Quality improvement (QI) is one of the key activities at the heart of the BSG Clinical Services and Standards Committees (CSSC).

We all strive to excel and improve our services for patients but there are many challenges in the current NHS environment. The BSG has a long history of being at the forefront of high quality care. Key successes, internationally recognised, are the development of the JAG accreditation scheme and more recently IQILS. These projects have led to significant improvements in quality of care and training which directly improve patient care and outcomes.

A large number of local QI projects are being undertaken by colleagues throughout the four nations. It is one of the roles of the CSSC to learn about and disseminate excellent work as well as lead QI activities nationally.

What is the CSSC practically doing to progress QI at the BSG?

There are a number of QI initiatives which are currently being undertaken and are in various phases of development which are listed below:

1. The BSG Quality Standards Framework

This is an ambitious national project, initiated in 2016, which is currently being piloted throughout the 4 UK nations. Its core objectives are ultimately to raise the standards of gastroenterology and liver services for patients in all hospitals, and to reduce variance in the provision of care.

Following consultation with key stakeholders, 50 standards have been agreed which cover areas key to excellent patient care.

Pilot sites that have volunteered to take part include a mixture of hospital types. They range from DGHs to university and tertiary trusts, covering a range of demographics, rural and urban.

Following pilot survey responses, the project team are undertaking feedback sessions with every site. The aim is to add qualitative information to the overall analysis, as well as to identify service areas that are either missing or need improvement or additional focus.

For further information/details, please contact the Quality Standards Framework project team on qsf@bsg.org.uk or see the PDF document below which details the current version of the standards.

We are beginning to analyse the dozen responses we have received to date which is starting to highlight recommendations and questions that will need further consideration by BSG higher committees/officers. Timescales have also flexed to accommodate the current challenging clinical landscape, but the pilot will be brought to a definite close to enable all options to be explored.

Outcomes to date along with options for future strategic direction will be presented at BSG LIVE in a dedicated QSF session. 

2. BSG Endoscopy Quality Improvement Programme (EQIP)

High quality gastrointestinal (GI) endoscopy improves patient care. Raising standards in endoscopy improves diagnostic accuracy, management of pathology and ultimately improves outcomes. Historically the development of the Joint Advisory Group (JAG) on GI Endoscopy, the Global Rating Scale (GRS), JAG Endoscopy Training System (JETS) training and certification have led to major improvements in UK endoscopy but significant variation in practice remains. To improve quality further the BSG EQIP has been established with the aim of raising quality and reducing variation in the quality of UK endoscopy.

A multifaceted approach to QI is being undertaken: BSG Endoscopy Quality Improvement Programme (EQIP): overview and progress

Upper GI EQIP will support adoption of standards alongside regional upskilling courses. Lower GI EQIP will focus on supporting endoscopists to achieve current standards alongside approaches to reducing post colonoscopy colorectal cancer rates. Endoscopic retrograde cholangiopancreatography EQIP will adopt a regional approach of using local data to support network-based QI. Newer areas of endoscopy practice such as small bowel endoscopy and endoscopic ultrasound will focus on identifying key performance indicators as well as standardising training and accreditation pathways. EQIP will also support QI in management of GI bleeding as well as standardising the approach to new techniques and technologies. Where evidence is lacking, approaches to gather new evidence and support the translation into clinical practice will be supported.

ERCP is amongst the highest risk procedures performed routinely by endoscopists. We are running a project to develop a national programme of service quality improvement for ERCP that leads to safe, timely, and effective ERCP that is compliant with relevant guidance. We will achieve this by carrying out a comprehensive audit of ERCP practice across the UK and surveying current practice in hospitals that perform ERCP and individual independent ERCP practitioners. Find out more about the project and how to get involved here.

3. BSG ‘Success’ Stories

The BSG CSSC has initiated and promoted service ‘success’ stories from around the UK. The aim is to share experiences of how colleagues have responded to challenges to their service and learn from each other. Our authors are happy to be contacted directly and to share details of what they did. We hope that you will find their experience useful.

If you have a service ‘success’ story that you would like to share, please contact the BSG team for further information. We are also happy to receive any comments that you may have about this initiative.

