Dental Services

Project

Documentation of safety netting advice on the Dysplasia Clinic.

Leads: Alexandra Perks, Consultant in Oral Medicine and Facial Pain; Sumaiya Irhouma, Specialty Registrar in Oral Medicine

What was the problem?

The newly established Dysplasia Clinic aims to keep patients under close review. Early detection and reporting of changes to areas of dysplasia can improve outcomes, so patients need clear safety netting (self-monitoring) advice, and this needs to be documented. Baseline practice on documenting this advice was not known.

Aim

To evaluate current documentation of safety netting advice given to dysplasia patients, agree a local standard, implement an action plan to improve documentation quality, and assess whether documentation improved as a result.

What did we do?

Ran four PDSA audit cycles reviewing dysplasia clinic patient records, discussing findings with the clinic team at clinic huddles after each cycle and reinforcing the importance of giving and documenting safety netting advice.

What are the benefits for patients and staff)?

Patients are more likely to receive and have documented clear self-monitoring advice, supporting earlier detection of changes and timely intervention. The team also improved documentation of smoking and alcohol risk factors, and maintained clear recording of diagnosis, dysplasia severity and site affected.

Measures used

• Documentation of safety netting advice rose from 27% (cycle 1, n=30) to 58% (cycle 2, n=31) to 77% (cycle 3, n=30) to 100% (cycle 4, n=83), achieving the locally agreed 100% standard.
• Documentation of smoking status improved from 97% to 100%, and alcohol status from 80% to 100%.

Qi tools used

• Plan, Do, Study, Act (PDSA) cycle.
• Retrospective case note audit.

Project

Lead: Symone Lawrence, Governance Support and Improvement Manager

What was the problem?

Quality Improvement happens across the Dental Division, but there was no dedicated way to showcase smaller-scale projects outside of committee agendas and larger forums such as Improving 2gether.

Aim

To create a Dental QI newsletter, reviewed and published by March 2026, and shared across the division via the Intranet.

 
What did we do?

Drafted the newsletter and gathered feedback on its format via Copilot and the Dental Governance team, including adding a QR code for feedback. The first two issues were shared at the Dental Audit Committee in May 2026, and the team continues to gather QI projects, training opportunities and QI huddle leads to showcase in future issues. service activity.

What were the benefits for patients and staff? 

Smaller-scale QI projects across the division now have visibility and a platform to be showcased, alongside training opportunities and a QI tool of the month, helping spread learning and engagement in QI across the Dental division.

Measures used

• Feedback via Smart Survey ahead of Issue 4.
• Ongoing PDSA review of newsletter content and format.

Qi tools used

• QI Huddle brainstorming.
• Plan, Do, Study, Act (PDSA) cycle.

Project

Lead:  Katie Owen, Service Clinical Manager (Clinical Illustration); Tony Brown, Digital Communications Officer; Vicky Oakley, Graphic Designer (Digital and Inclusive Design Lead)

What was the problem?

Baseline surveys and research highlighted significant barriers to healthcare information access, particularly for disabled people. The findings demonstrated the importance of accessible communication and inclusive design, supporting the need to strengthen accessibility across BCHC communications.

Aim

To improve accessibility and inclusion across BCHC communications by increasing awareness and consistent use of accessible communication practices for staff and service users, achieved by embedding and promoting three key focus areas across BCHC communications during 2026.

• The ReciteMe toolbar.
• Accessibility Standards.
• Easy Read.

 
What did we do?

Three key changes were embedded across the Trust:

• The ReciteMe accessibility toolbar to improve access to information.
• A consistent WCAG 2.2 AA-compliant content design process.
• Co-produced Easy Read templates.

These changes improve accessibility, staff guidance and consistency while reducing costs through in-house development.

What were the benefits for patients and staff? 

The ReciteMe toolbar improves access to clinical information, while consistent accessibility standards and staff guidance strengthen BCHC communications. In-house Easy Read development has widened access and delivered cost savings.

