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3 Supporting the delivery of high-quality careWe disseminate via targeted reports and communicationsto the most involved audiences, and host nationalconferences and regional workshops. We provideslide sets which can be edited with local data to makedissemination as simple as possible and to encouragean accurate and consistent message. Broader audiencesare targeted through press activity, RCP publications,and presentations at regional and national conferences,workshops and meetings, along with numerousacademic papers published in peer-reviewed journals.Implementation activity depends very much on theproject topic and the specific findings orrecommendations. Generic approaches include use ofconference sessions and regional workshops to discussfindings and application of recommendations in detail,gathering feedback (via anonymous voting, discussion,focus groups) and creating action plans for local teams.Peer or expert reviews are often offered.The focus is always on the evidence base, bespokedatasets and identification of what will work inindividual circumstances. Audit data are widely shared,in various formats, to support patient choice initiatives,regulatory activities, such as the Care QualityCommission’s Quality risk profiles, 8 policydevelopment, for example, the strategy for services forchronic obstructive pulmonary disease (COPD) inEngland, 9 and evaluation of public expenditure such asthe National Audit Office report, Progress in improvingstroke care. 10Quality improvement projectsIn line with the key objectives of the white paper inEngland, Equity and excellence: liberating the NHS, 11and its own A strategy for quality, 1 the RCP manages anumber of innovative projects that aim to driveimprovements in specific aspects of healthcare wheredeficiencies or variations are identified through nationalclinical audit. Working in collaboration with specialistsocieties and patient groups to plan projects, and closelywith clinical teams at the front line, a number of qualityimprovement techniques are implemented to supportefforts to improve the patient experience and outcomesof healthcare services. 12AccreditationAccreditation is a self-assessment and external peerassessment evaluation process used to assess accuratelya service’s level of performance in relation to establishedstandards. Healthcare providers are required to produceevidence to demonstrate their compliance with thestandards. Accreditation is seen as a ‘badge of quality’for a healthcare provider and is important tocommissioners and patients alike.The RCP’s accreditation schemes have at their heart theHQIP-approach to professionally led clinical serviceaccreditation. They aim to improve the quality, safetyand outcomes of healthcare, the patient experience andservice delivery. The schemes are professionally led bymultidisciplinary teams. They are supportive ofhealthcare services and as such include training daysand facilitate sharing of best practice among teams. Akey feature is the self-assessment and improvementtools available to services for them to measure their ownperformance in relation to the standards before anaccreditation assessment takes place. If a healthcareprovider does not meet the standards at the time of theassessment, the assessors recommend key actions andwork with the service to support them in gainingaccreditation.Accreditation standards are reviewed periodically and inthis way are used as a driver for quality improvement asthe required level of quality is raised over time. Workingin partnership with our clinical audit colleagues is key, asconducting and reviewing clinical audits is an importantpart of accreditation criteria for the various schemes.Health informaticsGood quality medical record keeping is essential forgood quality care and the wide variation in the structureand content of medical notes presents a major problemfor the development of electronic healthcare. Thestandardisation of the administrative, demographic andclinical content of health records is needed to ensure unambiguousrecording, safe communication and reliableintegration of data held in different record systems. Itis also essential to ensure that any analysis of aggregateddata is valid and reliable. The need for informationstandards to support both safe clinical care and clinicalresearch has been confirmed by many reports in thelast few years. 9–17 If clinical research is to be effectivelyintegrated into the work of the NHS, standardisationof clinical information recording is required.In brief, information record keeping standards areneeded to ensure: appropriate data capture, in both structured formand free text, in different clinical and researchcontexts and locations valid and reproducible data extraction intosummary recordsC○ Royal College of Physicians 2013 269
Consultant physicians working with patients valid and safe inter-operability between systemswhen communicating or integrating patient dataheld in different systems – a reduction in ambiguitywill bring benefits for patient safety meaningful, valid analysis when data are aggregatedor analysed retrospectively to inform servicedevelopment, performance monitoring, activityanalysis and research common language for describing clinical researchquestions, and research commissioning, registration,management and reporting, which integrates withterminologies and definitions used in clinicalpractice.Patient safetyThe RCP has established a patient safety committee tolook at safety issues that arise in the practice of themedical specialties. This will work with the patientsafety initiatives in the devolved nations, includingNHS England. The National Reporting and LearningService, now at Imperial College, London, is a source ofdata for learning that can then be disseminated to ourmembers and fellows. We will work in partnership withother disciplines and external stakeholders and willfurther education in safety issues for our members andfellows.Revalidation and appraisalRevalidation is the process whereby doctors have todemonstrate on a regular basis that they are up to dateand fit to practise. This is achieved through a process offormal annual appraisal, where a doctor producessupporting information to demonstrate that they havemettherequirementssetoutintheGoodMedicalPractice (GMP) framework for revalidation set by theGeneral Medical Council (GMC) (www.gmc-uk.org).Doctors will be revalidated every 5 years in order toretain their licence. This will be based on the successfuloutcome of five annual appraisals, a multi-sourcefeedback, CPD and participation in audit. Arecommendation for revalidation will then be made tothe GMC by a responsible officer. Revalidation startedin late 2012.Although there has been suggestion that revalidation isa means of identifying ‘bad doctors’, the RCP is keen toensure that revalidation is a vehicle for achieving,maintaining and improving the quality of all physicians’practice and provision of care. Revalidation should be ameans of helping to identify areas for improvement atan early stage, and for ensuring that there are clearsupport mechanisms available. Revalidation will workin parallel to existing clinical governance andperformance management systems, but is very muchabout the individual doctor’s development.TheRCP’saimistoshapeaclearrevalidationprocessfor physicians, but to ensure that this process is part of aconsistent and equitable system for specialties that allcolleges and faculties support, and is also aligned withthe generic requirements of the GMC and RevalidationSupport Team (RST). We are working closely with theAcademy of Medical Royal Colleges, individual colleges,and other key stakeholders to achieve this.The RCP is involved in a number of activities. We: undertook a national pathfinder pilot to assess thestrengthened medical appraisal process and theGMC’s GMP framework developed validated multisource feedback (MSF)colleague and patient questionnaires which arecurrently used by different specialties in many trusts.We are now rolling out a specialty-specific version ofthe questionnaire, and we are currently piloting aversion for medical managers developed a personal clinical audit tool (p-cat)which is a simple online tool designed to assistdoctors to capture a high-quality audit, to documentthe process effectively and, importantly forrevalidation, to reflect on their participation and anyresulting change in practice. The output of the toolis a summary that can be provided as supportinginformation for appraisal are coordinating a ‘cohort’ to develop an e-systemfor revalidation, which will allow doctors to managetheir supporting information for appraisal. Thesystem will be designed to inter-operate withexisting college systems such as CPD, and othernational systems as necessary are providing high-quality appraisal training, andresponsible officer (RO) training developed, on behalf of the Academy of MedicalRoyal Colleges, consistent specialty guidance forappraisal, and to consider the aspects of specialtytraining required for appraisers, those advisingappraisers and ROs.As time goes on, the RCP will provide more detailedongoing guidance to members and fellows to support270 C○ Royal College of Physicians 2013
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AbbreviationsA&EAACsAMUsARCPCCGsCCS
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