How long will the scale take to complete?
The scale will take approximately 1-2 hours to discuss with your team and agree the responses to the measures. It will then take a member of staff approximately 10 minutes to input the answers onto the online system.
What is the deadline for completion of this national census?
The deadline for completion is at the end of April and October every year. The system can be populated once a month to enable you to track changes more frequently. However there will only be National and SHA comparisons available for the two national census months: April and October each year. We ask everyone to complete GRS submissions in these months so that we can develop a national view of endoscopy services in England. It also enables individual sites to compare their data with national averages.
When can we view our data?
You can view your own data as soon as you have submitted it. However, to compare your data against SHA and national averages you will need to do this after the last day of the month. This will allow other units to submit their scale by the end of the month.
Who should be involved in the completion of the scale?
We would recommend that the whole team has an opportunity to both discuss and contribute to the completion of the scale. We have advised that the following members of staff are key to this process, the nurse lead, the clinical lead and the operational manager for the unit.
Why is in important for nurse lead, the clinical lead and the operational manager for the unit to be involved in the discussions?
It is important to have a cross-section of professional groups involved in completing the scale to get an accurate assessment of the challenges facing the unit. This will ensure full engagement and ownership by the team. Action plans are more likely to be supported if the scale is approached in this way.
Why can't we see a comparison of our results with the first paper-based global rating scale that we submitted in Sept 2004?
The new version of GRS is underpinned by measures to derive a more objective assessment of the levels rather than just relying on the descriptors of the first version of the GRS. The first version of the GRS was set in a different format and was not underpinned with measures, therefore a straight comparison is not valid. The levels of the new GRS are more strict than the first version, therefore we expect units to achieve lower scores with the new GRS unless there have been significant improvements in their service in the intervening period.
Will my scores be anonymised?
The intention is that only your SHA Clinical Lead will be able to identify your scores. However, the Freedom of information Act states that we will be obliged to release information if requested to do so. Having said this, we will do our best to maintain anonymity.
Is this not just another set of Government targets?
We would prefer to use the term “aspirational goals” rather than targets. Health professionals working in the service have chosen the items and the measures that underpin the levels. If a unit is struggling to bring an item on the scale up from level D, then we will be offering that unit some support through the SHA clinical lead for endoscopy. Having said this some Government targets are embedded in some of the items. For example, there are targets in the Choose and Book item.
Is it true we do not have to complete this scale because our unit is part of a Foundation Trust?
There is no obligation for anyone to complete this scale. The purpose of it is to help endoscopy units identify areas for service improvement, benchmark themselves against the rest of the service and enable them to prioritise their efforts to improve the service. It also provides support to achieve these goals and may help them achieve more support for their service from their Trust. We would like you to complete the scale so that we can assess whether our programme is having an effect on the service. The more units that respond the better the picture we will have for the service, we will then be in a Ber position to campaign for more central support.
Will the GRS eventually be used as a quality measure for the service?
This GRS provides a patient centred view and we would ultimately, like to use the scale as a quality measure. For those units who wish to participate in the bowel cancer-screening programme their unit will be subject to an accreditation visit and this scale will be one of the quality measures used for that process. The exact level an endoscopy unit will have to achieve has yet to be decided, but in the first instance, we will not be expecting every unit to achieve the top level on every item. However, in future years we will be raising the minimum standard and all units participating in bowel cancer screening should be achieving the upper level on all items on the scale.
Can I use this scale to help me get more resource for my unit?
If the score identifies that you could do much better for certain parts of your service we would expect Trust management to ask whether there was anything you could do within your current resource to improve the situation. Once you have gone through this process we believe you would be in a powerful position to bid for more resource. For example Trusts are getting increasingly concerned about clinical risk and will be eager to minimise risk through the processes in the scale. They should also be developing a better understanding of what their patients want from the service and we would expect them to be keen to be able to demonstrate improvements in patient satisfaction through patient lead initiatives.
The GRS is recommended in the (Feb 05) CEOs guide to achieving the cancer waits targets
The Trust Board supports our desire to improve our patient care and says that the aspirations of the GRS are laudable. However, it says that the budget is in deficit and there is just no money to support the service. What do we do?