Measures used

Easy Read insourcing reduced Category Supplier spend by 80% in 2025, saving £8,025 compared with the 2022-2024 average. Future work will continue to measure accessibility impact and test further efficiency opportunities through PDSA cycles.

Project

Lead: Samantha Davies, Dental Nurse

What was the problem?

The community dental team felt it would be valuable to have a local newsletter to share good news stories and snippets of useful clinical good practice. The existing Dental Bites newsletter was mostly management-driven and covered the whole division, so the team wanted a more locally focused newsletter for Community Dental Services (CDS), initiated by staff themselves.

Aim

To inform, celebrate and connect locality staff by sharing good news stories, recognising successes, and fostering a culture of shared learning and good practice. 

 
What did we do?

Staff were asked what sort of information they wanted included in the newsletter, and their feedback was collated to draft a newsletter for consideration. Once the draft was approved, a date was agreed for the first launch, along with a mechanism for gathering news stories for each future issue. Next, all CDS clinics will be asked to send their stories and information on a bimonthly basis, with stories collated and newsletters produced and distributed bimonthly.

What were the benefits for patients and staff? 

The project is still at the launch stage, so outcome benefits are not yet available in the source material — please add these once the newsletter has been running.

Measures used

After 3 issues (6 months), the project will be evaluated to see whether all sites are submitting stories and whether there is sufficient input to continue the newsletter.

Project

Lead: Laura Smith, Special Care Dentistry Services

What was the problem?

Adult patients with limited or no verbal communication in Special Care Dentistry settings can find it difficult to understand and take part in appointments.

Aim

By January 2027, to improve non-verbal visual communication between Special Care Dental clinicians and adult patients with limited or no verbal communication, achieving a 10% increase from baseline in clinician satisfaction scores for communication.

 
What did we do?

The team developed a visual communication toolkit and trained a sample of clinicians to use it, then trialled it across five clinicians' appointments over one week, with the toolkit and guidance available in each appointment room. Findings from this first cycle are being reviewed using outcome, process, structure and balancing measures to decide whether to adapt, abandon, or roll the approach out more widely.

What were the benefits for patients and staff? 

Clearer visual communication is expected to help clinicians and patients understand each other better during appointments, improving clinician satisfaction and patient experience, while measures are also in place to check the change does not add significantly to appointment time, clinician workload, or patient distress.

Measures used

Clinician satisfaction scores, use and availability of the communication toolkit, and clinician training completion rates, alongside balancing measures such as consultation length, clinician workload, and patient distress or anxiety.

Qi tools used

• Driver diagram.
• Plan, Do, Study, Act (PDSA) cycles.

Project

Lead: Bev Taylor

What was the problem?

Following recruitment of new Band 5 Specialist Nurses after a service reconfiguration, the team identified a lack of structured induction, clinical supervision and role-specific development. This project established these support mechanisms to aid competency, confidence and successful integration into practice.

Aim

To develop and implement a structured induction, clinical supervision framework, and professional portfolio to support the transition, development, and competency achievement of newly appointed Band 5 Specialist Nurses within Birmingham Community Dental Services, by June 2027.

 
What did we do?

Structured clinical supervision packs were developed for Band 4 and 5 nurses, providing a consistent framework for competencies, responsibilities and professional development. This supports safe, autonomous practice, standardises supervision across sites, and enables regular monitoring to address audit findings, reduce variation and improve compliance.

What were the benefits for patients and staff? 

The changes aim to rebuild a consistent rhythm within the workforce, strengthen team accountability, and restore pride and ownership in the delivery of safe, high-quality patient care. Each team member will have a clearer understanding of their contribution and the role they play in maintaining effective services and positive patient outcomes.

Measures used

Measures include audit compliance, consistency across sites, team working, task completion and staff development, using audits, competency checklists, staff feedback and supervision records. Together these assess both implementation of the new support structures and their impact on practice, compliance and team performance.

