1. Endoscopy Global Rating Scale and Knowledge Management System National Endoscopy Team April 2008 www.grs.nhs.uk

2. What is the Global Rating Scale (GRS)? The GRS is a web-based self assessment tool that provides a standard for accreditation and a quality framework for service improvement

3. Endoscopy Global Rating Scale The GRS evolved from a desire to determine whether endoscopy units were providing a patient-centred service www.grs.nhs.uk

4. From this desire a question arose : What matters to a patient having an endoscopy? www.grs.nhs.uk

5. What matters to a patient having an endoscopy?  At a series of meetings held throughout England endoscopy staff were asked what they thought was important for a patient having an endoscopy  from their responses the 12 items, or patient-centred standards, of the Endoscopy Global Rating Scale were created

6. Twelve patient-centred standards endoscopy global rating scale · Clinical quality  appropriateness  information/consent  safety  comfort  quality  timely results www.grs.nhs.uk Quality of patient experience  equality  timeliness  choice  privacy and dignity  aftercare  ability to provide feedback

7. Item 12 - Ability to provide feedback The twelfth item of the GRS, requires an endoscopy service to regularly seek and act upon feedback from its patients This item ensure the GRS captures all important aspects of the patient experience

8. Endoscopy Global Rating Scale  In the first stage of development levels of achievement (D-A) were created, where level D was basic and level A an excellent service  Descriptors were formulated for each level Descriptor is a statement that describes what has been achieved at a given level of the scale www.grs.nhs.uk

9. GRS - levels and descriptors for the Quality item Level D – Nationally agreed quality standards are published in the department Level C – There are processes in place to monitor the standards Level B – Action is agreed if performance falls below the standards Level A – Action taken in response to poor performance is reviewed to ensure the action has been effective www.grs.nhs.uk

10. Endoscopy Global Rating Scale  To enhance objectivity of self assessment each descriptor was underpinned by two to five ‘measures’ A measure is a statement that describes a process or standard www.grs.nhs.uk

11. D C B A 1 2 3 4 5 6+ 12 patient centred items Each item has four levels A-D (descriptors) Each level is underpinned with 1-5 measures 1 2 3 Endoscopy Global Rating Scale The patient experience 2 dimensions: clinical quality & quality of the patient experience 1 2 P www.grs.nhs.uk

12. Endoscopy Global Rating Scale  To facilitate reporting of scores a web-based reporting system was created www.grs.nhs.uk

13. Access to data entry screens Global Rating Scale homepage

14. Each item has a series of statements that have to be answered ‘yes’ or ‘no’ GRS data entry screen

15. What has the GRS achieved? www.grs.nhs.uk

16. Endoscopy Global Rating Scale Endoscopy Global Rating Scale National census twice yearly (April and October) Following a pilot in September 2004 six national censuses have been held at six month intervals The GRS is now used as the quality standard for JAG and bowel screening accreditation visits www.grs.nhs.uk

17. 10/06 10/05 04/07 % scoring A or B GRS – National results one item - six censuses over 2.5 years (207 units) 04/05 04/06 10/06 10/05 04/07 this slide is the key for the next two level B or better is the current standard for an acceptable service 10/07

18. GRS National results up to October 2007 GRS National results up to October 2007 % scoring A or B Completion rates 85%94%100%97% 98%

19. % scoring A or B GRS National results up to October 2007 GRS National results up to October 2007 Completion rates 85%94%100%97% 98%

20. What do these results mean?  Scores have been steadily improving at each census across all items, bar the appropriateness item (which was modified recently)  The very high completion rates demonstrate the service values the GRS  Extensive feedback indicates that improvements in GRS scores reflect substantial improvements in the patient experience  Formal and informal review of evidence supporting self report scores (conducted by peer review teams) indicates that teams are as likely to underestimate achievements as overestimate them www.grs.nhs.uk

21. GRS and Service Improvement  The GRS provides a framework on which to prioritise tasks  The web-based knowledge management system links solutions directly to problems www.grs.nhs.uk

22. GRS Knowledge Management The Knowledge Management System (KMS):  Shares existing knowledge across the service  Generates new knowledge to support the service  Provides knowledge from outside the service  Embeds knowledge of what works Benefits of the KMS  Immediate information and support at the frontline  Encourages a sharing community  Helps teams improve their service more rapidly

23. Knowledge Base: Login required KMS Demo Constantly updated Quick and easy

24. Access to the KMS There are various access routes into the KMS: GRS Home page or from each measure or through action plans Login is now required www.grs.nhs.uk

25. New KMS Google style search functionality 1.Getting Started 2.Policy and guidelines 3.Audit Tools 4.Useful Links 5.Patient Information 6.Sample Questionnaires 7.Presentations 8.Case Studies

26. New KMS search results

27. KMS Case Study Submission

28. GRS Action Planning functionality

29. GRS - other tools GRS - other tools

30. Other domains and tools See separate presentations for more information on these domains  Workforce Domain  Training Domain  Productivity Tool

31. A* GRS – a new functionality A* GRS – a new functionality

32. Achieving an A* on the GRS If a unit self scores an A* it means that it is able and willing to help others achieve level A on that item

33. Access to sites rated A*

34. This contact will be able to help you achieve level A on this item

35. This screen allows A* users to provide feedback on A* sites and view others’ feedback

36. The GRS has achieved a great deal It has: raised the profile of endoscopy improved teamwork improved standards identified service gaps provided evidence for investment supported the JAG accreditation process It has improved the patient’s experience of endoscopy

37. Visit the site www.globalratingscale.com www.grs.nhs.uk