Improving Quality in Liver Services
We're delighted that the Royal College of Physicians (RCP) exemplar liver accreditation programme, Improving Quality in Liver Services (IQILS) is going from strength to strength.
Forty liver services across the UK are now registered on programme. This means they can access invaluable expertise and the latest guidance on improving standards and enhancing patient experience. Accreditation is achieved when the liver service demonstrates that they are meeting a series of standards where patients are at the heart of their service. A key aspect of the IQILS accreditation is involving patients in improving standards.
Martine Walmsley, Chair of Trustees, PSC Support, contributed to the development of IQILS through the pilot scheme Liver QuEST as the lead patient representative on the project, and is continuing to support the initiative to improve our liver services through her participation in the IQILS steering group.
Martine said, 'IQILS represents an important step for liver services and we must see liver services engaging and gaining accreditation. Currently there is an alarming disparity in the provision of liver services between different regions of the UK. IQILS provides a framework that not only supports the delivery of high-quality liver care but will also allow patients to make informed decisions about where to access the treatment they need. Ultimately every liver patient deserves to have access to high-quality care, regardless of their location. I’d like to see IQILS become a mandatory accreditation.
'While we were developing the new standards, we saw first-hand hard-working teams and outstanding practices in different hospitals; it wasn't just the larger hospitals delivering excellent care. As more liver services join IQILS and develop their services, patients can only benefit.
'It’s particularly relevant to patients with rare diseases like PSC, who because of location, might be cared for at hospitals without a special interest in PSC - they need to be assured that they are getting high-quality care.'
Jan 2016 - Liver QuEST
The Liver Quality Enhancement Service Tool (QuEST) aims to support hospital teams working in Liver Services to improve service quality, care and safety for patients accessing and undergoing treatment for liver disease. In order to achieve Liver Quest accreditation, the Liver Services are expected to have demonstrated that they are working to a series of standards where patients at the heart of their service.
The draft Standards are organised into five Domains:
- Leadership, Organisation and Delivery
- Clinical Quality
- Patient Experience
- Integrated Care
- Workforce and Training
Martine Walmsley, Chair of Trustees at PSC Support and a PSC patient herself, is providing patient representation for liver disease patients in the development of the LiverQuest process. As part of an assessment team, Martine has been carrying out accreditation assessments in hospitals that have volunteered to be part of the LiverQuest development process. Martine in particular looks at patient engagement and involvement in the Liver Service and each assessment includes reviewing the Liver Service's website, reviewing patient information and materials (eg leaflets), interviewing patients, reviewing hospital-sought patient feedback and actions taken, and considering respect and dignity from the patient perspective, shared decision-making, conducting a site visit and, of course writing a report about the Liver Service and reporting back on the accreditation process itself and suggesting ways to improve it before it goes live.
Martine Walmsley commented, 'Personal experience and close reading of the 2014 Lancet Commission report confirm that liver services in the UK are patchy and inconsistent at best. Not all patients are able to access quality information and care close to home resulting delays in diagnosis, misdiagnosis, ineffective monitoring and symptom management, missed opportunities for intervention/inappropriate intervention, and even for the sickest patients, delayed referral for liver transplant assessment (meaning they are too ill to have a transplant). I am proud to be part of the Liver QuEST development team. As a patient myself, I look at a Liver Service through different eyes to the clinical members of the accreditation team. In developing the standards, I am able to highlight areas for more focus or attention, because they are important to patients. There is a real emphasis on 'what patients want' when thinking about what a Liver QuEST-accredited Liver Service should look like. It's taking a long time and a great deal of effort, but I think worth it if we can develop a process for accreditation that realistically allows Liver Services to develop and improve in ways that help patients.'
'Ideally, accreditation means patients can be confident that medical teams are well-trained, up to date, working as safely as possible and their staff know what they are doing, or have access to strong networks of expertise (especially important for the rare liver diseases). Furthermore, accreditation means that liver services will deliver the care patients want and need, and will be developing their services with patients, side by side. We know some liver centres already do deliver a world class service and LiverQuest is an exciting opportunity to see this best practice truly shared and allow the liver community to begin to address the vast inconsistencies in care and standards across the UK.'