Qi tools used

• A Driver Diagram and PDSA (Plan, Do, Study, Act) cycles, which will be used going forward to evaluate additional change ideas.

Project

Lead: Laura Thomas Hollyoak, Community Dental Services

What was the problem?

The service received feedback from dental service users that there was nothing to occupy children while in the waiting room. As a result, service users' anxiety and stress could build up in the waiting room before their appointment started.

Aim

To reduce the carer and service user feedback of stress and anxiety caused in the waiting room by 30%, monitored over 12 months from 09.06.26 to demonstrate this has been sustainably achieved.

 
What did we do?

Three Plan, Do, Study, Act (PDSA) cycles tested ways to improve patient feedback. Toys were trialled but withdrawn due to safety concerns, while a sensory activity wall was adapted to a wipeable activity table following IPC advice, which was then successfully tested

What were the benefits for patients and staff? 

The project is still in progress, the team plans to review the data to see whether the change idea has improved on the issue the project aimed to address, so outcome benefits are not yet available.

Measures used

The team is measuring the percentage of patient and carer feedback that reports anxiety caused by a lack of service user equipment in the waiting room. A baseline of the initial feedback has been collated, and the team is now monitoring this percentage rate over a 12-month period to see whether the final PDSA has an impact on reducing anxiety for carers and service users in the waiting room.

Qi tools used

• Driver Diagram.
• PDSA (Plan, Do, Study, Act) cycles.

Project

Lead: Symone Lawrence, Governance Support and Improvement Manager

What was the problem?

LfE is a positive reporting system for celebrating good practice, such as compassion, adaptability and collaboration. Nomination numbers in the Dental Division were consistently lower than in other divisions, limiting the learning and improvement this system can offer.

Aim

To increase the number of LfE nominations within the division by June 2026, with an SPC chart showing the trend to indicate a change in process.

 
What did we do?

• Ran a smart survey to gauge staff awareness of LfE within the division.
• Began sharing a monthly summary of nomination themes in the division's 'Dental Bites' newsletter.
• Delivered an LfE and QI awareness presentation at governance meetings across specialties with lower nomination numbers (Orthodontics, Paediatrics, Community Dentistry Services).

What were the benefits for patients and staff? 

• Improved staff morale and motivation by recognising and sharing positive practice.
• Greater learning and improvement, using Appreciative Inquiry to identify nominations with quality improvement potential.
• Early signs of a positive shift in nomination numbers, with five consecutive data points above the mean by June 2026.

Measures used

• SPC chart and driver diagram used to monitor nomination numbers over time.

Qi tools used

• Driver diagram.
• Smart survey.
• SPC (Statistical Process Control) chart.

Project

Lead: Symone Lawrence, Governance Support and Improvement Manager

What was the problem?

Producing regular reports for divisional committees and meetings from Datix was time-consuming. The idea for dashboards came from a QI Huddle, after seeing them used effectively at the Trust Risk Management meeting.

Aim

To develop dashboards that reduce the time taken to produce reports and provide specialty-specific, live dashboards by the end of December 2026.

 
What did we do?

Created an 'Open Incidents' dashboard giving the leadership team live visibility and cutting the time needed to produce this weekly report, along with two further dashboards tracking actions from PSIRF responses and complaints, rolled out to senior leadership and clinical managers. A specialty-specific dashboard was then developed with the Head of Service and is being trialled in Oral Medicine, with feedback due back to the Divisional Quality Assurance Group in August 2026.

What were the benefits for patients and staff? 

Reduced time spent producing routine reports, live visibility of open incidents and actions for leadership teams, and a model for specialty dashboards that can be rolled out more widely across the division.

Measures used

Feedback from stakeholders and the Divisional Quality Assurance Group, and ongoing PDSA review of dashboard usefulness.

Qi tools used

• QI Huddle, stakeholder analysis.
• Plan, Do, Study, Act (PDSA) cycle.

Project

Lead:  Katherine Bilcliffe, Dental Matron

What was the problem?

