Quality Standards for Paediatric Audiology
In 2005, a multidisciplinary group of professionals working in Paediatric Audiology from England, Scotland and Wales, under the guidance of MRC Hearing and Communication Group, began developing quality standards and an accompanying quality rating tool ( QRT) for Paediatric Audiology using the NHS Quality Improvement Scotland ( QIS) methodology. This, for a number of reasons, was not completed, although a draft document was produced.
In 2008 the multidisciplinary Paediatric sub-group of the Scottish Audiology Services Advisory Group ( ASAG), using the draft document as a starting point, undertook to complete this work resulting in the production of this document.
At the same time, discussions were undertaken within the Welsh Assembly Government to undertake a similar development process for the production of standards and the audit of paediatric services.
Comments and feedback are welcome on the document.
In January 2003 the Public Health Institute of Scotland published a Needs Assessment Report on Audiology Services in Scotland. This report identified a number of areas in which Audiology services were failing to meet the standards expected by service users and stakeholders. Many of the concerns raised were applicable to both adult and paediatric services; some were specific to either adults or paediatrics. Concerns raised included:
- Inadequate facilities at base hospital, peripheral clinics and community sites
- Shortages in qualified staff and appropriately skilled staff leading to compromised service access and quality
- Financial pressures compromising service quality, with an undue emphasis on activity at the expense of outcome
- Poor inter-agency links
- Large variations in services across NHS Boards
- Inferior service quality and outcomes in comparison to elsewhere in the United Kingdom and overseas
- Good working practices often not in place. Developments in Audiology services elsewhere in the United Kingdom largely absent in Scotland
- A lack of well functioning Children's Hearing Services Working Groups
- A need for audiologists with additional paediatric training and experience to deliver the audiology care for children
As a result of these findings a number of recommendations were made by the Audiology Needs Assessment Group. Among these were the recommendations that " NHS Quality Improvement Scotland ( QIS) should produce an agreed set of standards for audiology services, and conduct an assessment of the services' ability to meet these standards, taking into account established documents from voluntary bodies and professional organisations" and "The Scottish Executive should establish a formal Audiology Services Advisory Group".
In response, an Audiology Services Advisory Group was established "to monitor the development of NHS audiology services in Scotland and to provide appropriate advice to NHS Boards, the health department and other relevant bodies that will facilitate effective and efficient development."
When approached, NHSQIS indicated that it would not be possible to undertake the work within a timescale that would be acceptable to the Group. It was then suggested that work be undertaken by a sub-group of the Scottish Government's Audiology Services Advisory Group ( ASAG), following the NHSQIS standards development methodology, to write standards for adult hearing rehabilitation services.
1.2 NHSQIS Methodology
1.2.1 Basic Principles
Standards developed using the NHSQIS quality assurance process are required to be clear and measurable, based on appropriate evidence, and written to take into account other recognised standards and clinical guidelines. The standards are:
- Written in simple language and available in a variety of formats
- Focussed on clinical issues and include non-clinical factors that impact on the quality of care
- Developed by healthcare professionals and members of the public, and consulted on widely
- Regularly reviewed and revised to make sure they remain relevant and up to date
- Achievable but stretching
The way in which standards are developed is a key element of the quality assurance process. Project groups working on standards development are expected to
- Adopt an open and inclusive process involving members of the public, voluntary organisations and health care professionals
- Work within NHSQIS policies and procedures
- Test the measurability of draft standards by undertaking pilot reviews
1.2.3 Format of Standards and Definition of Terminology
All standards quality assured using the NHSQIS process follow a similar format:
- Each standard has a title, which summarises the area on which that standard focuses
- This is followed by the standard statement, which explains what level of performance needs to be achieved
- The rationale section provides the reasons why the standard is considered important
- The standard statement is expanded in the section headed criteria, which states exactly what must be achieved for the standard to be reached and how the service will achieve this. Each criterion is expected to be met wherever a service is provided. The criteria are numbered for the sole reason of making the document easier to work with, particularly for the assessment process. The number of the criteria is not a reflection of priority.
1.2.4 Assessment of Performance Against the Standards
Assessment of the performance of Audiology services against the standards will take place using the attached Quality rating tool. This will include both self assessment by individual services and external assessment by peers. The Audiology Quality Improvement sub-group of the Audiology Services Advisory Group will be responsible for overseeing this assessment procedure.