quality matters neqip and nzgrs new zealandconference.co.nz/files/docs/gastro2018/thur...
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Dr Malcolm Arnold, Carolyn Davison, Michelle Hight NEQIP
Quality Matters
NEQIP and NZGRS New Zealand
New Zealand Society of Gastroenterology Annual Scientific Meeting, Dunedin 2018
Being small doesn’t mean that you can’t think big thoughts
2011 2012 2013 2014 2015 2016 2017 2018
NBSP Endoscopy Service review
Spread 28 regionsNEQIP - GRS
GRS Pilot 4 DHBs
Biannual Census
NEQIP re-established
Developing Endoscopy in New Zealand
Progressing the Endoscopy Quality Journey
NEQIP TEAM 2016
Dr Malcolm Arnold, Clinical Lead
Karma Percy, Admin Lead
Sherry Sharp, Nurse Lead
2018
Michelle Hight, Admin Lead
Dr Malcolm Arnold, Clinical Lead
Carolyn Davison, Nurse Lead
NZ Endoscopy Quality Drivers 2018
1. National Bowel Screening Programme (NBSP)
Biennial screening, age 60-74 years
FIT test with colonoscopy
Commenced July 2017
Staged approach to implementation
National Bowel Screening Programme and NEQIP
7 DHBs rolled out
3 DHBs go live Feb - June 2019
NEQIP support for units ‘going live’
NBSP rollout informs NEQIP quality planning
GRS measures embedded in MoH assessment of preparedness
■ 10 DHBS go live July 2019 – 2020/21
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NZ Endoscopy Quality Drivers 2018
2. Nationally agreed clinical standards with NZGRS integration (EGGNZ)
- Units and individuals (performing bowel screening colonoscopy)
- Local credentialing in adult endoscopy
3. Patient access
- MOH colonoscopy timeliness targets
(urgent, semi urgent, surveillance)
NZ Endoscopy Quality Drivers 2018
4. Patient Experience
- Vulnerability, fear of discomfort & pain
- Safety, endoscopist competence
- Diagnosis related anxiety
What Matters to our Patients?
Appropriateness
Information & consent
Safety
Comfort
Timely results
QUALITY of PATIENT
EXPERIENCE
Equality
Timeliness
Choice
Privacy & Dignity
Aftercare
Ability to provide feedback
CLINICAL QUALITY
Patient Satisfaction
NZGRS National Completion Rates
4 Censuses over 2 years (29 units)
Mar 17 93%
Nov 17 100%
April 18 93%
Oct 18 96%
What are we doing well in NZ?
We are communicating results to referrers well
Our approach to clinical safety is improving
Many units are currently developing more robust consent processes
General upward trend in units reaching A & B standards
CLINICAL QUALITY % scoring As and Bs
Mar 17 Nov 17 April 18 Oct 18
PATIENT EXPERIENCE % scoring As and Bs
Mar 17 Nov 17 April 18 Oct 18
NNZ WORKFORCE % scoring As and Bs
Mar 17 Nov 17 April 18 Oct 18
Key areas for quality improvement
Safety
Quality
Timeliness
Training
NNZ TRAINING % scoring As and Bs
Mar 17 Nov 17 April 18 Oct 18
Low Hanging Fruit
NZGRS Standards currently unmet
21.7 There is an electronic reporting system (ERS) capable of
capturing key audit data
21.9 The ERS provides basic audit reports for trainees
ProVation!!!
1.3 There is a published patient information sheet for all
diagnostic procedures performed in the unit
Written patient information is currently in
development by NEQIP, EGGNZ, and
JAGUK
Interim action: develop local information,
consult KMS, other units
6.9 All endoscopy reports are dispatched within one working
day of the procedure or communicated electronically or by
fax the day of the procedure
ProVation has the capacity to upload all
reports at midnight to local patient
management systems (saving money on
paper & coloured ink) with immediate
electronic transfer to GP and/or other referrer
THE NEQIP YEAR AHEAD: Priority Areas
1. Update of NZGRS
- Broad based
- Improve clarity of measures
- Measures that are more achievable
- More NZ centric
THE NEQIP YEAR AHEAD
2. KMS (Knowledge Management System) to be updated
and modernised with the addition of more NZ ‘best
practice’ resources
Your help is needed!
3. Strengthen unit endoscopy user group functionality and
action planning processes
Our help is available!
THE NEQIP YEAR AHEAD
4. Training
- Many areas as yet unaddressed in New Zealand
- EGGNZ and NEQIP work in progress to develop an
improved endoscopy training landscape
5. Expansion beyond self assessment processes ....
It’s no longer enough to say that we do
things well. How do we know that things
are as they seem….?
Do good self reported NZGRS scores =
good practice?
Validating Service Quality: Accreditation
Standards
Accreditation based on EGGNZ standards with validated NZGRS scores
Level B minimum standard
Process
Peer review visits (service delivery and training)
Pre accreditation support from NEQIP
Aim to be mandatory for NBSP
Improving Endoscopy: Top 10 Tips
1 LEADERSHIP
Successful redesign needs a steering group
2 COMMUNICATION
Network with other units, locally & nationally
to discuss and share ideas
3 VALIDATE WAITING LISTS
Clerical validation and clinical list validation
ensure that the procedure is still appropriate
4 CAPACITY AND DEMAND
Improves understanding & subsequent
redesign
5 INCREASE EFFECTIVENESS
Identify and reduce DNAs, cancellations, late
starts; introduce pooling of lists, booking
systems
6 PATIENT INVOLVEMENT
Gain insight Into patients’ perceptions
7 ENGAGEMENT
Ask staff opinion, find out what they expect and
want from their unit
8 PROCESS MAPPING
Identify unnecessary steps in the patient journey
9 CLINICAL GOVERNANCE
Learn from, and actively respond to incidents
and complaints
10 SUSTAINING CHANGE
Continuously assess and improve supporting
infrastructure, systems and procedures.