Creating shift rotas for community dental services was a manual process which was extremely time consuming due to the volume of clinical locations and staff and often adjustments were needed at short notice.

Aim

To reduce the time spent on creating and adjusting  programmes, as well improving their automation to, accuracy, consistency and analytical capability for the Community Dental Nursing Team by December 2025.

 
What did we do?

• Created a excel workbook with automated capabilities.
• Review implementation over the next 6 months and research further ways to automate programme.
• Released as pilot in Birmingham.
• Collected feedback from Dental Nurses and Clinicians.
• Streamlining annual leave request processes could provide report to be pulled to further support the correct tracking of annual leave approval in line with service activity.

What were the benefits for patients and staff? 

• Time saved.
• Accuracy levels improved.

Measures used

• 5 W's and 2H's (who, what, why, where, when, how, how many) were used to identify the root causes of the issues.
• Fishbone diagrams were created to identify cause and effects of the issues.
• Change ideas were ranked and prioritised.
• Data was collected and displayed, analysed using pareto charts.
• Multiple PDSA (plan, do, study, act) cycles were planned and used.

Qi tools used

• Datix Reports.
• Audits.
• Feedback.

Project

Clinical Illustrations and Orthodontics essential care project.

Leads: Katie Owen, Interim Clinical Illustration Manager; Malaaika Al-Koky, Specialist Registrar ST1

What was the problem?

Feedback was received from patients around various topics such as unsure of what to expect with the clinical photographs that were due to be taken, neurodiverse and anxious patients unsure what to expect, a patient was upset around removal of her headscarf and where the photos would be seen and also where the clinical photography department actually was.

Aim

By August 2024, to ensure all patients are fully aware of what to expect when clinical photographs are taken.

What did we do?

To create two improvements covering the following:

• Patient engagement (new leaflet) so the patient is aware of what to expect from their clinical photography appointment throughout their treatment. Improving patient experience.
• Inclusivity (photography contact sheet): the patient is shown the requested clinical photographs required for their treatment. Options for those with head coverings are available for the facial views. Images will be available on the orthodontic department in each bay to improve the consent process.

Implementation of improvements:

• A leaflet was produced and reviewed at the patient engagement forum which raised awareness to patients of what to expect in their clinical photography appointment.
• This will be provided to all Orthodontic patients at their initial appointment (new patient clinic).

What are the benefits for patients and staff)?

• Less confusion for patients on what to expect at appointments.
• Patients having full understanding of procedures being undertaken and the requirements needed in advance of appointments.
• Time saved for staff not having to answer additional queries that are now covered in new leaflets.

Measures used

• Patient feedback.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Process Mapping.

Project

Safe sedation practice (SAAD)

Leads: Laura Warrilow, Specialist Paediatric Dentistry; Ayman Dhanji, Specialist Special Care Dentistry.

What was the problem?

There are a number of individual audits and projects surrounding sedation and this is an ideal way to centralise this information and ensure we are looking at all elements of quality and safety. It is an opportunity for us to highlight the many areas of sedation we are already doing well and our previous good work e.g. the sedation template. It’s also a good way to look for areas we might be able to improve, for example how we record sedation training. Once completed, this will provide a summary document which could act as evidence of good practice should it ever be needed for the CQC.

Aim

The aim of the project was to ensure each of the community clinics where sedation is carried is fit for purpose and in line with the criteria from the SAAD safe sedation practice scheme to ensure that the sedation carried out is in line with the defined principles for safe sedation practice, as outlined by SAAD.

What did we do?

• The aim is also to start off by doing this in CDS and once a process that works has been established, the aim is to then look to evaluate sedation in Paediatrics BDH.
• The project will be quite broad, completed for both Paediatrics and Special care across all CDS sites delivering sedation, meaning 13 clinics in total. Some aspects can be looked at on an overall basis, for example policy, others will be site specific, for instance equipment available.

