What do We Mean When We Talk About Systems Change? A Look at Smiles for Life

January 31, 2012

A training program has changed the medical education system at 460+ residency programs – systems change that could have an impact on oral health outcomes in the future.

Why do we try to change systems? As we talk about in our theory of change, the Connecticut Health Foundation (CT Health) wants to improve the health of state residents through changing systems. If we can change a system, we won’t just help one person, we’ll help hundreds, and improve health outcomes for future generations. That’s why a majority of our investments have a systems-change approach.

But what does a systems-change approach really mean? In the abstract, it’s not an easy concept to understand. So that’s why we’re taking a look at our grant to the Smiles for Life (SFL) curriculum to provide an example. SFL is a national oral health curriculum designed to teach primary care practitioners about the importance of good oral health – and is also a great example of systems change.

Changing Systems in Oral Health

At CT Health, we know that oral health is part of overall health. Research is clear that poor oral health can lead to problems with overall health such as cardiovascular disease, diabetes and low birth weight.

And yet our current health system separates the mouth from the body. This divide is most clearly seen in how dental insurance coverage is separate from medical insurance coverage and often is purchased and paid for separately.

Part of linking these two systems together involves educating primary care doctors on the importance of oral health so that they can educate their patients. The best way to integrate oral health into medical health is to reach doctors while they are in residency training.

“Habits learned during residency are the ones that stick with physicians,” says Joanna Douglass, BDS, DDS, CT Health oral health consultant and one of the original creators of SFL in 2005. “Even if a physician learns a new way of doing something later on, their preference is to return to the old way. Physicians that learn about oral health early will keep promoting it in the years to come.”

By educating current and future medical providers about the importance of oral health,  oral health champions can be created in other professions.

To Change a System, Start Small

SFL didn’t start off trying to change the entire medical educational infrastructure – it started with family medicine.

Back in 2004, some family physicians, a PhD educator, and a pediatric dentist, formed a work group within the Society of Teachers of Family Medicine, an academic association. This group was building on work funded previously through grants from a federal agency, the Health Resources and Services Administration. The goal was to put together an oral health curriculum for medical providers.

“As a residency director, I can tell you that if you make this kind of training mandatory, but then don’t give the faculty something to work with, you won’t make much progress,” says Alan Douglass, MD, one of the original creators of SFL. “Giving the faculty an easily accessible tool was a critical component of our success.”

CT Health, with other funders, funded the initiative to develop the actual curriculum. The first version was available only on CD-ROM. Later on, the SFL training was made a requirement of family medicine training at 460 medical residency programs across the United States. Now, SFL is available on the Smiles for Life website. More importantly, it has been expanded to include individual physicians, physician assistants, nurse practitioners, students, and other clinicians. The courses are free and count towards continuing medical education credits.

And Beyond

More recently, the Boston-based DentaQuest Foundation has spearheaded the creation of the National Interprofessional Initiative on Oral Health (NIIOH), which will take SFL to the next level. According to their website, NIIOH is “a consortium of funders and health professionals whose vision is that dental disease can be eradicated.” Not only is NIIOH disseminating SFL into other disciplines, it’s also bringing together different accreditation bodies, as it is these organizations that shape educational standards.

While we can’t say that this program alone will reconnect the mouth with the body, it’s definitely a great start.

Photo by Miss Millificent used under the Creative Commons license.

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