Table 3 Illustrative quotes of patient experiences

Section 1. Patients’ Overall Perception of Dental Quality and Safety

Provider Training and Qualifications

I14X: “For me, the doctors, make sure they have the right degree or masters, or they went through all the rules and studies that need to [be] completed before they start practicing.”

H1X: “What are their education? What's your background? What schools did you go to? And did you go to what school? There's a difference between going to the University of [State], then someone who went to a two-year college. You know what I'm saying?”

H15X: “I always feel comfortable when the provider tells me how long they've been doing this or sometimes I will ask them or just kind of gauging by your age, like whether […] they like their job? Do they enjoy what they're doing?”

H1X: “Well, first of all, I want to know if they've been, of course, in business a long time. If they haven't been in business long, if they've been in business for a year, I would probably not go to that provider… And so other things that will be a factor for me is do you have a lot of patients that have come to you and [do] they like you? What is your rating?”

U5X: “Maybe my other concern is the fact that we have this pre-assumption in the back of our minds that we are coming to a dental school, they are students. So, already, in your mind, you have already kind of put like a question, that this is the quality of care you are going to receive. You're giving them the benefit of doubt that "Okay, they are students in as much as there's a professor helping them or somebody behind them or shadowing them," but you are looking at the fact that they're not yet there. So, you have already adjusted your level of expectation…”

U1X: “Actually, I think I felt safer. I didn't know it beforehand coming to an academic dental office … Because you have, like, a double-check. You have the student who's been groomed on what's supposed to happen, and then you also have a teacher that's overlooking it. So, there's like, two layers of safety there, and when you go to a dental office, a local or a private one, I don't know that there's anybody that really oversees, say, the hygienist or the dentist. Nobody oversees the dentist.”

Communication

U2Y: “I guess by the information they give you. I mean, when they first meet you, the information they give you is the way I would think they can assure you that they're going to be safe in what they do. Like, at the dentist school, the students explained, the one I had explained to me exactly what she was going to do before she did it, and it kind of made me feel okay.”

I15X: “What for me is mostly concern[ing] when I go to the dentist, [is] that [the] dentist communication should be very honest. Because today I did my root canal … and I did my x-ray before. Before that, I went to three or four places to do my x-ray, different dentists w[ere telling me different things. It was three fillings with steel, later four. If we can restore the tooth they say, "No, you have only extractions options."

Cleanliness and Clinic Environment

U1X: “Well, I think maybe by observation, you would want to feel like their instruments were clean. Now how you would go about knowing that I'm not sure. You assume it, I think. And you assume that their hands… Lot of times they wear gloves.”

Durability of Dental Treatment

U12X: “…Nothing's made like it used to be done in the old days…, sometimes if you had a cap put on, most of the time it would last for a long, long time. And now days it seems like it could be only good for three years or so; or four years and I have to redo that cap.”

Section 2. Patients’ Reaction to Poor Quality Dental Care and Adverse Events

Breach of Trust

Researcher: “Would you still get care from that provider?”

U5X: “Oh, no”

U3X: “I'll think about it”

U4Y: “I wouldn't… I would stop procedure. If you don't know whether you're supposed to [treat] the right side and you started on the left side, I'd thank you, but I wouldn't… And then, I would say, No. I'm sorry. I'm going to go somewhere else."

I17X: “I just wanted to say like a year ago I went to a dentist's office, and I sat in that chair for 30 min and she must have given me 30 to 50 x-rays because she couldn't get it right and I almost literally walked out because you've got that thing in your mouth, and I hate that thing anyway. I literally almost got up and said, never mind. I don't want this anymore. But I definitely would never go back.”

I7X:” I went through a very bad experience during my extraction so right now I have this concern, I'm going to ask them if they are like qualified are they students or what? I never asked them…Yeah. I have that fear now. I'm very scared now, I have this implant pending. I'm not doing it just because of that fear.”

Fear and Embarrassment

I7X: “… it happened in the evening till the next afternoon… because I had that fear here and the pain here and there…they put the bone graft and of course I had stitches. Everything aggravated, I was scared to till date… I didn't know till last year and I'm not doing going for implant. I'll just leave [it] like that.”

U11X: “…but sometimes you don't really understand, this is what's going to happen…you don't even know what some of these words mean, but like I say, you're afraid to speak up because you're like, "Am I going to look stupid?" I think that little confidence is like, "Well they know what they're doing. I don't know what I'm talking about so I don't want to look like I'm less of a person because I don't know how to communicate my needs.”

Clinic Response to Adverse Events

U6X: “… the attitude also matters because if they are understanding and they are trying to work with you, you know error is human. So, you try to work with them. But if they are adamant about what they have done and they don't want to work with you, then yeah, you seek legal advice and take it from there.”

U2Y: “Well, like she said. Everybody can make a mistake. But it depends on the attitude about the mistake. Like, if they have the right attitude, "I'm sorry. I'll take care of it," that's okay. But if they're almost like, "Hey. I don't have nothing to do with that part," then you move to another… your attitude's going to change. It's all about attitude.”

H6Y: “I don't know if there is like a patient advocate. Who would you call or ask]?”

I16X: “I would say keep phone numbers open because of course the greatest weapon is what way of communication? Try to have somebody in the office who can take that feedback, not just the doctor itself. It you don't feel comfortable talking to your doctor, then get somebody that can… get somebody that is a feedback person. have them there.”

H1X: “Because if I was experiencing an issue with a doctor and I did not feel I was getting the right care or I wasn't able to ask the right questions, I would be able to advocate, get my advocate involved so that he will understand what I need, what my needs are before I walk through the door. And so that way I can get my needs met.”

Section 3. Patients’ Perception of Their Role in Promoting Quality and Safety

Rationale for Participation

U11X: "… If this is happening, this could happen to me or somebody else."; “So, I personally …make it a big deal when I see something that is out of the normal or I'm concerned about, even if it's not personally dealing with me, I tend to report it. Because I feel like if this is happening, who knows what else is happening and who it's happening to?”

H1X: “… I'm an advocate for myself, not everybody can do that. I advocate for myself because I need to know that I'm getting the best care and if I feel like I need a second opinion, I'm going to do that too… I even had this situation where I went to a different provider because I felt like I wasn't getting my needs met, and I did go and I got my needs met. It's all about being able to say what you need, not everybody can do that, I can.”

Timing of Participation

U9X: “Well, yeah. If something happens, something like that day with my root canal. Yeah. That was not good. And yeah, I let him know in a hurry. This is not going to work. Cause I went back and said, okay, I paid you up front, and you didn't do the job. I want at least half of my money back.”; “Patients should do it when they're all done with whatever you're having done… [not] asking their opinions later….”

I11X: “I would prefer not to have it right away, but maybe wait until the next day to ensure the patient is able to provide accurate feedback.”

Format of Participation

U6X: “Sometimes when you visit a physician, they have these surveys at the end of the visit. It's just a small note, a slip that they tell you to give your comment……. maybe it's not going to be like the whole year but periodically, you can put those boxes that people can write comments on how their visit was, so they can put it down.”

H14X: “Yeah. Possibly or that little reminder card. Why we want to continue improve that quality. If you have any concerns, please let us know. We want to learn from you…and encouraging people with concerns that they really want to hear them…”

I15X: “If the patient really cared about their health, they care about their self, they will. I was so desperate to let them know what I was thinking so I wrote a letter. So, I think if patients want to, they will.”