Framework For Service Improvement Research Articles

Paediatric Endoscopy Global Rating Scale: Development of a Quality Improvement Tool and Results of a National Pilot.

The endoscopy Global Rating Scale (GRS) is a web-based self-assessment quality improvement (QI) tool that provides a framework for service improvement. Widespread use of the GRS in adult endoscopy services in the United Kingdom (UK) has led to a demonstrable improvement in quality. The adult GRS is not directly applicable to paediatric endoscopy services. The objective of this study is to develop and pilot a paediatric endoscopy Global Rating Scale (P-GRS) as a QI tool. Members of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Endoscopy Working Group collaborated with the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) to develop the P-GRS. After a period of consultation, this was piloted nationally at 9 centres and data were collected prospectively at 2 census points, May and December 2016. The P-GRS mirrors the adult GRS by dividing care into 4 domains and includes 19 standards with several measures that underpin the standards. Eight services completed the online P-GRS return in May 2016 and 6 in December 2016. All pilot sites identified areas that needed improvement and post-pilot reflected on the key challenges and developments. Several positive developments were reported by the pilot sites. The national pilot helped ensure that the P-GRS developed was relevant to the paediatric endoscopy services. The pilot demonstrated that even in the first year of engaging with this QI tool, services were starting to identify areas that needed improvement, share best practice documents, put in place QI plans, and support greater patient involvement in services.

Not enough time for research? Use of supported funding to promote allied health research activity.

PurposeThe current project evaluated the impact of a short-term, supported funding initiative that allowed staff from allied health (AH) professions to undertake research activity within rostered employment time. Specifically, the project will report on outcomes pertaining to individual research capacity, research output, and overall satisfaction with the initiative.Participants and methodsSixteen AH clinicians (n=16) from six AH professions participated in the evaluation of the initiative, with data being collected within a service improvement framework. Clinicians received up to 4 weeks of protected time relieved from their clinical duties to undertake research activities, including writing for publication, undertaking a systematic review, data analysis, and preparation of ethics applications. An AH Research Fellow provided additional support and mentorship, including the development of an implementation plan. Evaluation included pre–post measures of individual research capacity using a 15-item self-report Research Capacity and Culture (RCC) survey, a post-implementation satisfaction survey, and monitoring of research output achieved.ResultsStatistically significant improvements (p<0.05) were found on 14 out of 15 items on the RCC tool, with meaningful improvements in securing funding, analyzing qualitative data, writing for publication, literature searching skills, and providing advice to less experienced researchers. Overall satisfaction with the initiative was high, with positive comments from AH professionals (AHPs) regarding the initiative. Research output arising from the initiative included eleven manuscripts being submitted, with six currently in publication and others under review.ConclusionThe preliminary findings support the feasibility of implementing a local, clinical funding model to promote individual research capacity and research output for AHPs. The short-term funding should be supported by local mentorship and guidance. Local barriers and suggestions to optimize implementation, including integrating within existing research infrastructure and using flexible “backfill” options, will also be described.

Implementation of a Practice Development Model to Reduce the Wait for Autism Spectrum Diagnosis in Adults

This study examined waiting times for diagnostic assessment of Autism Spectrum Disorder in 11 adult services, prior to and following the implementation of a 12 month change program. Methods to support change are reported and a multi-level modelling approach determined the effect of the change program on overall wait times. Results were statistically significant (b = − 0.25, t(136) = − 2.88, p = 0.005). The average time individuals waited for diagnosis across all services reduced from 149.4 days prior to the change program and 119.5 days after it, with an average reduction of 29.9 days overall. This innovative intervention provides a promising framework for service improvement to reduce the wait for diagnostic assessment of ASD in adults across the range of spectrum presentations.

Consumer Information for clients with diabetes – a survey of Podiatrists current practice in the Hume region

Background This survey was undertaken as part of the work of the Consumer Information Working Party within the Hume Diabetes Service Improvement Collaborative HDSIC. The HDSIC is part of the implementation of the National Chronic Disease Strategy. The task of the HDSIC is to apply the National Diabetes Service Improvement Framework in the Hume region to increase the access to high quality diabetes service. The objective of this survey was to understand podiatrists’ decision-making and behaviour regarding consumer information given to clients with diabetes. This would identify gaps between current practice and Priority 4 Provide clear and consistent information for people with chronic conditions and their carers (Hume Regions Chronic Care Strategy HRCCS 2012-2022). This information will then be used by the collaborative to develop consumer information recommendations and support service providers to address issues relating to health literacy.

The future of the Endoscopy Global Rating Scale

Since 2005, endoscopy units in England have been self-assessing the quality of patient care using the Endoscopy Global Rating Scale (GRS). The GRS provides a framework for service improvement as well as being an assessment tool. A peer-review accreditation process of all 216 units, based on the GRS, began roll out in 2006. This article describes the GRS′s history, results achieved, its impact on the service as well as challenges and plans for the future. It demonstrates the positive impact it has had on the endoscopy peer-review accreditation process. The article shows that the GRS has lead to a substantial improvement in the quality of care of patients having an endoscopy in England during a period of reduction in waiting times. It is clear that the GRS has a future in endoscopy services, but there are challenges if the achievements are to be sustained.

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The Care Services Improvement Partnership (CSIP), which works with the health, local government, public, voluntary and private sectors to improve services, health and wellbeing, is developing a set of 'high impact changes' to provide a framework for service improvement and to support the of Health white paper, Our Health, Our Care, Our Say: A new direction for community services.

IT-driven patient safety at the heart of radiology service improvement

Patient safety is a fundamental requirement of modern health-care systems and the application of information technology (IT) to this activity should have improvements in the area as one of its goals. Indeed, ensuring that the diagnostic IT strategy is optimized, for example, the use of IT in service redesign or data analysis, forms one of the main platforms for the National Framework for Service Improvement in Radiology. This paper presents both the concept behind and the results of a project that has been under way in the UK involving St Helens and Knowsley NHS Trust and IRS Ltd concerned with implementing effective IT-driven scientific support in the field of medical radiation protection. Locally developed software is employed in assessing, managing, and analysing patient dose data arising from X-ray examinations performed in the busy department of a large district general hospital (DGH). Such data are analysed in a variety of ways, for example, over time and according to location (department or X-ray room). This analysis not only provides a measure of performance against nationally agreed dose reference levels (DRLs) but also enables a detailed analysis of any variations as well as the establishment of local DRLs (performance indicators). This process provides quantitative input to management strategies aimed at service improvement. Such strategies are geared towards the support of the Ionizing Radiations (Medical Exposures) Regulations 2000 as well as implementation of quality-management principles at the heart of radiology practices.

Make Outcomes your Big Idea: Using Outcomes to Refocus Social Care Practice and Information

This paper explores how a research‐based understanding of outcomes in social care can be incorporated into practice. Drawing on research by the Social Policy Research Unit and the practical experience of North Lincolnshire Social Services Department, this paper highlights how culture change and the involvement of stakeholders are key to using outcomes ideas as a motivational framework for service improvement.