Luminary Learning Gastrointestinal Disorder- Issue 1

48  • LUMINARY LEARNING: GASTROINTESTINAL DISORDERS experience. It is recommended that any training programme solution must seek to ‘up skill’ all vascular surgeons to become proficient in endovascular techniques and for interventional radi- ologists to require broad clinical training in order to adequately and safely apply these new endovascular techniques. One such initiative is a 1-year integrated fellowship for interventional radiologists and vascular surgeons where the evaluation found that the fellows support, like and recommend further integration of their roles. The fellowships were found to be mutually benefi- cial to both disciplines [11]. The case study of the emergence of endovascular procedures across two medical specialties scope of practice, highlights the tensions that can arise with the changing nature of medical prac- tice with advances in technology and innovation. SIT illustrates the difficult and complex adjust- ment that is required of self-esteem of doctors in this fast changing healthcare context. What is considered by one Royal College as ‘performance of innovative techniques or procedures within the context of a specialty or family of medicine (such as vascular services) may be seen by another Royal College as a ‘technique’ or ‘speciality’ belonging to their own specialty’s ‘scope of practice’. In such situations employing organisations need to take a lead to develop integrated service models, where new skills are acquired by vascular surgeons and interventional radiologists and a team approach is facilitated. Only when this is achieved will the goal of offering high quality patient centred health procedures, within a team based culture, with less invasive procedures be delivered to patients. The Quality Excellence Framework (EFQM Excellence Model) is a total quality framework [14] widely applied to healthcare in Italy [15] Holland [16] and Germany [17] with its American equivalent the Malcolm Baldrige award or the Australian Excellence award in Australia. The EFQM has nine dimensions which are grouped into five enablers and four results. The enablers describe how staff can improve: leadership, policy, strategy, people, partnerships and resources and processes, while the results cover what the staff achieve: customer (patient feedback and sat- isfaction) people and society and key performance results. The model works primarily as a self- assessment tool which helps to prioritise improvements. The staff achieve a rating which is either a stage three, four or five level rating dependent on an external assessment and this process can support the integrated care model and support a competency approach with its balanced meas- ures of processes and results (Fig. 1). Fig. 1: The EFQM excellence model. 167 and processes, while the results cover what the staff achieve: customer (patient feedback and sat- area such as endovascular services that is con- tinuing to evolve across medical specialties, a Leadership Enablers ©EFQM 2012 Results Learning, Creativity and Innovation People People Results Customer Results Society Results Business Results Strategy Partnerships & Resources Processes, Products & Services Fig. 17.1 Th EFQM excellence model 17 ‘Clinicians Versus Clinicians Versus Managers’ or a New Patient Centred Culture That Eradicates ‘Them…