The Global Rating Scale in clinical practice: A comprehensive quality assurance programme for endoscopy departments

Background: The Global Rating Scale is an endoscopy quality assurance programme, successfully implemented in England. It remains uncertain whether it is applicable in another health care setting. Aim: To assess the applicability of the Global Rating Scale as benchmark tool in an international context. Methods: Eleven Dutch endoscopy departments were included for a Global Rating Scale-census, performed as a cross-sectional evaluation, July 2010. Two Global Rating Scale-dimensions - 'clinical quality' and 'patient experience' - were assessed across six items using a range of levels: from level-D (basic) to level-A (excellent). Construct validity was assessed by comparing department-specific colonoscopy audit data to GRS-levels. Results: For 'clinical quality', variable scores were achieved in items '. safety' (9%=B, 27%=C, 64%=D) and '. communication' (46% = A, 18% = C, 36% = D). All departments achieved a basic score in '. quality' (100% = D). For 'patient experience', variable scores were achieved in '. timeliness' (18% = A, 9% = B, 73% = D) and '. booking-choice' (36% = B, 46% = C, 18% = D). All departments achieved basic scores in '. equality' (100% = D). Departments obtaining level-C or above in '. information', '. comfort', '. communication', '. timeliness' and '. aftercare', achieved significantly better audit outcomes compared to those obtaining level-D (p<0.05). Conclusion: The Global Rating Scale is appropriate to use outside England. There was significant variance across departments in dimensions. Most Global Rating Scale-levels were in line with departments' audit outcomes, indicating construct validity.