Dr Ian BarnesCellular Pathology NEQAS

BirminghamTuesday 29th October 2013

Video at: http://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england

Clinical effectiveness, patient experience, safety

Professionalism, leadership and governance

“make quality our primary concern” Transparency, sharing intelligence, data

and insight Incident reporting, lesson learning Interrogation of assurances of quality

Learning and sharing are key drivers for quality improvement

Quality should be embedded in career plans from the first stages

Reducing unwarranted variation “values and behaviours of staff” – culture

and governance Clarity of roles and responsibilities Set out a Quality Framework

Expectation of transparency both in terms of lab and staff performance and behaviour

Changing culture and governance by modifying values and behaviours

Clarity of roles and responsibilities Strong leadership A clear quality framework

“To identify whether there are any issues within quality assurance frameworks and governance at a national level in pathology services, and to make recommendations for addressing them.”

Commissioned by the National Medical Director in response a localised Trust issue in immunohistochemistry

Board first met Jan 2013 Investigation through three workstreams, led

by expert chairs, looking at tiers of the system:◦ Individual responsibilities ◦ Provider and trusts responsibilities◦ Whole-system responsibilities

Interim Report to Prof Sir Bruce Keogh in August 2013

Final report due late 2013

Stakeholder Engagement & Communications

Pathology Quality Assurance Review BoardChair: Dr Ian Barnes

Review Management TeamProject management

Professional Development

Quality Assurance and

Governance

NHS National System

NHS EnglandNHS Medical Director, Prof Sir Bruce Keogh

Report any Clinical &

Safety concerns to SofS

Concise and focussed

Around 10 recommendations

“Reliable, Robust and Responsive”

Crafted to align and support NHS direction of travel

To be launched late 2013/early 2014

A pragmatic definition of quality based on -Reliability, robustness, and responsiveness

Reliable: given the right question, services will provide the right answer

Robust: services will continually improve processes in the light of experiences

Responsive: capable of adjusting to varied needs of patients and clinical users, and of changing in response to demand, to user feedback and to developing technology and service requirements

Oversight of pathology quality assurance Commissioning Governance of QA within Trusts Transparency Measures of performance Education, training, roles Information technology and management

What exists already? What is lacking? Interrogation of data, management by

exception

Transparency? Integration? Verification?

Oversight? Sanctions?

SUIsSHOTMHRA

CCGsIn

tern

al

Govern

an

ce

Inte

rnal

Assu

ran

ce

EQAScheme

sCPA

JWG (via NQAAPS

)CQC

Include requirements in the National Contracts

Highlight responsibilities of commissioners, “duty of care”

Access to data to assure themselves of the quality of the services purchased

Commissioning for high quality 7-day services

Enhance the mechanism by which trusts assure themselves of the quality of the services they provide

Link this to commissioners responsibility for services purchased

Creates a push-pull requirement for focus on quality

Francis defines transparency as “allowing information about the truth about performance and outcomes to be shared with staff, patients, the public and regulators”

What data is meaningful to patients/commissioners/trust boards/users/ GPs/CQC/CPA etc?

How to pull this from existing data and present Oblige trusts to publish their own QA data? Creates flow for oversight scrutiny Personal performance data

IQC EQA schemes

◦ Process ◦ Individual

Accreditation College KPIs Error reporting

◦ Internal◦ External: SUI, MHRA, SHOT

Other – benchmarking, Atlas of Variation

Individual and lab performance Monitoring for persistent poor performance Referral and sanctions Data streaming to national dashboard Harmonisation Minimum standards for EQA Minimum standards for labs eg workload

thresholds

Internal◦ Department◦ Pathology Directorate◦ Hospital management

External◦ Commissioners (purchasers)◦ UKAS (accreditation)◦ EQAS (scheme oversight)◦ Error reporting◦ National Dashboard

No anonymity, available for public scrutiny, regulatory bodies assured of quality

Postgraduate curricula Quality training in core modules Additional training for leadership and

management roles Include in CPD Key roles and responsibilities for pathology

quality Survey of ~2500 staff…

Recommendations will require multiple ownership

Enhancement of existing systems to◦ Exploit existing data streams◦ Involve existing organisations◦ Deliver change through better integration of

existing structures Professionalism and a change of culture will

be key requirements

i.barnes@nhs.net