What is the endoscopy global rating scale (GRS)?

The GRS is a tool that enables units to assess how well they provide a patient-centred service. It is a web-based assessment tool that makes a series of statements requiring a yes or no answer. From the answers it automatically calculates the GRS scores, which provides a summary view of your service. The scale tries to strike a balance between being comprehensive but not too complicated. To achieve this, the scale has different layers:

• Dimensions
• Items
• Descriptors or levels
• Measures

Dimension
Dimension refers to a broad aspect of care. In this case there are two dimensions: quality and safety (now called Clinical Quality); and customer care (now called Quality of Patient Experience). Customer care might also be referred to as patient-centred care. In the customer care dimension we have things that patients are usually more aware of. Patients tend to be less familiar with the items in the quality and safety 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 we have no measure of how well a unit is doing with this aspect of care.

Descriptors
Descriptors begin to create a more complete picture of what is going on by describing in words different levels of achievement for an item. These levels vary from basic (D) to excellent (A). While scoring an item with descriptors gives an accurate picture of what is going on, the scoring process can be subject to bias. To minimise bias we have underpinned the descriptors with measures.

Measures
These are statements that are intended to be unambiguous. In other words a unit has either achieved them or it hasn't. In the GRS a measure requires either a yes or no answer. Creating unambiguous statements is quite a challenge therefore most descriptors have several measures to reduce the chance of miscoding an item.

Will the GRS stay the same from now on?
It has taken a year to develop this tool during which time there has been considerable consultation. Despite this there is a constant temptation to keep refining it but this process eventually approaches a point of diminishing returns. While we appreciate that the scale could always be improved, we believe the time has come to stop changing it and get it into everyday practice. The scale will remain fixed for the foreseeable future, while 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 practice.

Download the GRS Workforce Domain Presentation here

Download the GRS Explanation Powerpoint Presentation here