Reconsidering how we define quality: insights from the co-development of an actionable definition of oral healthcare quality,mntion.

BACKGROUND: The burden of oral diseases on society remains relevant as vulnerable groups lack accessibility to oral healthcare and it is expensive on a societal scale. While there is renewed political will from the UN to expand Universal Health Coverage to oral health, quality issues remain. Solving such complex systematic problems requires coherent efforts that span multiple stakeholders and sectors. The co-development of a definition of oral healthcare quality serves as a key enabler for quality improvement interventions as it facilitates collective understanding and normative directionality. METHODS: As part of the EU DELIVER project, a five-step co-development process was leveraged for consenting an actionable definition for quality of oral healthcare: (1) literature screening to identify relevant themes of quality of oral healthcare; (2) compilation of a starting list from these themes; (3) World Café sessions to deliberate about themes to define quality of oral healthcare; (4) thematic analysis of information from the World Café sessions; (5) final voting and completion of the definition. The definition provides a clear foundation and normative directionality for co-developing quality indicators and targeted interventions for quality improvement. The Consolidated criteria for reporting qualitative studies (COREQ-32) were used to report the study. RESULTS: Drawing from the breadth of the extant scientific literature and the depth of stakeholder insights from the World Café sessions, the following working definition was agreed upon: "Quality oral healthcare refers to the contribution of healthcare to optimal oral health. This entails that care alleviates oral health inequity, is comprehensive, empowers patients, mitigates harm and encourages learning systematically, improves well-being, minimizes waste of resources and is provided at the right time. To maximize quality, care should be equitable, accessible, patient-centered, safe, effective, efficient and timely." The definition forms the basis for the operationalization of targeted quality improvement interventions on the practice-, community- and health systems levels. CONCLUSIONS: The definition for quality of oral healthcare is the first that was co-developed together with providers, policy-makers, and patients from various European countries. This definition provides meaningful normative direction and is highly relevant to collective problem-solving aimed at optimizing the quality of oral healthcare.