The Pathology Quality Assurance Review - Update

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


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.


How Good is Quality in Pathology ?


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


Quality Review – The need for change

• Visibility• Transparency• Accountability• Unacceptable variation• Error reporting• Patient safety• Patient experience


Quality Review – Recommendations

• Training• EQA• Governance• Error Reporting• Informatics & Standardisation• Accreditation• Commissioning


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.”


Recommendation – Training

• Undergraduate• Specialty Training• Clinical Scientists• BMS• Others

Curricula Modules

E-Learning Packages


Recommendation – CPD

• Explicit: Quality section/tag• Appraisal• Revalidation• Continual Quality Improvement• CPA/UKAS• Employers/Governance

“Upskilling the workforce ”


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.”


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


RCPath Key Performance Indicators


RCPath KPIs – Examples

• Staffing

• Training & Education

• Repertoire

• Engagement with Users & Patients

• Interpretative Advice and MDTs

• Timeliness – TATs & Clinical Advice

• EQA – Analytical & Interpretative


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.”


Recommendation – Error Reporting

• Error reporting system• Patient harm• Near misses• Lessons learnt• Transparent and reportable• UKAS Inspected


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.”


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


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.”


Recommendation – Accreditation

• UKAS• End to End Service• Minimum Standards• Excellence• Transparent• Regular – Spot checks• Culture change


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.”


Recommendation – Commissioning

• Pathology Services Commissioning Toolkit - Define requirements• IT – NLMC• Key Assurance Indicators• IQC/EQA• Error Reporting• Demand Management

• POCT – MHRA Guidelines


Delivery & Implementation

• Oversight Group• October 2014 – First meeting

• Quality Assurance Quality Dashboard• UKAS Status• Appraisal Rates• Key Assurance Indicators• EQA Performance• Personal QA


The Quality Dashboard


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.”


Action

Recommendation – EQA

Labs

EQA Schemes

NQAAPs

JWGQA

•MHRA•CQC•UKAS•NHS-E•Patients

Action


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


(current JWGQA)


(current NQAAPs) Technical EQA

Schemes

Regulators and relevant authorities

(e.g. PPP committee)

Pathology Services

TrusteeBoard



Development

UKAS

Technical EQA Schemes

Pathology Services

TrusteeBoard




Professional Standards (RCPath) and equivalent

groups

TrusteeBoard



Development



(current JWGQA)


(current NQAAPs)


UKAS

Technical EQA Schemes

Regulators and relevant authorities

(e.g. PPP committee)

Pathology Services

Professional Standards (RCPath) and equivalent

groups


Consultation


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?


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

The Pathology Quality Assurance Review - Update

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