Introduction The Bowel Screening Wales (BSW) programme has completed 12,000 colonoscopies since 2008. All Screening Colonoscopists are assessed, approved and quality assured by BSW. Colonoscopy is an invasive procedure with inherent risks. Complication rates in the BSW programme have occurred at expected levels but investigation has highlighted potentially preventable causes. We have developed a Performance Management Framework (PMF) to support colonoscopists where lesion assessment or therapeutic decision-making was associated with a pattern of adverse outcomes.
Methods A researcher (NH) conducted semi-structured interviews with BSW colonoscopists following active diary collection on BSW lists (Jan–Feb 2013). Narrative data was examined related to documented or recalled near-miss episodes or complications and evaluated alongside existing published case-control or cohort studies and BSW root-cause analysis data to inform the development of the PMF. The main criteria used in its development were; fairness, transparency, consistency of application, practicality and alignment to existing BSW QA frameworks (centralised data, feedback, QA visits and training). A draft PMF was presented to BSW Lead Colonoscopists in November 2013.
Results The framework comprises the following steps: 1) Identification of issues; 2) Investigation; 3) Observation; 4) Training. Issues may be identified from performance data, reported near-miss episodes, self- or peer-reported complications or from patient complaints. Investigations review all documentation, endoscopic images, pathology and radiology depending on the nature of incident. Trained QA assessors and mentors are required to provide detailed observation of performance in the context of colonoscopist’s usual working environment, using validated DOPS methodology (incorporating discussion around decision-making). The final step involves the colonoscopist agreeing a tailored training plan based on feedback from BSW QA advisors, assessors and mentors. This states 1) the nature of the concerns identified; 2) specific goals to be achieved; 3) timetabling and 4) tools to be employed to measure progress. Where there is serious concern for participant safety the BSW Colonoscopy Panel may consider suspension pending appropriate investigation and training. The outcome of training will be reviewed by this Panel to determine ongoing suitability to perform as a screening colonoscopist.
Conclusion A pragmatic Performance Management Framework for BSW Colonoscopists has been developed. It seeks to provide a safe and supportive environment for both patients and colonoscopists respectively undergoing and performing complex therapeutic interventions, aiming to provide early identification of problems through central data analysis and specific, targeted training interventions where required.
Disclosure of Interest None Declared.
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