Results were very positive confirming that a safe and high-quality sedation service is being run. Working across a wide range of sites across CDS and a variety of setting, for example clinics, Dental Hospital and tertiary hospitals and it is positive to see that standards have been maintained throughout. SAAD document suggests results are categorised and it has been identified that there is nothing that would count as a major deviation requiring immediate action. An excellent standard of observed patient care was documented.

Next steps:

• Review induction for staff as it is currently variable throughout CDS and staff groups. This includes developing a plan to have formalised sedation induction checklist for Paediatrics, Special Care and Nursing.
• To ensure there are copies of sedation qualification retained and the sedation policy read.
• There is currently no formalised process for monitoring competency within existing members of staff. A proposal is to introduce a “Sedation Passport” to be integrated into the “Radiology Passport.” All staff will be required to complete initially then updated at appraisal which would include evidence of appropriate CPD and cases being recorded.
• It was identified that there was a gap with easy read or paediatrics patient specific leaflet. These are in development.
• There were some issues with record keeping identified with minor issues primarily at assessment stage. The Paediatrics team are amending their template to reflect this and Special Care supporting clinicians to improve.
• Identified that staff due some medical gas training e.g. handling cylinders safely and look at long term how often needs to be repeated.
• Implement changes and mechanisms to maintain them going forward.
• Share project and learning with dental division and support the roll out of evaluation beyond CDS.

What are the benefits for patients and staff)?

• Ensuring good practice for Safe Sedation (SAAD).

Measures used

• Patient feedback.
• Staff feedback.
• Review of small sample of clinical records.
• Observation.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Audit.
• Feedback.

Project

Preparation is key.

Leads: Fionnuala Loy.

What was the problem?

A service evaluation in 2016 showed that the majority of Dental paediatric patients are severely anxious. There had been many changes and a global pandemic which may have impacted on the dental anxiety levels of our paediatric population. There was a need to reflect on our current practice and make improvements which highlight there were no online preparatory video information on dental assessments specific to BDH is currently available.

Leaflets on dental assessments are available (hard copy only) and were designed for children with learning needs and autism. These leaflets are not routinely being sent with new appointment letters.

Aim

To reduce pre appointment anxiety in dental assessments for children with learning needs and autism by August 2025.

What did we do?

First PDSA cycle was to:

• Assess the anxiety level of patients attending for dental assessments at the Birmingham Dental Hospital (BDH).
• To gain feedback from patients about current preparatory resources for dental treatments at Birmingham Dental Hospital (BDH).
• To ascertain if patients feel that a preparatory video on dental assessments in the BDH would be helpful before their treatment appointment.

First PDSA cycle showed over 40% of new patients coming to the dental hospital for a paediatric dental assessment are anxious and over 50% of these patients did not know what to expect. The majority of patients from this survey would like preparatory information and video information is preferred to leaflets.

The team liaised with clinical illustration re: video for new patient appointment (to include radiology visit as per feedback).

 
Dental’s internet pages have the 2 videos to support our paediatric patients attending their Dental appointment under ‘Videos for Patients Visiting our Services’.

PDSA Cycle 2:

• To gain service user feedback on how helpful the questionnaire has been to prepare paediatric patients attending new patient assessments.
• To find out if the QR code and link for the survey were easy to find on the new patient letters.

What are the benefits for patients and staff)?

• Reduced pre-appointment anxiety in patients.

Measures used

• Patient feedback.
• Staff feedback.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Feedback.

Project

Making every contact count: Orthodontics

Leads: Nabeela Caratela, Dental Core Trainee.

What was the problem?

Missed opportunities for signposting and recommending brief advice for a number of behavioural risk factors which can support patients towards improving their oral and general health.

Aim

By August 2025 to increase awareness and knowledge amongst the Orthodontic Team of the MECC (making every contact count) national initiative.

What did we do?

Results of 1st QIP:

• Limited awareness and training of the MECC initiative. Limited knowledge of relevant services and resources to signpost patients to. The main barriers to giving patients advice were lack of time and knowledge, feeling uncomfortable with sensitive conversations and lack of patient compliance. Due to time pressures, signposting may be more feasible than giving patients specific advice.

