The Endoscopy Global Rating Scale GRS

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The Endoscopy Global Rating Scale (GRS)

• Achieving top Marks

Roland Valori Debbie Johnston BSG Annual
Meeting-March 2006
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GRS - patient-centred outcomes

• Quality and safety
• appropriateness
• information/consent
• safety
• comfort
• quality
• results to referrer

• Customer care
• equality of access
• timeliness
• choose and book
• privacy and dignity
• aftercare
• patient feedback

www.grs.nhs.uk
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GRS - levels for Safety item

• Level D
• adverse events reviewed
• Level C
• level D events are acted upon
• Level B
• level C action is monitored for effectiveness
• Level A
• level B and prospective monitoring of 5 known
  adverse events

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GRS National results
scoring A or B
85 completion
94 completion
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GRS National results
scoring A or B
85 completion
94 completion
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GRS next census April 2006 Why complete?

• Completion provides
• clear identification of gaps in the service
• evidence for more resource
• incentive for staff
• objectives
• deadlines
• evidence for merit awards

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Bowel cancer screening programme
Colonoscopy site
accreditation visit
Screening centre
treatment
Persons aged 60-69
accreditation visit
Colonoscopy site
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JAG accreditation visit

• accreditation will be based on validated GRS
  score
• A for timeliness
• B for all other items

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• GRS has finally given the service the direction
• that it needs. It has really fired up endoscopy
  teams to work together across the patch.
• They share more and they support each other.
• We have built an SHA wide Endoscopy knowledge
  network as a direct result of it.
• Sue Tunnicliffe-Endoscopy Facilitator BBC
  SHA-Oct 2005

www.grs.nhs.uk
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Quality improvement how to do it

• The GRS provides a framework on which to
  prioritise tasks
• A web-based knowledge management system links
  solutions directly to problems
• Action planning templates and a traffic light
  system complete the support function of the GRS

Supported by a how to do it approach
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The GRS - top tips

• Look at all the tools and advice available before
  you start
• Include the whole team
• Complete it online twice a year
• Engage with your local SHA lead, they will
  provide support, guidance expertise

Complete the GRS
Service Example Raise awareness of the GRS to
all members of the team and explain how it works
publish the results of consecutive surveys to
demonstrate improvements Meeting the
Challenges looking to the future March 2006
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The GRS - Getting to grips with it
top tips from the service

• Involve as many of the following staff and
  departments

Dont go it Alone
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Service Example

• The Endoscopy Service in New
• Cross Hospital (Wolverhampton)
• negotiated to have a dedicated
• GRS Project Lead for a fixed
• period.
• Dr Andrew Veitch and Jane McKiernan,
• (GRS Project Manager)
• andrew.veitch_at_rwh-tr.nhs.uk
• jane.mckiernan_at_rwh-tr.nhs.uk

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The GRS- Top tips

• Establish links with neighbouring endoscopy
  departments is strongly recommended.
• Each SHA has an endoscopy clinical lead that can
  bring endoscopy units together to share
  experiences of service improvement.

Link with others
Service Example Many SHAs have established
Endoscopy Network Group. The units share
approaches and successes in the development of
GRS. Co Durham Tees
Valley SHA
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Co Durham and tees valley SHA - Endoscopy
Coordinator Roles
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The GRS- Top tips
Be Brutally Honest

• Be brutally honest with the self-assessment for
  GRS
• There will be some early easy wins that will be
  great morale boosters for the team.
• Use the new GRS poster to raise awareness with
  all staff groups

Service Example Print and display the results
for the team is aware of how well they have done
and which measures have not been achieved.
Avon
Gloucester Wiltshire SHA
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The GRS- Top tips
Identify the Quick Wins

• If resources are limited prioritise work to get
  quick wins, otherwise the task will be too
  daunting.
• This will just mean some simple changes in
  processes to achieve higher levels on the GRS.

Service Example Use the Knowledge base to
download tools and guidelines, but remember to
adjust whatever you use to the context of your
local service
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GRS item 11 Aftercare levels C and B
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GRS item 1 Consent levels C and B
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The GRS- Top tips
Finish outstanding work

• If resources are limited prioritise tasks to get
  quick wins,
• This may mean some simple changes in processes to
  achieve higher levels in some items.

Service Tip Review outstanding work as a team.
Agree and assign the uncompleted tasks. Use the
GRS Knowledge System to avoid re-inventing the
wheel. Be Adept-Adopt and adapt.
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The GRS- Top tips
Create Action Plans

• Prioritise actions ensuring an individual or team
  has responsibility.
• Involve as many in the process as possible
  share the work!
• Involvement creates ownership sustainability.

Service Tip Many endoscopy services have
assigned leads for specific GRS items. This
ensures involvement by the whole team
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The GRS- Top tips

• Ensure that the whole team is aware of the KMS.
• The KMS provides practical examples from other
  endoscopy units of
• Guidelines
• Audit tools
• Presentations etc

Use the KMS
Service Tip The team should be encouraged to
both use and contribute to the KMS
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GRS Knowledge Management System

• GRS What is new?
• New Homepage Letter
• BSG Quality Safety
• Measure changes
• Demos.
• Knowledge Base (KMS)
• Updated Documents

www.grs.nhs.uk
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Access to Knowledge Management
Access directly through the GRS Home
page or From each measure or Through the action
plans No Login required
www.grs.nhs.uk
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Future of knowledge management for Endoscopy

• Currently demand is huge for the KM system. The
  service wants us to develop it further.
• Local Knowledge communities are gaining momentum
  and feeding in their learning and successes.
• Scotland live April 06, Wales and Northern
  Ireland considering its implementation

It will be only as good as you make it
www.grs.nhs.uk