Patient Safety: Is Your Dental Practice a High-Reliability Organization?

Linda Harvey, RDH, MS


The COVID-19 pandemic has brought heightened awareness to safety and infection control. As a result, patient safety as well as team safety became our singular focus. Enhanced protocols were implemented, and teams were prepped to discuss these updates with patients. Now is the perfect time to revisit your overall patient safety culture.

Traditionally, the concepts of patient safety culture are based upon research in industries outside of healthcare that carry out complex, hazardous work, such as aviation and nuclear power plants.

Organizations that consistently minimize and/or overcome adverse events despite risks are known as high-reliability organizations (HROs). Specifically, HROs implement procedures to recognize and prevent adverse events.

The term adverse event in healthcare describes patient harm that arises as a result of medical care, rather than from the underlying disease. Wrong-side surgery, administering the wrong medication or dose, and disease transmission, are all considered adverse events. Similarly, dentistry has inherent risks and, on occasion, adverse events occur.

Even in situations where an adverse event does not occur, the potential for a near miss may exist. The Patient Safety Network (PSNET) defines a near miss as “any event that could have had adverse consequences but did not and was indistinguishable from fully fledged adverse events in all but outcome”. In many settings, a near miss is also defined as a “good catch,” meaning that the potential error or event was recognized before it actually occurred.

The Institute of Medicine (IOM) defines patient safety as “freedom from accidental injury.” Preventing harm to patients aligns with the Hippocratic Oath: “First, do no harm.” And as such, all healthcare professionals pledge to maintain high ethical standards in their practice.

All dental practices establish a work culture through a mission statement or practice philosophy. But have you established a patient safety culture for your practice? Are you certain your practice is an HRO and not fraught with hidden risks?

Increasing Patient Safety Awareness

Health Catalysts, a forward-thinking data warehousing organization, states that “in 2016 the total cost burden for patient harm in the US was $146 billion. Of these adverse events, 30% to 70% were potentially avoidable, leaving a significant opportunity for healthcare to improve patient safety.”

Health Catalysts further states that patient safety improvement rests heavily on an organizational culture of patient safety, in which leadership supports systemwide attitudes, actions, teamwork, and technology to reduce the risk of patient harm. (Click here to download their Seven Keys to Unlocking Patient Safety Culture)

How does this relate to your practice? Dentistry is a microcosm of healthcare, and these statistics should raise our awareness about the potential for adverse events and near misses in our practices.

Dig a little deeper into your patient care processes and identify areas where you can minimize the potential for adverse events. The COVID-19 pandemic certainly impacted infection control protocols, which, if not followed properly, could result in disease transmission. Equally important is teaching the team to recognize and problem-solve near misses and good catches. 

Adverse events have the potential to occur in any area of your practice. In addition to preventing wrong-side surgery, sterilization missteps, or a medication error, evaluate the safety of your business office processes.

Proper coding and billing not only maintains the financial health of your practice, but also supports your safety culture. Conversely, improper coding and billing that results from errors, lack of knowledge, or incomplete chart notes, directly impacts safety and quality of care. The importance of recognizing near misses and good catches encompasses all areas of your practice.

Improving Team Safety Competency

To paraphrase author Thomas Reid in Essays on the Intellectual Powers of Man (1786), we are only as strong as our weakest link. Leverage team meetings as well as continuing education opportunities to continually strengthen your safety culture.

For example, have your safety/infection control coordinator(s) provide a brief report on quality measures impacting patient safety, such as dental unit waterline testing or sterilization monitoring. Team meetings provide the perfect forum to foster patient safety awareness by discussing lessons learned as well as opportunities for improvement. Remember, when a near miss or good catch is identified, you have an obligation to act.

According to the PSNET Patient Safety Network, high-reliability healthcare organizations commit to a culture of safety that includes four key features:

  • Acknowledging the high-risk nature inherent in dentistry and committing to consistently maintaining safe operations. COVID-19 heightened the need for consistently maintaining safe operations related to respiratory risks. There’s no room for outdated habits or processes just because “that’s the way we’ve always done it”.
  • Supporting a blame-free environment, in which staff can report errors or near misses without fear of repercussions. Fear of retribution, teasing, or any other non-supportive behavior, whether it’s from team members or the doctor, breeds an unhealthy safety culture.
  • Encouraging team collaboration to resolve patient safety concerns. Communication, communication, communication!
  • Dedicating sufficient resources to address safety concerns, including finances and personnel. Don’t wait for equipment to break and possibly cause injury before replacing it. Schedule time for staff to carry out the role of safety coordinator adequately and proactively.


Providing quality care in a safe and trusted environment includes a strong patient safety culture. Take proactive steps to ensure your practice is an HRO! Here are three quick tips to establish your practice as an HRO.

  • Be transparent about how your practice is running in all areas—what’s working, what’s not, and where any processes are breaking down. This enables you to objectively review the reliability of all systems from the business office to the clinical areas.
  • Challenge the “way you’ve always done something”. Verify that a process or system still adequately serves the practice, starting with infection control.
  • Redefine team meetings by adding patient safety and systems-focused topics. Create an atmosphere where staff can objectively voice concerns and offer solutions rather than criticize or be criticized.

Similar to maintaining oral health recare for your patients, maintaining your practice as an HRO is an ongoing process. Start by taking the first step today!

Ms. Harvey is a nationally recognized healthcare risk management and compliance expert who helps dentists and teams navigate regulatory requirements. She is the founder and president of the Dental Compliance Institute as well as a compliance consulting firm. Her career in dentistry began as a dental hygienist. Since that time, she has worked in corporate risk management and has been recognized as a Distinguished Fellow in the American Society of Healthcare Risk Management. In addition, she was honored to consult with the ADA on three separate occasions regarding compliance.

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