GRS Implementation in Newfoundland Catherine Dubé, MD MSc FRCPC Lead, CAG GRS Sub-Committee The Global Rating Scale (GRS) • • The Endoscopy Global Rating Scale is a survey designed for periodic use within the endoscopy units to determine 1. How good the services provided within the unit are 2. What needs to be done to further improve the services The construct of quality is based on a patientcentered approach Primary Goals of the GRS • To assess how good an endoscopy service is at providing a patient-centered service • To support quality and service improvement by helping endoscopy staff identify areas in need of attention, through a process of monitoring and review of outcomes Domains of the GRS • • • • • Quality of the procedure Quality of the patient’s experience Workforce Training Productivity Clinical Quality • • • • • • information/consent safety comfort quality of procedure appropriateness communicating results to the referrer Quality of the Patient Experience • • • • • • equality of access timeliness booking flexibility privacy and dignity aftercare ability to provide feedback to the service The Endoscopy Global Rating Scale Patient centred quality P 1 2 domains: clinical quality & quality of 2 the patient experience 6 items 6 items 12 patient centred items Each item has four levels A-D DCB A 123 Each level is underpinned with 1-5 descriptors (128 in total) Structure of the GRS • • Each item includes a series of 8-12 descriptors • Descriptors are grouped into levels of achievement (D to A), where level D is basic and level A is excellent Descriptor = a statement regarding what has been achieved (yes/no answer) GRS and Quality Improvement: from a D level to an A level  A Observations are recorded, reviewed, acted upon and monitored for effectiveness Patient feedback  B Observations are recorded, reviewed and acted upon  C Observations are recorded and periodically reviewed  D Observations are recorded Standard Monitor the impact of changes Define outcomes Continuous quality improvement Implement changes Feedback results Measure outcomes Effectiveness of the GRS • • • • • • • Provided a focus Raised the profile of endoscopy Improved teamwork Raised standards Identified service gaps Provided evidence for investment Supported accreditation It has Improved the patients experience of endoscopy Getting Started • Biannual survey and data entry (lasts 1-2 hours) • • • Spring (March 1 – May 30) Needs a site-specific team with 3 or 4 people • • • • • Fall (Sept. 1 – November 30) Usually an MD Charge Nurse Endoscopy Unit Manager Also involve a clerk from the start Expand to subgroups for action plans Interpreting the Results • • Expect levels D and C results: similar to UK units in 2005 • • Results are not necessarily continuous Results reflect the fact that we have been providing sound clinical services but in the absence of an iterative process of evaluation/modifications Purpose of the first round • • Get a snapshot picture Establish priorities/plan of action So You Did The Survey, Now What? • • • • • • Need to set objectives Map objectives to services Develop action plans around these objectives Plan long-term goals and short-term easy projects Communicate your results and develop priorities as a group Perform a patient satisfaction survey Activity Mapping Referral Triage Preprocedure Consultation Booking Information/consent Bowel Prep Admit to GI unit Procedure Procedure Recovery Postprocedure Communicating results Follow-up Safety Quality Comfort Dignity Don’t Get Overwhelmed! • • • • • Tackle Quick Wins first Create teams and/or designate a specific person in charge of each project Define clear timelines Keep the momentum: • Plan periodic meetings and/or updates Keep in mind that changes don’t happen overnight Key Ingredients • • • • • Participation at all levels • Educate the staff Momentum Tackling quick fixes as much as bigger projects Feedback information and progress • • Communication Motivation Structure • • Coordinators Project-specific teams Strengthening the Momentum • Sit down to repeat the GRS every 6 months even if you feel nothing has happened • Don’t get bogged down about statements which may not apply to your unit • Make noise about this • • • Involve your administration early Communicate results of patient satisfaction survey Get exposure: rounds, newsletters… GRS website • • Data entry & reporting site - http://mdpub.org/grs/index.php Knowledge Management System • • • • Electronic library of policies, forms, case studies Action Planning Tool Contacts, FAQ’s, Newsletters Contact Sandra Daniels ([email protected]) to obtain access to the GRS website CAGs Support to Participating Sites • • • • • • Access to GRS-Canada website QPE newsletter Annual QA forum at CDDW Webinars Workshops Development of a Canadian library of resources CAG Quality in Gastroenterology