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The Egg

The Egg. Accreditation of stroke services. A pilot project to test the hypothesis that service accreditation is the natural and necessary link between revalidation and a quality service for patients. Why?. Quality and revalidation are both high national priorities Intuitively they are linked

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The Egg

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  1. The Egg

  2. Accreditation of stroke services A pilot project to test the hypothesis that service accreditation is the natural and necessary link between revalidation and a quality service for patients

  3. Why? • Quality and revalidation are both high national priorities • Intuitively they are linked • Missed opportunity not to study the link

  4. Why? • Revalidation for UK doctors starts 2009 • Revalidation “positive affirmation of competence” • “missing a trick”

  5. Quality patient care • Difficult to define • Difficult to measure • Difficult to teach • Difficult to learn • Difficult to practice

  6. Physician competence • Difficult to define • Difficult to measure • Difficult to teach • Difficult to learn • Difficult to practice

  7. Most doctors will revalidate • 95% or more will revalidate • More than 100k doctors to revalidate • How does this process capture the 5% of underperformers? • How does it improve the performance of the majority?

  8. Linkage • Revalidation of individuals • Revalidation of services • The same process “individual vs team” • Collection of information to demonstrate competence and a continuous process of improvement

  9. Multi stakeholder project • Department of Health • Health Foundation • Health Care Commission • Royal College of General Practitioners • Royal College of Nursing • Stroke Association

  10. Revalidation for Physicians • 5 year cycle • The sum of 5 years work • “positive affirmation of competence” • Collection of supporting information • Structured annual appraisal

  11. Two parts to revalidation • Performance • Award of licence to practise by General Medical Council • Competence • Award of certificate of competence by the relevant Royal College

  12. Revalidation certificate issued by GMC License to practice + Certificate of competence

  13. Supporting information • Performance in areas of patient care, including complaints, 360˚appraisal, audit, team performance and quality outcomes • Competence in specialist area as defined by the medical specialist society and Royal College including audit, team performance and quality outcomes

  14. Quality outcomes in defined conditions • Linked to team performance • Linked to high quality data • Linked to national audit • Linked to national benchmarks

  15. Assumptions • High quality doctors more likely in high quality teams • Doctors will find revalidation easier in high quality services • High quality services will not tolerate low quality doctors • Low quality doctors are likely to improve in high quality services

  16. Our model • Describes a service in terms of Competence“what it can do” • Measures the service Performance “how it does it” • Benchmarks performance • Commissioner adds capacity/size/site

  17. Simple model • Competence + performance = Accreditation • Accredited service = quality service • Capacity “how much, where” is for commissioners depending on size and complexity of population

  18. We are designing an accreditation model that is: • Based on quality assurance • Uses data already available • Uses few targeted peer review visits • Is not site specific: “what not how” • Is based on performance and competence

  19. How do we define an accredited service? • Must be a high (ish) bar • Must be potentially attainable by all • Must improve quality year on year • Must move bar up year on year • Status must be demonstrated regularly

  20. Why stroke? • Good national data • Good national network • “small service” • Complex service, • moves between hospital/community • acute, peri-acute and chronic care • Keen staff

  21. How stroke? • One strategic health authority • Index first stroke or TIA • End point leaving rehabilitation • Measures based around national stroke audit • Benchmark

  22. Competent stroke service must be able to: • Assess TIA • Assess new stroke • Image within 24 hours • Admit to acute stroke unit • Transfer to stroke rehabilitation unit • Assess for carotid surgery • And more

  23. Commissioning for Quality • Accredited Services Commission for size • Capacity

  24. Too much inspection • Model is simple • Enables regulation • Replaces 1000 questions • Reflects values of the service • Reflects patient requirement • Engages clinicians useful measurement

  25. If successful link demonstrated • Patterned accreditation • How many services to ensure high performance trusts/commissioners?

  26. The Egg

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