The use of conversation mapping to frame key perceptual issues facing the general dental practice system in England.

OBJECTIVE: To demonstrate the use of a novel qualitative methodology namely conversation mapping, which can be used to capture differences in stakeholder perspectives and give a root definition of the problem in a complex policy area. The methodology is used in the context of the changes introduced in the English general dental practice system in April 2006, to investigate the key issues facing the system, as perceived by general dental practitioners (GDPs). BASIC RESEARCH DESIGN: From a broad trigger statement, three transformational statements were produced. Each participant recorded their contribution on a hard diagrammatic form as a 'map', with others responding with their own written comment, thus generating three conversation maps. Thematic analysis resulted in the generation of a preliminary model summarising key perceptual issues. RESULTS: The five emergent themes identified were: financing, dentists' wants/needs, the role of the public and patients, system goals and policy level decision making. Financing was identified as the core category to which all other categories were related. CONCLUSIONS: Conversation mapping, a methodology arising from a systems approach, can be used to develop a 'rich picture' of an oral health care system in order to define the core problem within this policy area. Findings suggest that GDPs identify the financing of the system as a fundamental source of problems within the general dental practice system. This appears to be at variance with the perception of policy makers, who report a more limited view, identifying the system of remuneration as the 'heart of the problem'.

Measurement of attitudes of U.K. dental practitioners to core job constructs.

OBJECTIVES: To develop a measure to identify dental practitioner attitudes towards core job dimensions relating to job satisfaction and motivation and to test this against practice characteristics and provider attributes of U.K. practitioners. RESEARCH DESIGN: an 83-item questionnaire was developed from open-ended interviews with practitioners and use of items in previously used dentist job satisfaction questionnaires. This was subsequently sent to 684 practitioners. Item analysis reduced the item pool to 40 items and factor analysis (PCA) was undertaken. RESULTS: 440 (64%) dentists responded. Factor analysis resulted in six factors being identified as distinguishable job dimensions, overall Cronbach's alpha = 0.88. The factors were: 'restriction in being able to provide quality care (F1)', 'respect from being a dentist (F2)', 'control of work (F3)', 'running a practice (F4)', 'clinical skills (F5)', and 'caring for patients (F6)'. All six factors were correlated with a global job satisfaction score, although F1 was most strongly related (r = 0.60). Regression model analysis revealed that 'whether the dentist worked within the National Health Service or wholly or partly in the private sector' (p < 0.001), 'time since qualification' (p = 0.009), and the position of the dentist within the practice (whether a practice owner or associate dentist), (p = 0.047) were predictive of this factor. CONCLUSIONS: Six core job constructs of U.K. practitioners have been identified, together with several practice characteristics and practitioner attributes which predict these factors. The study demonstrates the importance of refining measures of dentists' job satisfaction to take account of the culture and the system in which the practitioner works.

Facets of job satisfaction of dental practitioners working in different organisational settings in England.

INTRODUCTION: Before April 2006, English dentists were either working as an NHS general dental service (GDS) practitioner (fee-per-item, no local contractual obligations); an NHS personal dental service (PDS) practitioner (block contract with the primary care trust (PCT)); a private practitioner (either fee-per-item or capitation-based, independent of the PCT); or in a situation where they were mixing their NHS work (either under the GDS or PDS arrangements) with private work. OBJECTIVES: To a) investigate the extent of the mix of NHS and private work in English dentists working in the GDS and PDS, b) to compare global job satisfaction, and c) to compare facets of job satisfaction for practitioners working in the different organisational settings of PDS practices, GDS practices and practices where there is a mix of NHS and private provision. Method A questionnaire was sent to 684 practitioners, containing 83 attitudinal statements relating to job facets, a global job satisfaction score and questions concerning workload. RESULTS: Response rate was 65.2%. More PDS than GDS dentists were found to treat the majority of their patients under the NHS. GDS dentists working fully in the NHS were least likely to be satisfied with their job, followed by PDS practitioners and then GDS dentists working in mixed NHS/private practices. Private practitioners were the most satisfied. CONCLUSION: Differences between GDS, PDS and private practitioners were found in global job satisfaction and in the facets of job satisfaction related to restriction in being able to provide quality care, control of work and developing clinical skills.