Actions following 1st cycle:

• Delivery of formal training and resources at the West Midlands Consultant Orthodontic Group Meeting and Orthodontic Nurses and Therapist Meeting, July 2024.
• Presentation of findings at WMCOG and Nurses meeting.
• Peer-reviewed CPD publication: Dental Nursing Journal.
• Post-intervention survey to quantify the impact of the action plan.

Results of 2nd cycle:

• Overall, knowledge and awareness of MECC amongst the Orthodontic Team improved following completion of this project. The Orthodontic Team is in an ideal position to provide the recommended very brief advice to patients regarding behavioural risk factors. Provision of very brief advice and signposting appropriately should take seconds to a few minutes and should not impact existing time constraints.

What are the benefits for patients and staff)?

• Patients are signposted appropriately regarding behavioural risk factors during existing appointments or contacts.
• No need for additional appointments for signposting.
• Provision of brief advice and signposting is done in existing appointments and should not impact time constraints.

Measures used

• Prospective, 2 cycle.
• Bespoke prospective questionnaire.
• 10 questions to assess knowledge, attitudes, current implementation and barriers surrounding ‘MECC’ amongst the Orthodontic Team.
• The questionnaire was disseminated at the West Midlands Consultant Orthodontic Group Meeting via paper forms and for those not in attendance, via Google Forms in February 2024 (1st QIP cycle).
• A questionnaire to evaluate the impact of the interventions was distributed via paper forms at the West Midlands Consultant Orthodontic Group Meeting and Dental Nurses Meeting in July 2024 (2nd QIP cycle).

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.

Project

Amazing Amelia.

Leads: Stacey Quinton, Specialised Oral Health Improvement Practitioner Team Lead and the Oral Health Improvement Team.

What was the problem?

The Oral Health Improvement team are a newly established team delivering evidence-based programmes throughout Birmingham and the Black Country to address oral health inequalities for our services users that have the greatest need.

Aim

Create a booklet to address oral health inequalities for service users with the greatest need throughout Birmingham and the Black Country.

What did we do?

• Created an Amazing Amelia story booklet to give to service users to support oral heath inequalities.
• A leaflet was also developed aimed at adults with Learning difficulties called ‘My teeth and Gums with a similar idea.

What are the benefits for patients and staff)?

• A notable achievement which has been greatly accepted and welcomed by colleagues and service users is the production of Amazing Amelia story booklet.
• They have worked extremely hard to establish links within their local communities and have played a pivotal role in making positive changes to ensure success.
• This has been presented as a quality improvement project to various committees in the Division and wider in the Trust including Improving Together forum highlighting how children and their families learn about how to look after their teeth.
• The resource is currently undergoing a Makaton review.

Measures used

• Feedback from service users and carers.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Qi Huddle meetings.

Project

Oral surgery directions.

Leads: Cherelle McCalla, Dental Nurse.

What was the problem?

A member of staff felt that there could be improvements made within the area due to ‘patients getting lost on their way out (of clinic) and to x-ray,’ so set out to find a solution and sought the opinions and thoughts of the nursing team. 

Aim

By August 2025, to provide signage and floor stickers showing directions from dental clinics to x-ray.

What did we do?

This was raised during a QI huddle as a new improvement idea which was then discussed as a team during the Qi huddle. As part of these discussions, it was suggested that floor sticker and a sign at the end of the department corridor may be a small but effective way of solving this problem.

After working closely with Clinical Illustration to bring the idea to life and liaising with Senior Management to seek approval for the Quality Improvement idea, the change has now been successfully introduced, and floor stickers and sign have been added showing the way into the Oral Surgery Department.

What are the benefits for patients and staff)?

• Less confusion for patients in finding x-ray and back to clinic.
• Time saved for patients in finding x-ray.
• Time saved for staff in not giving directions.

Measures used

• Patient feedback.
• Staff feedback.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Qi Huddle.