4. BSG Care Bundles

These pragmatic user friendly toolkits have been developed by experts from the BSG Section Committees and allied organisations such as AUGIS/ BASL etc depending on the topic of interest. They are intended to be used by frontline colleagues to provide high quality optimal care for patients presenting with everyday GI/ Hepatology conditions.

5. BSG Service Development Prize

This prestigious annual prize was introduced in 2019 to recognise and reward colleagues undertaking significant service development work throughout the four nations. The prize is awarded at the BSG plenary session following rigorous scoring/ review by members of the CSSC Executive and Editor of Frontline Gastroenterology. We strongly encourage you to submit your work to the BSG team. Find more out about the prize.

6. BSG QI Symposium

The popular annual QI symposium takes place at the BSG annual meeting. It is an opportunity to invite keynote speakers to inform the audience of previous and current national QI work. It is also an excellent forum to showcase ongoing activities such as the BSG quality standards framework, EQIP and IQILS.

7. Invited service reviews (ISR)

The BSG in conjunction with the Royal College of Physicians of London (RCP) introduced this review service for gastroenterology and hepatology in October 2019. The ISR scheme has been very successfully run by the RCP for a number of years. The process is well established and been refined following several iterations. The College has a wealth of experience in conducting this highly respected review process.

For those of you who are unfamiliar with the scheme, an ISR is a well defined, impartial, rigorous peer review process. Executive members of Trusts/ Boards usually medical directors or chief executives contact the BSG/ RCP London to  invite the ISR team to conduct a visit when it is felt that a department or service would benefit from an external review. Strict terms of reference are defined and visits typically occur over 2 days depending on the remit and involve a selected panel of relevant experts. A report with recommendations is produced for the Trust/ Board to enact. The report is independently quality assured by the QI lead of the CSSC. Historically ISRs lead to significant positive changes and improvement in service delivery.

We are always keen to learn about QI projects, innovative interventions and new ways of working. If you would like to be a pilot site for the national BSG Quality Standards Framework or contribute to QI please do contact the BSG team.

Finally in the words of Albert Einstein ‘The world we have created is a product of our thinking; it cannot be changed without changing our thinking’.

Dr Andy Douds, BSG Quality Improvement Lead and Deputy Chair, BSG Clinical Services and Standards Committee

BSG QI Initiatives

RCP Future Hospital Journal

The recent Future Hospital Journal has presented a series of articles that offer readers the opportunity to view quality improvement from multiple perspectives including theory, educational requirement, delivery and intended outcomes of quality improvement.

Embedding quality improvement into routine clinical practice, the editor, Ed Nicol, of the Future Hospital Journal, a Journal of the Royal College of Physicians challenges us with this observation, “Our patients rightly expect quality healthcare, our politicians expect the £100bn funding of the NHS to deliver quality healthcare and we, as clinicians, strive to deliver quality healthcare; so why is quality improvement (QI) so difficult to routinely deliver, and why does it remain a Cinderella function in healthcare?”

Access the Future Hospital Journal

BSG Endoscopy Quality Improvement Programme Overview

Access the ‘BSG EQIP: overview and progress’ article

Quality Standards Framework (QSF) Pilot Project

The Quality Standards Framework (QSF) pilot project was launched after extensive consultation in September 2022. This was at the beginning of what emerged as another challenging period for clinical service delivery across the UK, and with winter and workforce pressures, we were grateful to receive initial interest from 18 volunteer sites. Efforts were made to secure four-nation participation in the project, which did achieve initial engagement in each nation. Final outcomes however, included two Scottish sites, with the rest located in England.

At the closure of the project on 31st May 2023, 14 sites had been able to complete submissions and 12 had attended valuable, qualitative feedback sessions, which informed some of the themes that emerged from survey responses. 

A package of support was developed to assist teams to take part, including a financial offer of £1,000.00 for local project administration together with early, drop-in Q&A opportunities.  A free place for a nominated nurse from each participating service was also offered, on condition that claimants attend the QSF session at BSG LIVE. Perhaps reflecting capacity in the health landscape, only two sites claimed financial support, although eight took up the benefit of the free nurse place at BSG LIVE.

Individual outcomes and trends are also being prepared for sharing, alongside all other, anonymised results, with all participating services. A final report which will include a full options appraisal, will then be drafted for presentation to CSSC.