Oral and maxillofacial surgery (OMFS) is one of the 10 GMC-recognised UK surgical specialties. OMFS is concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck.

• The scope of the specialty includes several subspecialties that deal with, for example, the diagnosis and management of facial injuries (trauma), head and neck cancers (oncology), salivary gland diseases, facial disproportion (orthognathic surgery), facial pain, impacted teeth, cysts and tumours of the jaws as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections (oral and dentoalveolar surgery)…
• The OMFS specialty is unique in requiring dual qualification in medicine and dentistry.

For more information, visit the Royal College of Surgeons of England website    

The British Association of Oral and Maxillofacial surgeons (BAOMS) is a professional body representing Oral and Maxillofacial Surgery. Its members include consultants and trainees, at any stage of training, in the specialty as well as dentists and doctors working in OMFS departments.

For more information, visit About BAOMS

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In recent decades, changes in the management of patients and in the health service mean that patients, surgeons and commissioners need accurate and timely information to be able to make informed decision about care.

• A patient-centred approach has become a core component of what is considered high-quality healthcare. In current surgical practice, the patient’s perspective and involvement in shared decision-making and a focus on patient-reported outcomes have become increasingly important.
• The increasing cost of healthcare has reached unsustainable levels. Healthcare commissioners are under increasing pressure to ensure that expenditure is directed towards care that delivers a demonstrable benefit in health-related wellbeing to patients and efficiency in the delivery of healthcare services will help ensure a sustainable model of service provision.

Back in 2018, there was insufficient systematic collection of data to demonstrate effectiveness or quality of care across OMFS in the UK. That is why BAOMS initiated the QOMS project for its specialty. QOMS aims to be in a position to provide care users and providers with that information to make those choices.

Since, the QOMS project has delivered an efficient audit programme for the specialty but more work is still needed to encourage more OMFS departments to join the project.

For more information, visit the Royal College of Surgeons of England website    

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When it comes to measuring quality of care, one size does not fit all.

A widely accepted definition of quality care is “doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results”. It does not tell what to measure or how. There is no one measure of quality that can capture all these different aspects.

Quality of care depends on who your audience is and how they want to use that information:

• Surgeons want to know that they are providing the best care to their patients. They are generally interested in clinical outcomes (e.g. has the tumour been completely removed? Has the patient remained disease free? Did the patient develop any postoperative complications?) 
• Patients want to know what their outcome may be (e.g. can I be cured? What are the risks?...), how their quality of life may be affected (e.g. can I breathe, eat, or speak normally? Do I look better? Can I go back to work?...). There is also a strong psychological component attached to the patient’s experience as there could be a gap between surgical/treatment success and patient's satisfaction. Patients’ outcomes and experiences are usually collected using specific tools or questionnaires called patient-reported outcomes or experience (PRO or PRE).    
• For commissioners, outcomes are about care quality, costs and value-for-money. Databases already exist for the latter (e.g. the Hospital Episode Statistics in England).  

Figure 1. Tailoring Quality of Care Measurement

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From the onset, we knew we would not be able to measure quality of care in its entirety and that we would need to take some difficult decisions and make some compromise.

Figure 2. Development process of QOMS

1. Which subspecialties or areas of OMFS practice should be included?

The main considerations for a subspecialty to be considered for inclusion in QOMS were that:

• It should not be an obscure or minor area of practice
• No other dedicated audit or registry was already in place (e.g. the cleft audit, the BATS TMJ Replacement audit)
• Variations in care is present
• Standards already exists or not

2. Which procedure(s) and conditions to be considered?

The volume and risk associated to a condition or a procedure are important factors that dictate the type of quality-of-care indicators that are relevant:

• Low-volume and low-risk procedures (e.g. Sistrunk procedure): no SMART indicators
• Low-volume and high-risk procedures (e.g. craniosynostosis surgery): Structural measures*
• High-volume and low-risk procedures (e.g. orthognathic surgery): Structural or process measures*
• High-volume and high-risk procedures (e.g.: major head and neck cancer resection with flap repair): process or outcomes measures*

Table 1. Types and definitions of quality-of-care measures 

Figure 3. Volume and risks of procedures and conditions

3. Which quality of care indicators to be included?

SMART is an acronym that describes the criteria quality-of care indicators should fulfill:

• Specific to OMFS
• Measurable and readily accessible (this means it must rely on collecting information regularly documented in clinical care)
• Actionable by the surgical team
• Relevant to the surgical team, patients and/or the commissioners.
• Timely as the value of data decreases with time.

