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

Dig Liver Dis. 2012 Nov;44(11):919-24. doi: 10.1016/j.dld.2012.06.021. Epub 2012 Jul 25.


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.

MeSH terms

  • Benchmarking
  • Endoscopy, Digestive System / standards*
  • Endoscopy, Digestive System / statistics & numerical data
  • Humans
  • Outcome and Process Assessment, Health Care / methods
  • Patient Satisfaction / statistics & numerical data
  • Quality Assurance, Health Care / methods*