In search of quality

The recent review of dental services lead by Professor Jimmy Steele recommends that quality be addressed in dental service provision in England. Therefore the concept of quality needs to be made explicit in order to avoid ambiguity. The difficulties surrounding quality definitions saw the emergence of quality standards in the 1980s. The British Standard BS5750 became popular with organisations throughout this period and now through various revisions since the early 1990s it has been replaced by the ISO9000 standard. This is a written standard which has to be adhered to by any organisation wishing to be accredited with the quality ISO9000 kite mark. One of the fundamental issues to be dealt with in any organisation utilising the ISO9000 standard is that of its product. Without knowing the product it is impossible for an organisation to know if its activities have resulted in effective product realisation. So what is our product as a profession? Historically, I would imagine that we would have defined it as activities reacting to the vast amount of disease present in the population. Today our product includes restorative care but that is only a small part of what we now consider oral health to be. Therefore, we can surely say that as a profession our product is oral health. Contemporary definitions of oral health embrace a more three dimensional holistic 'social model of health' view rather than a two dimensional physical 'medical model of health' view. There is much in the dental literature demonstrating how the former contemporary definition can be measured using oral health-related quality of life measures. Should these measures not be fundamental to professional product realisation within a quality system?