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About this session

The purpose of this workshop was to discuss the value of sharing best practice across the fertility sector with a view to improving the quality of service for patients, and how to agree how it could best be done.

Overall feedback

Participants were keen and expressed their desire to be involved in work with the HFEA to focus on quality in the fertility sector. In line with the wider DH quality agenda, quality was defined as having three dimensions: safety, efficacy and patient experience.

Participants talked about formal quality processes and systems, but also about concrete areas of their practice that would benefit from a quality improvement focus. Particularly nurses pointed out that they are already doing a lot of sharing of good practice.

Distinct areas where quality improvement work would be beneficial

• Patient experience (unsuccessful patients, communication, waits, manners, premises and waiting rooms (NHS) etc) 
• Patient information (strong requests for HFEA to provide templates of information that fulfil our requirements and for the sector to share what they find works well, leaflets, rather than web based Q&As) 
• Pregnancy loss, reasons for, types of patients etc 
• Multiple births, and general follow up of IVF pregnancies 
• Patient feedback (how to gather, how to improve returns, what to ask for, what to do with it) 
• Witnessing and other lab practices 
• Ultrasound practices – a number of participants pointed out that the HFEA doesn’t think of ultrasound practitioners as their stakeholders and doesn’t liaise with their professional body, the BMUS

Formal quality processes

• Dissatisfaction with the amount of work (particularly for small centres) validation generated, for example where one nurse has to end up validating her own practice 
• Lack of certainty about meaningful quality indicators, particularly for the less technical areas of work (patient information, counselling etc) 
• Strong demands that HFEA should, together with sector representatives, work up ‘templates’ for quality systems, for example by reviewing and making relevant ISO 9001, rather than letting centres duplicate all their efforts into developing quality systems that we then deem not good enough 
• Strong desire by some to be involved in such work (we need to follow this up, even if we decide not to do this work) 
• Concerns that work on quality systems can become a complete paper exercise that takes staff away from the real purpose of their job, without adding much value (box ticking exercise etc) 
• Agreement that a centre could ‘look good on paper’, but not actually deliver good quality care and vice versa. 
• Concerns that HFEA might focus too much on ‘paperwork’

Obstacles to quality improvements

• Competitiveness, between centres, particularly in cities 
• Amount of work involved in developing a Quality System which makes people reluctant to ‘give it to others for free’ 
• Isolation of centres (both in and outside NHS) 
• Lack of follow up – centres don’t know what happens to their patients later on in real life 
• NHS 18 weeks target for hospital treatments – participants complained that patients reach their clinic late into that 18 week period which means that they then need to be rushed into treatment (NHS only obviously) 
• Work load issues and pressures (also in the private sector) – concerns that clinic management is keen to increase patient throughput without increasing staff levels’; participants were clear that this increased risks

HFEA role

• Some participants argued that quality work needed to be led by a different part of the organisation than the HFEA’s compliance function 
• Desire for facilitation rather than prescription 
• Some participants strongly argued that the HFEA should lead on work to develop quality standards to reduce regulatory burden for clinics

Next steps

• There was some support for focussed workshops on the areas identified above 
• Some participants suggested that we should hold a workshop particularly for quality managers, since they are a set of stakeholders we haven’t engaged with yet in a formal way

Page last updated: 30 October 2009

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