Philosophiae Doctor - PhD / In order to manage public dental services, information is required about what work is being performed by the staff at the various clinics. Tally sheets have been used in the past to record treatment procedures but this is not an effective method of recording the amount of work done by staff at public dental clinics. But tally sheets are inaccurate, open to abuse, and fail to provide the necessary information for managers. Nor is it of any real value for providing feedback to staff on their performance. This inhibits a core aspect of job satisfaction for the staff, which is feedback. The staff just persevere, continue doing the same thing and feel frustrated. This contributes to poor work performance. Instead of using a tally sheet, 4 digit treatment codes are used for all treatment procedures (as used in the private sector for billing purposes) and additional codes were developed for services such as brushing programmes for which billing codes do not exist. These are recorded for each patient, together with a code for the patient category. A relative value unit (RVU) has been developed for each treatment code that has been weighted according to policy guidelines and the amount of time and effort required to provide the service. This was done for clinical treatment procedures as well as for community-based preventive activities. A computer program has been developed that captures the treatment codes which are saved in a number of databases that are linked to Excel pivot tables. The data can therefore be easily manipulated by the user to obtain the required information in the form of counts of procedures, monetary cost of the same clinical services in the private sector (useful with the proposed advent of National Health Insurance) and also in the form of relative value units. iii This is available for the current reporting period as well as for previous periods, allowing a detailed analysis of services rendered and staff performance over a period of time to show trends. Use is also made of an Objectives Matrix where the performance of each staff member can be measured according to seven objectives (Key Performance Areas) (five in the case of oral hygienists) to produce an overall Performance Index – which is a score out of ten. This enables performance appraisal to be carried out much easier than by comparing performance based on a number of diverse treatments provided. The data for all the public dental clinics in the Western Cape Province has been analysed for the period 1994 to 2012 using this system, and it has been shown that the system is sensitive enough to highlight problem areas as well as provide a balanced overall view of the service, as measured by a number of variables. The system is “low tech” in that it runs on a “stand alone” personal computer, but it could easily be applied to an integrated, networked information system provided the latter contained the treatment codes, and certain other patient, staff and clinic identifiers. It is therefore suitable for developing countries, such as South Africa, that may later develop a comprehensive Health Information System based on an electronic medical record. The emphasis is not on the information technology, it is focussed on the concepts behind the processing of the data into meaningful information for managing public dental services.

Philosophiae Doctor - PhD / In order to manage public dental services, information is required about what work is being performed by the staff at the various clinics. Tally sheets have been used in the past to record treatment procedures but this is not an effective method of recording the amount of work done by staff at public dental clinics. But tally sheets are inaccurate, open to abuse, and fail to provide the necessary information for managers. Nor is it of any real value for providing feedback to staff on their performance. This inhibits a core aspect of job satisfaction for the staff, which is feedback. The staff just persevere, continue doing the same thing and feel frustrated. This contributes to poor work performance. Instead of using a tally sheet, 4 digit treatment codes are used for all treatment procedures (as used in the private sector for billing purposes) and additional codes were developed for services such as brushing programmes for which billing codes do not exist. These are recorded for each patient, together with a code for the patient category. A relative value unit (RVU) has been developed for each treatment code that has been weighted according to policy guidelines and the amount of time and effort required to provide the service. This was done for clinical treatment procedures as well as for community-based preventive activities . A computer program has been developed that captures the treatment codes which are saved in a number of databases that are linked to Excel pivot tables. The data can therefore be easily manipulated by the user to obtain the required information in the form of counts of procedures, monetary cost of the same clinical services in the private sector (useful with the proposed advent of National Health Insurance) and also in the form of relative value units. This is available for the current reporting period as well as for previous periods, allowing a detailed analysis of services rendered and staff performance over a period of time to show trends. Use is also made of an Objectives Matrix where the performance of each staff member can be measured according to seven objectives (Key Performance Areas) (five in the case of oral hygienists) to produce an overall Performance Index - which is a score out of ten. This enables performance appraisal to be carried out much easier than by comparing performance based on a number of diverse treatments provided. The data for all the public dental clinics in the Western Cape Province has been analysed for the period 1994 to 2012 using this system, and it has been shown that the system is sensitive enough to highlight problem areas as well as provide a balanced overall view of the service, as measured by a number of variables. The system is "low tech" in that it runs on a "stand alone" personal computer, but it could easily be applied to an integrated, networked information system provided the latter contained the treatment codes, and certain other patient, staff and clinic identifiers. It is therefore suitable for developing countries, such as South Africa, that may later develop a comprehensive Health Information System based on an electronic medical record. The emphasis is not on the information technology, it is focussed on the concepts behind the processing of the data into meaningful information for managing public dental services.

Magister Scientiae Dentium - MSc(Dent) / ‘A satisfied worker is a happy worker’, this statement by Robbins (1998), sums up the importance of job satisfaction. Locke (1976), defined job satisfaction as the ‘positive emotional state resulting from the appraisal of one’s job and job experiences’. The Northern Cape province is the largest province in South Africa, by area. Oral health mainly focuses on primary health care and pain relief. Dental staff in the public sector are employed at district level, and not at sub-district level. This scenario requires dental staff (dentists, dental therapists, oral hygienists and dental assistants) to travel to rural areas that have working conditions that are not always optimal for dental treatment. Faced with numerous work-related challenges, it is believed that staff morale and motivation is particularly low in the province, as in the rest of South Africa in the public health sector (Howse, 2000). This research assessed the job satisfaction of dental staff in the public sector in the Northern Cape, and aims to make management aware of the need and the importance of oral health services, for staff and patients. The study found that the majority of the dental staff appear to enjoy their working environment (60%), love what their job entails (76%), and would like to continue their job in the long run (74%). Eighty percent of the participants reported that they experienced teamwork and 71% appreciated the support of their staff, which are very positive findings. However, it appears that the staff are not totally happy or satisfied with their work environment, and have identified various factors that need to be addressed to improve their job satisfaction. Seventy-four percent of the staff listed resources (human, financial, physical) as the major work-related factors that need to be addressed to improve their job satisfaction. iii The majority of the dental staff reported that the staff shortage, the poor communication with their administrator, the inadequate quantity and quality of equipment, the limited services being offered to patients, the lack of opportunities to make use of and improve their clinical skills, and their salary, are factors that need to be addressed to improve their job satisfaction. Just over half of the participants also stated that the salary they earn is not as important as the satisfaction gained from serving the public, and 80% of the participants felt that their job allows them to make a contribution to their community. Having a significant proportion of staff who feel that the salary they earn is not as important as serving their community is both interesting and praiseworthy. The dental staff seem to be giving of their best despite their current work environment, but expressed a need and willingness to deliver a more comprehensive oral health service that makes full use of their clinical skills, and that is not constrained by a lack of finances or limited treatment options. This is a positive foundation that needs to be built on to improve a service that clearly needs improving. The Department of Health of South Africa should provide adequate oral health services to the public, and should ensure that the dental staff are satisfied with their jobs. By identifying areas of concern that affect job satisfaction, these specific areas can be improved (Shugars et al, 1990). By increasing the dental staff’s job satisfaction, the staff morale can be improved. This will lead to increased productivity and quality of care (Harris et al 2008; Syptak et al, 1999). Satisfied practitioners are particularly important for a successful dental practice and the well-being of patients (Puriene et al, 2008a).