We updated the King's College Hospital (KCH) NHS Foundation Trust's 'NICE Policy'.
This includes process flowcharts for implementing each type of NICE guidance, including the new Medical Technologies and Diagnostics guidance, and Quality Standards, in the Trust. The policy and flowcharts also help demonstrate compliance with the NHSLA Standard on NICE (Standard 2.8 for 2012/13), and thus include steps for assessing relevance, organisational gap analysis, and ensuring recommendations are acted upon.
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Aims and objectives
The aim of the project was to update KCH's existing 'NICE Policy', to improve the implementation of all types of NICE guidance, including Medical Technologies and Diagnostics, across the Trust. Furthermore, updating the policy would also help the Trust demonstrate ongoing compliance with the NHS Litigation Authority Standard on NICE (NHSLA Standard 2.8 for 2012/13).
The main objective was to develop robust, bespoke and efficient processes for implementing and monitoring NICE guidance across the Trust, using existing teams' and committees' knowledge and expertise. These processes would be set out in flowcharts, one for each of the six current types of NICE guidance: Interventional Procedures guidance-IPG; Technology Appraisals-TA; Medical Technologies guidance-MTG; Diagnostic Technologies guidance-DTG; Clinical Guidelines (short and full)-CG; and Public Health guidance (PH). Additionally, a seventh flowchart for Quality Standards (QS) would also be created.
These flowcharts would each include steps for implementing, monitoring and auditing the guidance, and would form appendices to an updated version of the Trust's formal NICE Policy. In doing this, implementing guidance produced from NICE's longer-established programmes (IPG, TA, CG, and PH) would be more efficient, and appropriate processes for NICE's newer guidance products (MTG, DTG and QS) would be developed and put in place.
Reasons for implementing your project
KCH had an existing formal policy on NICE ('NICE Guidelines Policy v2.0'), dated July 2010. This policy however did not distinguish between the numerous types of NICE guidance and thus only set out one process for implementing all 'NICE guidelines' (a term the Trust formerly used to refer to any and all NICE guidance products). Although this process was well established and followed, enabling the Trust to achieve NHSLA Level 3, it was inefficient. The KCH Clinical Effectiveness Department (CED) was responsible for developing, monitoring and running the process, for every piece of guidance NICE produced, and was accountable to one KCH committee (the Evidence-Based Practice Committee - EBPC).
The main opportunities for improving efficiency were focussed around tailoring the Trust's processes to each type of NICE guidance, based on the nature of, and differences between, the guidance products. One aspect of this was substituting the existing local, generic 'Guidelines Assessment Form' with some of the tools that NICE produces to help Trusts implement their guidance. Additionally, increasing productivity and avoiding duplication of work could be achieved by using the knowledge and expertise of different teams and committees at KCH, other than just CED and EBPC, in implementing some types of NICE guidance across the Trust.
How did you implement the project
This project was done as a part-time secondment from NICE to the Clinical Effectiveness Department (CED) at KCH, taking about 12 working days between April and December 2011. First I gained a thorough understanding of how the Trust already implemented NICE guidance, as set out in KCH's 'NICE Guidelines Policy v2.0', by shadowing and talking to CED staff. Next I worked with CED staff to identify other potentially relevant committees and teams within the Trust, based on the nature of the different guidance products, and the EBPC approved my initial project plan. I then met with staff from each team identified, and observed numerous committee meetings, before fully mapping the six guidance types to these teams and committees, including information on whether they already used NICE guidance. I explored how the Implementation Tools that NICE produces could be better used, such as the Baseline Assessment Tools for CGs and PHs being used for organisational gap analyses. I then developed process flowcharts, with guidance from CED staff, with steps to demonstrate compliance with the NHSLA Standard on NICE (such as assessing relevance, organisational gap analysis, and ensuring recommendations are acted upon), for each type of NICE guidance, based on the mapping results. Project updates were presented regularly to the EBPC, as the committee with overall responsibility for NICE guidance at the Trust, and advice sought when needed. Each flowchart was then presented to, and signed-off by, the team or committee identified as responsible for that type of guidance (the Chair of the New Clinical Procedures Committee signed-off the IPG flowchart, for example). The new processes were piloted using the guidance published by NICE in December 2011. Once all flowcharts were agreed, KCH 'NICE Policy v3.0' was written to capture the changes. This policy was ratified by King's Executive on 12 March 2012, and became a formal policy for the Trust.
As this project was only finished at the end of 2011, it is too early to be able to demonstrate much impact of the changes yet, such as increases in productivity for CED staff or increased efficiency of implementation processes. Anecdotal evidence however indicates that the new processes are working and should realise some of the potential improvements identified.
One promising area is that the new process for TAs removes a substantial amount of administrative work from CED, by avoiding duplication of work undertaken by Pharmacy. Given the number of TAs published, it is likely to be relatively easy to gather evidence of increased efficiency around this process.
Another example is from piloting the new process for IPGs, based on those IPGs published in December. The KCH New Clinical Procedures Committee is responsible for approving these procedures for use in the Trust, and agreeing appropriate monitoring and audit conditions. Previously, the Committee relied on Divisions and/or individual clinicians to apply to the NCPC to use a new procedure, and identify whether a relevant NICE IPG existed as part of that application. If so, the IPG was then implemented. The new process flowchart still includes this application route, but has a new alternative entry route too based on proactively contacting staff about IPGs when they are published by NICE. It was seen that proactively contacting the relevant Division asking them whether they already use the procedure in each IPG published, or intend to do so soon, increased the number of applications to the Committee, and thus the number of IPGs implemented fully. This anecdotal evidence however will hopefully be built on with more robust evidence of impact of the new processes.
Key learning points
The processes developed for KCH (see Appendices A-G of the KCH NICE Policy, found below in 'supporting material') are bespoke and tailored to the teams and committees that exist at the Trust. These processes are just one way that a Trust could implement NICE guidance, but hopefully there are still learning points from this project.
One point is to use the expertise and knowledge of relevant teams and committees, and not necessarily centralise all NICE work to one team. For KCH, giving responsibility for TAs to Pharmacy and IPGs to the NCPC was sensible and efficient. Additionally KCH, although a large teaching hospital, has a Public Health Committee, and they are now responsible for all relevant NICE Public Health guidance. The Clinical Effectiveness Department still has oversight and monitors all the processes, which is reported to the Evidence-Based Practice Committee. The EBPC, who were previously responsible for all NICE guidance, are now freed up to take a more advisory role for those implementing NICE guidance, as well as their other duties.
Another point is the opportunity to use a Trust's NICE Policy to demonstrate compliance with the NHSLA Standard on NICE. The sections of the new KCH NICE Policy are set out specifically to aid this, and relevant steps in each flowchart are identified using colour coding.
KCH NICE Project Manager - on secondment from NICE
Is the example industry-sponsored in any way?