NICE Guidance and Quality Standard Assurance Evaluation: a process redesign to improve effectiveness and efficiency.

Purpose

NICE assurances processes which evaluate local clinical practice and services against NICE guidance, quality standards and interventions are important clinical effectiveness and quality improvement strategies. Trusts are required to undertake a local NICE assurance process and results of evaluations are reported centrally.

The aim of this project was to develop a more efficient, robust and meaningful approach to our NICE assurance process across our complex, multi-professional clinical division. Our division has over 30 different clinical services in acute and community settings across East Sussex. The objective was to create a single, unified and responsive approach across all our uni- and multi-professional services.

Approach

A PDSA process was applied which introduced the following strategies:

 

  • Allocation of a Clinical Effectiveness Facilitator to the Division.
  • Established core NICE MDT with professional and service level expertise and oversight.
  • Established network of NICE responders across professions and services.
  • Education on NICE products, resources and tools for evaluation, responses and action plan development.
  • Development of priority rating system to show levels of compliance and action plan implementation.
  • Fortnightly conference calls where the core team triages and evaluates new and updated guidance and quality standards, and follows up on outstanding action plans.
  • Invitations are sent to service or professional responders to evaluate specific guidance.
  • Continual evaluation and refinement to elements within the process and input from wider responder group fed into the redesign.

Outcomes

Outcomes and quality impacts include an improved Division position from extensive target breeches and poor levels of response compliance of 65% for clinical guidance evaluations and 36% for quality standards evaluations to consistently achieving 100% within the 3 month target.

The process redesign is supporting the development and completion of more clinically and operationally meaningful and collaborative guideline evaluations, action plans, business cases and service changes.

At a central level, our clinical division has moved from a 'poor' to 'outstanding' clinical effectiveness position. Using NICE resources and tools to support evaluation and impact measurement in clinical and operational processes is now embedded in quality improvement initiatives.

Cost and savings

Investment in effective NICE assurance processes by NHS service providers is important. This project enabled development of a single, unified and meaningful approach to our NICE Assurance process across our large mutli-service clinical division.

The process redesign has enabled our services to have greater oversight and benchmarking of our levels of evidence-based care, demonstrate the quality of services and be proactive with cost-beneficial developments and innovation.

Implications

Education to support greater understanding and use of NICE resources and tools to support quality care, safety and cost-effectiveness of service delivery and planning is important.

How the utilisation of the NICE Assurance process in a timely fashion is able to highlight gaps within service delivery and support the development of business cases to implement requirend changes that increase compliance with the guidance and ultimately improve the patient experience.

Top three learning points

  1. Developing local NICE champions within services and professions has supported better processes and helped raise awareness.
  2. Engagement and support at service manager and executive level has increased appreciation of the value of investing in a robust process of assurance. There is now awareness that busy clinicians need dedicated time to set up and evaluate action plans and that Clear lines of accountability are needed for seeking responses from, and carrying out evaluations on, services and professions within services.
  3. Using non-clinical staff to do administrative tasks, data collation and reporting is invaluable.

Fund acknowledgements

This project was unfunded. 

Additional notes

This work was presented at Physiotherapy UK 2019 and the NICE Shared Learning Awards conference 2019, where it was selected as one of the 'Highly recommended Entries'.

 

Please see the attached Innovations poster below. 

 

For further information about this work please contact Carol McCrum.