Post on 04-Jan-2022
The Pathology Quality Assurance Review - Update
Dr Bernie CroalRCPath
Pathology Quality Assurance Review – March 2015
Overview
1. PQAR Summary/Current Status
2. Main Recommendations
3. Technical EQA
4. Personal Proficiency
5. Timescales, Consequences, Threats
Pathology Quality Assurance Review – March 2015
Quality Review - Ownership
• NHS England
• Sir Bruce Keogh• Medical Director NHS-E + Comm Board
• Politically Driven
• Kingsmill Hospital Issue
• Quality already high but could be better.
• Would allow quality mapping to other medical services.
Pathology Quality Assurance Review – March 2015
Pathology Quality Assurance Review – March 2015
How Good is Quality in Pathology ?
Pathology Quality Assurance Review – March 2015
How Good is Quality in Pathology ?
• Already High Quality• IQC/EQA• CPA/UKAS
• ?Process assessed/minimum standards• End to end pathway ignored (ISO15189?)
• Significant Gaps• Clinical outcomes and relevance• Lack of transparency/scrutiny• No assurance indicators of quality• Quality training poor• Accountability/Governance
Pathology Quality Assurance Review – March 2015
Quality Review – The need for change
• Visibility• Transparency• Accountability• Unacceptable variation• Error reporting• Patient safety• Patient experience
Pathology Quality Assurance Review – March 2015
Quality Review – Recommendations
• Training• EQA• Governance• Error Reporting• Informatics & Standardisation• Accreditation• Commissioning
Pathology Quality Assurance Review – March 2015
Recommendation – Training
“A systematic approach should be taken to educating,training and developing the skills of the pathology workforcein quality management systems and quality improvementmethodology, in ways appropriate to professional group,role and grade. This process should be led by HEE.”
“HEE should work with the professional bodies andregulators to ensure that quality management and assurancecan be recognised as an essential requirement in CPD, andin individual appraisal requirements.”
Pathology Quality Assurance Review – March 2015
Recommendation – Training
• Undergraduate• Specialty Training• Clinical Scientists• BMS• Others
Curricula Modules
E-Learning Packages
Pathology Quality Assurance Review – March 2015
Recommendation – CPD
• Explicit: Quality section/tag• Appraisal• Revalidation• Continual Quality Improvement• CPA/UKAS• Employers/Governance
“Upskilling the workforce ”
Pathology Quality Assurance Review – March 2015
Recommendation – Governance
“The quality and governance systems of pathologyproviders must be integrated with trust governance andquality structures. This should include the measurement ofappropriate quality assurance indicators and theidentification of an accountable board member within theorganisation. CQC and the Chief Inspector of Hospitals haveindicated that robust information on the quality of pathologyservices could contribute to the overall assessment ofquality under the new hospital inspection model.”
Pathology Quality Assurance Review – March 2015
Recommendation – Governance
• Quality Management Systems to be integrated high up in the Trust infrastructure
• Identified board member for Pathology Quality
• Explicit measures of quality – Dashboard
• Error reporting and management
Key Performance IndicatorsKey Assurance Indicators
Pathology Quality Assurance Review – March 2015
RCPath Key Performance Indicators
Pathology Quality Assurance Review – March 2015
RCPath KPIs – Examples
• Staffing
• Training & Education
• Repertoire
• Engagement with Users & Patients
• Interpretative Advice and MDTs
• Timeliness – TATs & Clinical Advice
• EQA – Analytical & Interpretative
Pathology Quality Assurance Review – March 2015
Recommendation – Error Reporting
“Existing guidance on the standardisation and transparentreporting of errors from pathology services must berigorously followed, including the reporting of all incidentsthat could have, or did lead to patient harm, to the NRLS.Pathology services should be encouraged to shareinformation and data about clinical risks, ‘lessons learnt’ andgood practice, in order to contribute to education and qualityimprovements nationally. The Trust Development Agency(TDA) and Monitor/CQC should encourage trusts to improvetheir adherence to existing guidance.”
Pathology Quality Assurance Review – March 2015
Recommendation – Error Reporting
• Error reporting system• Patient harm• Near misses• Lessons learnt• Transparent and reportable• UKAS Inspected
Pathology Quality Assurance Review – March 2015
Rec – Informatics & Standardisation
“The continued development of the NLMC to ensureconsistency of data and information across the NHS inEngland should remain a priority. Ministers and NHSEngland have confirmed that this task, undertaken byHSCIC, with support from professional bodies and others,must continue at scale and pace. The professional bodies,the IVD manufacturers and others should work towardsminimising the differences between analytical processes,requesting and reporting.”
Pathology Quality Assurance Review – March 2015
Rec – Informatics & Standardisation
• Lack of Standardisation• Reference Ranges• Units• Assays
• The National Laboratory Medicine Catalogue (NLMC) Mandatory
• Use of “Big Data”• Improvements in Clinical Audit• Patient Outcomes
Pathology Quality Assurance Review – March 2015
Recommendation – Accreditation
“In order that patients and clinicians can rely onaccreditation status as shorthand for a quality assuredservice, the accreditation of pathology services must beupdated showing clearly which laboratories are meetingminimum requirements, and which are excelling to providefirst-rate service quality. UKAS has agreed to undertake thiswork.”
