Saturday Smiles Clinic

Aim

The Saturday Smiles Clinic aims to expand targeted access to Gold Coast Oral Health services for high-risk groups within the community, specifically the patients eligible for the Child and Adolescent Oral Health Service (CAOHS) and improve service delivery uptake and output.

Outcomes

Externally, patient feedback has been overwhelmingly positive, with many highlighting the convenience and accessibility of weekend appointments, friendly staff and excellent standard of care provided. From 7th December 2024 to 12th April 2025 there was a total of 14 Saturday Smiles Clinics held.

From an organisational and productivity standpoint, the Saturday clinic trial demonstrated significant cost-effectiveness. On average it operated at a weekly surplus of $3 260.69. Internally, staff reported positive experiences attending the Saturday clinic.

Themes of feedback centred around:

• timely access of service for patients
• better patient outcomes
• flexible appointment books
• fewer fail to attend appointments
• happier and appreciative patients and parents
• increased income
• improved morale

Background

Queensland experienced the largest population increase among Australian states and territories in 2020-21. The annual growth rate of 0.9% was fastest than the national average (0.2%). This growth inherently increased the demand for healthcare services and infrastructure due to the expanding eligible community. Despite a 3.2% annual increase in eligibility,

Queensland's public oral health service utilization for the 0-15 age group declined by an average of 9.5% per year from 2017/18 to 2020/21. Notably, the Gold Coast HHS exhibited the lowest utilization rate among all Queensland Health and Hospital Services during this period. This study revealed a significant disparity in service delivery and utilisation within the Gold Coast Hospital and Health Services compared to other Hospital and Health Services, highlighting a critical need for evaluating current care models. The significant decline in utilisation despite increased eligibility strongly suggests that there are barriers preventing children and adolescents in the Gold Coast from accessing necessary oral healthcare.

In response, we sought to understand:

What are the that barriers impede service utilisation for the 0-15 age group, and how can we effectively address them?

Stakeholder feedback consistently identified access as a primary obstacle. The traditional Monday-to-Friday, 8am-4pm operating hours of the public Gold Coast oral health service presented a substantial barrier for school-aged children. Gold Coast Health requires all underage patients to be accompanied by a parent, legal guardian or carer for oral health consent and medical history disclosure. This challenge
is particularly acute for priority populations, such as those from socially disadvantaged or low-income households, where parental time off work translates to lost income. Parents also often hesitate to disrupt their children's education for appointments, leading to delayed care. Delayed dental care can lead to a wide range or negative effects such as dental infection, pain, and the loss of a tooth. To bridge this gap, the Saturday Smiles Clinic was launched. By extending service operations to Saturdays, we aimed to provide increased and equitable access for those unable to utilise the service during standard weekday hours

Discussion

The unwavering cooperation and support from our staff were pivotal to the success of this pilot program. The program's feasibility hinged on the willingness of personnel across all streams to dedicate their personal time and work on a Saturday. Their commitment was not only essential but deeply appreciated, as without their dedication, this initiative would not have been possible

During the pilot program, the following limitations were identified:

• Restroom Accessibility: Patient access to restroom facilities, located in an external building, was restricted. Building management denied a request for open access on Saturdays due to security concerns. To mitigate this issue, a protocol was implemented whereby patients could use the staff restroom when escorted by a staff member.
• Staff Absences: A potential operational barrier was identified concerning late-notice staff absences. Given the difficulty in securing last-minute replacements, patient appointments may need to be cancelled. To proactively address this, it is recommended that a stand-by list of available staff be compiled on the day preceding each Saturday clinic. Thereby minimizing the potential for patient cancellations.

The pilot program garnered positive feedback from both internal and external stakeholders.

• Patient Feedback: An overwhelming number of compliment cards were received from patients and families, expressing appreciation for the accessibility of weekend public health services. However, some patients reported difficulty locating the facility due to inadequate signage. This was effectively addressed by placing a sandwich board sign to enhance street visibility.
• Staff Feedback: Staff expressed gratitude for the increased flexible working conditions and the opportunity to supplement their income. Furthermore, a positive shift in company culture was observed, with staff citing a strong workplace
  atmosphere, collegial support, and positive patient interactions during Saturday shifts.
• Staff Health and Safety: A primary consideration was the potential impact of overtime shifts on staff health and safety. To mitigate fatigue and burnout, it is recommended to implement a policy limiting the number of overtime shifts within a specified timeframe, ensuring equitable distribution and promoting work-life balance. Future population growth projections underscore the critical need for expanded oral health service delivery and uptake.

Given the demonstrated success of the Saturday Smiles Clinic, the objective is to transition the Saturday clinic from a trial to a permanent service. The pilot program's Saturday shifts served as a significant staff incentive due to overtime remuneration.
However, permanent implementation presents a potential challenge. Integrating the Saturday clinic into regular roster patterns would likely necessitate a restructuring of staff schedules, potentially eliminating overtime penalty rates. This transition requires careful consideration to maintain staff morale and ensure continued participation. The expanding population necessitates increased service delivery across all healthcare sectors, not just oral health.

The demonstrated success of this pilot program suggests that addressing access barriers is universally beneficial and can lead to meaningful and positive outcomes for staff, patients and the organisation. A model of care incorporating Saturday clinic services could be readily adapted to enhance service delivery in various allied health fields, such as physiotherapy and podiatry. Particularly in fields where timely access significantly impacts patient outcomes, like mental health and social work, this model could be highly valuable.

References

1. Queensland Treasury (2022). Queensland Government Statistician’s Office. Population growth highlights and trends, Queensland.

2. Queensland Health (2024). Oral Health Services: Planning Guideline Consultation Paper.

3. Queensland Health (2012). Office of the Chief Dental Officer. Oral Health Services Information Sheet. Information Sheet 25 – June 2012 Weighted Occasions of Service.