Investigating Clinical Excellence Awards (INCEA): how do current assessors and other key stakeholders define and score excellence? Qualitative interviews study

Problem

The Clinical Excellence Awards (CEA) scheme has been in place since 1948 in England and Wales to reward consultants, academic GPs, and dentists in making an outstanding contribution to the NHS. Significant changes in the structure and delivery of the scheme have been anticipated for several years. Following review and a national consultation, a new National CEA scheme is in the process of being implemented from 2022/23. A core part of the revised scheme is to have a scoring system that is robust, equitable, able to distinguish between levels of excellence, and aligned with ACCEA’s (Advisory Committee on Clinical Excellence Awards) overall goals. The aim of this qualitative component of the research was to understand how key informants would define excellence, score to differentiate between levels of excellence, and ensure non-discriminatory definitions and scoring.

Approach

Semi-structured qualitative interviews were conducted with 25 key informants, which included ACCEA sub-committee assessors and representatives of professional organisations affiliated with the NHS. Purposive sampling was used to achieve a varied sample in terms of gender and ethnicity and to capture different views and experiences. Informants were invited on the basis of ACCEA membership or through membership of relevant national level organisations such as Royal Colleges or groups representing particular groups of doctors. Interviews sought to explore key informants’ views on defining clinical excellence, experiences of scoring excellence, and around equity. Interviews were conducted by phone or Zoom/Teams, audio recorded, and transcribed using a professional transcription company. Transcripts were analysed using an inductive thematic approach.

Findings

Informants felt that the CEAs have a role in incentivising doctors to strive for excellence. A broad range of views were expressed on what constitutes ‘clinical excellence’ and what should be rewarded, which included going over and above job expectations, making a difference to patients and the NHS, and demonstrating the impact of excellence. In scoring excellence, assessors provided varied definitions and preferences for measurement scores. Assessors detailed their approaches to guard against perceived challenges with the scoring scheme and to ensure a fair assessment, such as scoring consistently as a ‘dove’ or ‘hawk’ and being aware of their own potential unconscious biases. Perceived inequities were raised around generating evidence for certain specialities, in certain hospital settings, working hours, and due to the self-nomination process. A number of practical suggestions were made for ACCEA in relation to improving support and training for applicants and assessors, as well as promoting the scheme.

Consequences

CEAs represent a significant opportunity for senior doctors in England and Wales and use of public money. The findings bring insights to inform future scoring and assessment of application but also point to the broader importance of equity of opportunity to apply, to regular training for scorers and support for applicants.