Pathology Quality Assurance Review – March 2015
Recommendation – Accreditation
• UKAS• End to End Service• Minimum Standards• Excellence• Transparent• Regular – Spot checks• Culture change
Pathology Quality Assurance Review – March 2015
Recommendation – Commissioning
“In order to support commissioners in the next planninground, the PSCT should be updated. The National ClinicalDirector (NCD) for Pathology, with the NCD for Diagnosticsand the Chief Scientific Officer, will lead this project, workingin conjunction with local commissioners and professionalbodies. When the NICE QS is published, it should beincluded in the PSCT. Commissioners should follow theMHRA guidelines when commissioning POCT.”
Pathology Quality Assurance Review – March 2015
Recommendation – Commissioning
• Pathology Services Commissioning Toolkit - Define requirements• IT – NLMC• Key Assurance Indicators• IQC/EQA• Error Reporting• Demand Management
• POCT – MHRA Guidelines
Pathology Quality Assurance Review – March 2015
Delivery & Implementation
• Oversight Group• October 2014 – First meeting
• Quality Assurance Quality Dashboard• UKAS Status• Appraisal Rates• Key Assurance Indicators• EQA Performance• Personal QA
Pathology Quality Assurance Review – March 2015
The Quality Dashboard
Pathology Quality Assurance Review – March 2015
Recommendation – Quality Assessment
“The membership, role and function of the JWGQA shouldbe revised and expanded. It should set consistent standardsand performance criteria for all schemes across pathologyand work with UKAS to ensure their implementation in thescheme accreditation process. The JWGQA should adviseon publication of performance data. The National MedicalDirector has confirmed that he will ask the RCPath to leadthis work.”
“Further consideration must be given to the ways in whichindividual performance can be assessed, monitored andcompetence-assured. The National Medical Director will askthe professional bodies, led by RCPath, to review theseissues and report back within twelve months on theirfindings.”
Pathology Quality Assurance Review – March 2015
Action
Recommendation – EQA
Labs
EQA Schemes
NQAAPs
JWGQA
•MHRA•CQC•UKAS•NHS-E•Patients
Action
Pathology Quality Assurance Review – March 2015
Recommendation – EQA
• Expanded JWGQA• New EQA Standards
• Frequency• Ranges• Penalties• Referral
• Visible and Transparent• Quality Dashboard• Driven by Commissioning
TrusteeBoard
Quality AssuranceManagement Group
Technical EQA Scheme Performance Criteria
Development
Personal Performance Assessment
Technical EQA Scheme Quality Surveillance
(current JWGQA)
Discipline Specific Advisory Committees
(current NQAAPs)
NHS England Oversight Group
Oversight
Management
Work
Personal Proficiency Assessment
TrusteeBoard
Quality Assurance Management Group
Technical EQA Scheme Quality Surveillance
(current JWGQA)
Discipline Specific Advisory Committees
(current NQAAPs) Technical EQA
Schemes
Regulators and relevant authorities
(e.g. PPP committee)
Pathology Services
TrusteeBoard
Quality Assurance Management Group
Technical EQA Scheme Performance Criteria
Development
UKAS
Technical EQA Schemes
Pathology Services
TrusteeBoard
Quality Assurance Management Group
Personal Proficiency Assessment
NHS England Oversight Group
Professional Standards (RCPath) and equivalent
groups
TrusteeBoard
Quality Assurance Management Group
Technical EQA Scheme Performance Criteria
Development
Personal Proficiency Assessment
Technical EQA Scheme Quality Surveillance
(current JWGQA)
Discipline Specific Advisory Committees
(current NQAAPs)
NHS England Oversight Group
UKAS
Technical EQA Schemes
Regulators and relevant authorities
(e.g. PPP committee)
Pathology Services
Professional Standards (RCPath) and equivalent
groups
Pathology Quality Assurance Review – March 2015
Consultation
Pathology Quality Assurance Review – March 2015
Consultation
Pathology Quality Assurance Review – March 2015
Consultation
Pathology Quality Assurance Review – March 2015
Personal Proficiency• Existing Measures
• Quals, Exams, Appraisal, Revalidation, CPD, UKAS, KPIs
• Personal Proficiency Assessment• Interpretative Schemes• Other measures of knowledge and
application.• Provision – Professional bodies?
• Support and Surveillance• Local Appraisal & Revalidation• Transparency and Accountability?
Pathology Quality Assurance Review – March 2015
Timescales, Consequences, Threats
• Time• Education/CPD – 6 mths
• EQA Structures/Standards – 1 year
• PPAs – Years
• Consequences• Quality – Too far? Setting the standard?
• Threats• Professionals – Volunteer and Engage
• Funding – EQA Costs EQA Schemes Labs
– PPAs Individuals/Employers