Figure 4. Characteristics of quality-of-care indicators

What does QOMS want to achieve and how?

• Produce information on the quality of care received by patients undergoing oral and maxillofacial surgery in NHS hospitals.

QOMS plans to identify best performers against any given metric across the NHS, quality assure that data and then generalise the care practices that underpin it by case studies, newsletters, presentations at conference, as well as BAOMS website content. Where performance falls significantly below the average, and data checking confirms that to be the case, BAOMS intends to provide mentorship for change.

• Ensure that any change or improvements to OMFS services benefit patients.
• Learn about the best ways in which surgical teams can use patient information to improve quality of care.
• Understand better what happens to patients after they leave hospital following surgery, and whether the surgery has had a beneficial effect on their longer-term health and wellbeing.

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Clinical audits & service evaluations

Clinical audits & service evaluations are roughly the same thing:

• Clinical audits are a way of appraising medical care by evaluating the care provided against standards of care for a particular condition
• When there are no standards of care available, the process is called "service evaluation" instead and care is measured against a “national” average

They both help clinicians to check whether the care provided to patients meets those standards (if available) and help them to identify any shortcomings.

Areas of OMFS practice included in QOMS:

• Oral and dentoalveolar surgery (2021-2025)
• OMFS Trauma: Mandibular and isolated orbital wall fractures (2021 onwards)
• Oncology (cancer) (2021 onwards)
• Orthognathic surgery (position the upper, lower or both jaws) (2021 onwards)
• Reconstruction (correction of defects) (2021 onwards)
• Non-melanoma skin cancers (2021 onwards)
• Temporomandibular joint (2025 onwards)

Condition- or procedure-specific registries

The remits of OMFS also include the management of some rarer conditions affecting the head and neck regions. QOMS also includes registries that collect the data of patients affected by these conditions. In those cases, we are not measuring quality of care, but instead we are trying to gather evidence to better understand those diseases and how they are treated in the UK. Currently, QOMS operates two such registries:

• Salivary Gland Cancers registry
• Rare and benign Lesions of the Jaws registry

Their aims are to understand better the natural history and treatments, by accumulating the data of patients affected by those conditions. This process is akin to research but has a set of distinct characteristics:

• It uses real-world data rather than data generated specifically for research.
• It deals with questions where research is not easily done due to the rarity of the condition or the lengthy follow-up required. For example, salivary gland cancers develop over long period of time, and their follow-up can be as long as 10 years following treatment.

Table 2. QOMS summary 

More details can be found on the Important documents page 

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Every time a patient interacts with a healthcare professional, new data is generated. That could include symptoms, diagnosis, treatment and recovery. We asked your surgeons to share some of that information with us. The nature and extent of the patient data QOMS collects vary between workstreams and the aspects of care being measured. They geenrally all include:

• Identifiable information e.g. patient name, NHS number or equivalent, gender, date of birth and postcode. Those are generally used to identify and trace patients across hospital record systems.

• Clinical data, which include information about baseline health status (co-morbidities), diagnosis, surgery and recovery/rehabilitation. They are used to assess outcomes and measure performance.

Figure 5. Simplified QOMS data flow with ‘hotspots’

The data is entered into and stored on our electronic database system, separate from that of the hospital, securely on servers in the UK.

Whilst data remain under our care, we will never share information that can identify you with any other organisations for reasons other than linking datasets with approved partners. The data collected may be however shared for secondary research but only after ethical approval has been obtained, and the application will be thoroughly reviewed by BAOMS. No patient identifiable information will be passed on.

Data will be analysed regularly. Before we take it out of the secure servers, we anonymise it. This means that NHS numbers are deleted, dates and postcodes are transformed into usable information like age, time elapsed between two clinical events, distance between a patient’s home and the hospital. That way all the information that could be used to identify a patient has been removed. During the analysis stage, the data of many patients are further combined together (e.g. averages) to produce a picture of quality of care in a hospital or a region.

Data is kept for 4 years after the end of data collection. Once some or all of data has been meaningfully analysed we will delete the patient identifiable information. The anonymised data can be kept and used for secondary purposes (e.g. research) other than its primary purpose (audit/service evaluation). When an entire dataset is no longer required, it will be completely deleted. 

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