Mission accomplished

1
Mission accomplished?

• Roland Valori
• February 2008

2
Mission accomplished?

• Depends on who you ask
• Patient
• Payer
• Policy maker
• Provider
• Workforce
• and what endpoint is used
• and when the mission was planned to end

3
Mission statement

• Best deal for the patient within resource
  constraints

4
Endoscopy 6 week waiters
From 250,000 to 5,000 without an appointment in
four years
5
GRS National results October 2007
scoringA or B
6
GRS National results October 2007
scoringA or B
7
JAG peer review accreditation visits

• Accreditation based on
• GRS
• Training domain of GRS
• Other factors principally
• workforce,
• environment and
• Decontamination
• Documentation supporting self GRS scores is
  checked

8
Roll out plan
First wave 2006/7
Second wave 2007/8
Third wave 2008/9
9
The ripple and halo effect

• BCS will improve the outcome of all patients with
  bowel cancer by
• raising awareness
• improved endoscopic services
• improved radiology, surgery and pathology

Fundamental principle introduction of bowel
cancer screening should not have an adverse
effect on symptomatic services
10
Bowel cancer screening - is a strong motivator

• Regardless of uptake rates, four colonoscopy
  lists are required to save
• one person dying from cancer and
• one person getting cancer
• Screening comes with resource

11
GRS JAG accreditation

• Mission accomplished for
• Patient
• Payer
• Policy maker
• Workforce
• Mission not accomplished for
• Provider organisations

12
What is left to do?

• Achieve sustainability
• Create a culture of excellence

13
Preparing for a sustainable solution
2007
2008
2009
2010
backlog
steady state
14
A high performing endoscopy service
Effective Leadership and Teamwork Ensures
Sustainable Improvements
Quality Framework
Tools and Techniques
15
Quality framework

• Standard
• A process to measure it
• A method of enforcement

16
Using the market to improve quality
Commissioner Family doctor Patient
Acute Hospital unit
all providers measured against the same standards
GRS accreditation
Community hospital unit
Private hospital unit
Training centre unit
17
Have we got all the standards right?
18
Quality indicators for removing high risk colonic
lesions
Remove the lesion safely and completely, and
retrieve it
Make a decision about what to do
Get to, and identify a lesion
Recognise what it is
19
Quality indicators for removing high risk colonic
lesions
Remove the lesion safely and completely, and
retrieve it
Make a decision about what to do
Get to, and identify a lesion
Recognise what it is
Knowledge
Judgement
Skills
Skills
20
Quality indicators for removing high risk colonic
lesions
Remove the lesion safely and completely, and
retrieve it
Make a decision about what to do
Get to, and identify a lesion
Recognise what it is
Knowledge
Judgement
Skills
Skills
Attitude
21
Attitudes affect judgements
Too cautious
Too cavalier
acceptable zone
Attitude
22
A high performing endoscopy service
Effective Leadership and Teamwork Ensures
Sustainable Improvements
Quality Framework
Tools and Techniques
23
We agree we should be measuring the standards
but it takes us away from patient care

• Getting the audits done for the JAG visit is a
  problem

24
Performance and revalidation
JAG
Licensing through accreditation
Licensing through revalidation
G
R
S
Acute Hospital unit
Registered endoscopists electronic log
G
Community hospital unit
R
Private hospital unit
S
Training centre unit
25
Integrating data in Gloucestershire
Reporting system
Late outcomes
Immediate outcomes
Acute Hospital unit x 2
Integrated endoscopist performance record
quality
safety
Community hospital unit x 3
Private hospital unit x 2
Training centre unit x n
comfort
feedback
Data captured from three recording systems
26
Colonoscopy completion rates
27
Performance Comparisons
28
Immediate adverse events- captured before the
patient leaves the department
29
Personal electronic log e-portfolio
Integrated endoscopist performance record
Baseline information
Trainer activity

CPD activity
DOPS
360
30
Select NEP from the menu
31
Enter a procedure
32
Trainers DOPS Entry Screen
33
Trainers DOPS Entry Screen
34
Completed DOPS form
35
Trainee Evaluation of Trainers Skills
36
Trainers Skills Analysis
37
Real Data - Trainers Skills Analysis
n 92
38
n 9
n 10
39
Populating an electronic log from available
databases (Gloucestershire)
SQL scope
Unisoft
PAS
Three endoscopy units
One e-portfolio
40
Performance Analysis
Data can be viewed over various date or procedure
number ranges, for individual sites or all
combined and for a single procedure type or for
all
41
Performance Analysis
Specific Colonoscopy data
42
Performance Analysis
43
A high performing endoscopy service
Effective Leadership and Teamwork Ensures
Sustainable Improvements
Quality Framework
Tools and Techniques
44
Endoscopy Team Leadership Programme (ETLP)

• The purpose of the ETLP is to help endoscopy
  teams achieve and sustain high performance
• It is very clear that high performance is
  achieved when
• highly competent leaders work together with a
  common purpose
• there is effective teamwork in the department
• there is a strong patient focus

45
Factors that underpin high quality, patient
focussed care
46
Endoscopy Team Leadership Programme
47
Endoscopy Team Leadership Programme
47
48
ETLP - assessment

• Measuring outcomes gives direction and tell us
  how we are doing
• The following outcomes will be assessed during
  the ETLP
• productivity of the service
• support for and development of the workforce
• quality of the patient experience
• clinical quality
• team assessment
• assessment of leadership and managerial skills

49
A high performing endoscopy service
Effective Leadership and Teamwork Ensures
Sustainable Improvements
Quality Framework
Tools and Techniques