In this situation endoscopy will be competing with other services for more resource. However, in many circumstances development in endoscopy has lagged behind other services and this is manifest by extraordinary long waiting times. Diagnostics is regarded to be a key constraint for the 18-week referral to treatment target and Trust Boards and commissioners will be under huge pressure to develop a no wait service for endoscopy and other diagnostics. Despite the difficult financial situation there has never been a better time to prepare a carefully constructed business case to support your service. However, do NOT assume that your bid will be successful unless it is backed up by sound evidence (data). The more information and comparative data you have, the higher the chance of success. If you believe you have had a sound business case rejected because of lack of resource please let your SHA clinical lead know.
Will the independent sector (IS) endoscopy services be required to complete this scale?
The Department of Health has asked us to provide a quality framework for IS procurement contracts. The GRS will form the bedrock of this framework. If the GRS is used in this way then it may also be used in the future to underpin patient choice. If this happens then endoscopy units could then be competing for business on the basis of their GRS score. The message for the Trust Boards is that the sooner the service is achieving high scores the more likely they are to hold on to the business. It may seem inconceivable for some units to think that they may not have enough work to do to sustain their infrastructure but some Foundation Trusts (who depend on item for service income) are very worried about losing volume activity in services such as endoscopy.
The scale requires intensive monitoring of processes and outcomes. We haven’t the time or resource to do this, however much we think it a good idea. Why should we bother?
Industry will devote 3-5% of its budget to quality assurance. An average endoscopy unit doing 5000 procedures a year will generate an income of at least £2,000,000/year, possible much more. 3% of this is £60,000/year. If you haven’t the resource to develop the processes we hope that the scale will help you provide clarity of what you need to support a bid to the Trust Board. Your clinical risk and Patient and Public Involvement departments will be delighted if you approach them for help and guidance. Usually they are struggling to engage clinical teams, not fending off enthusiasts.
We haven’t got an IT system that can provide us with data for the clinical outcomes. Do we need one?
It will be very difficult to achieve the highest scores on quality, safety, aftercare and comfort without a modern endoscopy reporting system. If you haven’t a system, or your current one cannot provide the data, we Bly recommend you place an early bid for such a system. If you wish to become a centre for bowel cancer screening it will be mandatory to have an IT system that can upload quality assurance data to a central computer.
The highest scores on the scale seem unobtainable because we are fire fighting all the time. Is it realistic to expect to achieve them?
We have tried to ensure that there is nothing unachievable on the scale. Some older units may struggle to provide sufficient privacy for patients but we hope that this deficiency (if it exists) will be highlighted by the scale and enable you to bid for new accommodation.
How does the scale support service improvement?
Our starting point when we devised the scale was to ask the question: what matters to the patient? We believe service improvement is all about making it better for the patient and the GRS is all about identifying the gaps in patient care. Once you now where the gaps are and how big they are you can start prioritising your efforts to improve the service. There are hover over help screens behind the majority of the measures that will provide you with all the knowledge we have to help you achieve a positive response to that measure. Additionally, there is a knowledge Management System (KMS) that can provide you with a variety of information:
- General information
- generic processes that you may wish to copy or modify
- guidelines on clinical care, auditable outcomes or pathways
- examples of best practice or ways to solve problems
- service improvement information
- data collection tools
- sample business cases
- key contacts
- sample presentations
- links to other websites
- etc
Most of us are keen to use the scale but some health professionals who use the department are letting us down and stopping us achieve higher scores. What do we do?
Sadly this is not an uncommon situation. It is also a difficult one to deal with. Very often the problem is due to misunderstandings and worries that have little or no foundation. Therefore the first thing to do is concentrate on improving communication. Poor communication is at the heart of most units that struggle to provide a quality service. If improving communication is ineffective it may be necessary to go through official channels: directorate management structures, governance and risk committees, medical directors etc. The solution very much depends on the problem. Remember, good communication is critical - it will resolve the majority problems.