts from public health program models. Basically, it illustrates how a dental hygienist can effectively initiate and operate a program within a setting outside of the private dental office (see the related chart). Dental hygienists can follow these steps when planning and operating a dental hygiene program within an alternative setting. Examples of interdisciplinary settings include:

Early Head Start/Head Start programs
Public/private schools
Primary care clinics
Nursing home/long-term care facilities
Hospitals
Hospice programs
Senior centers/adult day care programs
Community centers
Home health care programs
Prisons
Private industry

Assessment — This first phase consists of a thorough assessment of the population's demographics, dental needs, current dental hygiene and dental services, facilities, personnel, existing resources, and funding sources. Many times, this assessment is referred to as a "needs assessment" of the target population. A target population is a group of individuals with similarities. The similarities may be age, race, educational background, social or economic status, life situation, medical conditions, or other characteristics.

During this phase, it is important to focus on the administrative body with which the hygiene program would be collaborating. As always, it is important to gain support from this group or individual, and it may require discussing the possible outcomes from the assessment.

It is important to fully understand the populations and administrative bodies' value toward dental hygiene care. Both groups should be educated on the inherent need for dental hygiene care. In order to have full support, it is necessary that these groups value dental hygiene care. This underscores the need for effective dental health education for all parties involved.

Dental hygiene diagnosis — After prioritizing the needs found during the assessment phase, a dental hygiene diagnosis for the target population can be formulated. Many times, a target population may need two or three diagnoses. For example, the possible diagnoses of a nursing home population may include the population's high rate of plaque accumulation, periodontal infections, and lost dentures. After completing the diagnosis of the target population, it is necessary to develop goals and objectives for the program.

If we continue with the example of the nursing home population, goals may include:

Decreasing the plaque accumulation among nursing home residents
Decreasing the periodontal infections among nursing home residents.
Decreasing the amount of lost dentures among nursing home residents.

The objectives would be further defined by specifically addressing expected outcomes. An example of outcomes developed for the latter goal may be as follows:

"Following implementation of the dental hygiene program within the facility, residents will have dentures identified by labeling provided by the dental hygienists; referrals to a dentist for all residents with permanently missing dentures; and consents signed by all residents or the resident's legal power of attorneys for all patients not wishing to have lost dentures replaced."

Goals and objectives should be measurable through outcome assessments such dental indexes and surveys.

Planning — Developing an operational blueprint is an effective tool in the initial development of any dental hygiene program. This operational blueprint should be based upon your goals and objectives. For example, if you are writing an objective to label all dentures, plan an activity that will correspond to this objective, such as the hygienist identifying all dentures prescribed to residents. Plan for all possible issues including dental hygiene, dental and medical needs, cultural needs, facility, equipment, supply and funding needs, personnel needs, and management and marketing activities.

Remember, it will be the program's responsibility to maintain patient records, scheduling, billing, and collecting. Scheduling may take on another dimension when a multitude of health care providers is working together. Although it is impossible to address all issues that may develop during the program, it is important to look for possible constraints and formulate possible alternatives.

Implementation — Before actually implementing the dental hygiene program it will be necessary to propose your "planned program" to the administrative body in charge. A written proposal should include a brief introduction, significance of the program to the population and/or organization, the facts about the dental hygiene program, and a conclusion. This should be condensed to one to three pages. This proposal should confirm the value of preventive dental care to the reader.

Many times, the hygienist will have the opportunity to present the proposal to the body. Utilize professional presentation strategies, including handouts of the proposal in a condensed format and slides or transparencies. The importance of a professional presentation of the proposal cannot be emphasized enough. Show value to your program by being prepared, organized, and professional.

The dental hygiene program will begin operation during this stage, and revisions can be addressed and changes employed. The hygienists should specifically reflect on the set goals and objectives during this phase. Solicit feedback from individuals within the population, as well as administrators and other health care workers to aid in effective implementation.

Evaluation — The evaluation stage should be developed during the planning stage by developing goal measurements. Qualitative and quantitative evaluation should be employed, initiating ongoing revisions. Qualitative evaluation can be obtained from surveys, interviews, and ongoing feedback with all interested parties. Quantitative evaluation can be obtained via dental indexes and dental records.

It is vital to provide documented written and oral reports to administrators, the target population, and all other interested parties. These reports emphasize the importance of the dental hygiene program and help in promoting the value of preventive dental care.

In the private dental office setting, the hygienist frequently has little control over the delivery of dental hygiene care. Because society is demanding a more appropriate delivery system for dental hygiene services, times are changing. Dental hygienists have the abilities and skills to provide the optimum level of care. The best provider of dental hygiene care is the provider who is educated in dental hygiene sciences. By utilizing the paradigm for planning a dental hygiene program, the hygienist can effectively plan and operate a program within an alternative health care setting. With the preventive background hygienists possess, and the health care needs presenting themselves in the 21st century, it is the appropriate time to make a change in the delivery of dental hygiene care.

Christine Nathe, RDH, MS is an associate professor in the division of dental hygiene at the University of New Mexico in Albuquerque. She is the author of Dental Public Health: Contemporary Practice for the Dental Hygienist, which was published by Prentice Hall this year. For more information about the book, visit www.prenhall.com/DENTAL or www.amazon.com. Nathe can be contacted by e-mail at [email protected]

References available upon request.

Paradigm for planning a dental hygiene program

Assessment
Assessment via surveys, existing data, or dental screenings: