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Dimension
Dimension refers to a broad aspect of care. In this case there are two dimensions: 'Clinical Quality' and 'Quality of Patient Experience'. Quality of the Patient Experience might also be referred to as patient-centred care. In this dimension there are things that patients are usually more aware of and therefore more ocncerned about. Patients tend to be less familiar with the items in the Clinical Quality dimension.
Items
The items beneath each dimension give a more detailed picture of what the dimension consists of. The items are qualitatively different and therefore no item is more or less important than another. However, a patient may regard one item to be more important than another. At this level there is no measure of how well a unit is doing.
Descriptors
Descriptors begin to create a more complete picture by describing, in words, different levels of achievement for an item. These levels vary from basic (D) to excellent (A). The descriptors provide a more complete picture of what is going on, but they are inexact and therefore prone to misinterpretation. To maximise accuracy the descriptors have been underpinned with 'measures'.
Measures
These are statements of process or outcome that a service would be expected to achieve if it was providing a high quality patient-centred service. The statements are intended to be unambiguous: a service has either achieved them or not. In the GRS a measure requires either a yes or no answer. Creating unambiguous statements that adequately describe a level of achievement is difficult, therefore most descriptors have several measures.
Will the GRS stay the same from now on?
It took more than a year to develop the GRS, during which time there was considerable consultation with the service. Despite this there has been a constant temptation to keep refining it. However, this process eventually approaches a point of diminishing returns. The exception to this was the 'Appropriateness' item which was not fit for purpose and which was mdified in 2007. An explanation of this change is available through the 'recent documents' section on the homepage. The scale will remain fixed for the foreseeable future. However, the guidelines that underpin it will change as the evidence base changes. Thus we have a tool that gives continuity of measurement, while remaining flexible to changes in the evidence base.
What are the other dimensions of the GRS?
The GRS has two other dimensions: training and workforce. The workforce dimension is a generic tool applicable to any workforce team in a healthcare setting. It aims to help teams recruit, train and support the workforce and it gives a measure of how well this is achieved. It is structured in the same way as the GRS. The training dimension is specifically targetted at trainee endoscopists. Trainee endoscopists are usually 'guests' in an endoscopy department and, as such, have different needs.
Download the GRS Explanation Powerpoint presentation here
Download the GRS workforce domain presentation here |