Insights on service improvements 

The Irish Society of Gastroenterology (ISG) Summer Meeting 2025 featured a talk by Dr Andrew Yeoman, Consultant Hepatologist, Aneurin Bevan University Health Board, Wales. Dr Yeoman trained as a gastroenterologist before taking up hepatology Fellowships in New Zealand and England. He has had a longstanding interest in service improvement and is on the medical advisory board of the British Liver Trust, among other prominent positions. He delivered a talk at the conference titled ‘Quality improvements in hepatology: Insights from Improving Quality in Liver Services (IQILS)’.

“Although this talk is heavily liver-focused, and this is the ISG conference, I think the principles are equally relevant to, for example, IBD [inflammatory bowel disease] care, complex nutrition, or any specialisation in medicine,” said Dr Yeoman.

He discussed the concepts of quality assurance and quality improvement, and the need for developers to fully understand a system’s design before either pillar can be guaranteed.

IQILS was designed to help meet the rising tide of liver disease, and in his jurisdiction, there has been a four-fold increase in liver disease in the past 25 years, he explained. While alcohol-related liver disease is still the biggest cause of end-stage liver disease and death, there has been a nine- to 12-fold increase in metabolic dysfunction-associated steatotic liver disease during that same period. There has also been a four-fold rise in cases of cirrhosis in the past 25 years, as well as a significant increase in portal hypertension, he said.

IQILS is a mechanism, Dr Yeoman said, which guides organisations through accreditation and provides help and support, rather than being directive. This is done partly by highlighting areas for improvement and better practice within the standards. The IQILS website provides exemplars of high-quality care that services can use and also features business cases for specialist nurses.

Patient organisations are also involved and they provide valuable feedback on whether a service is providing the level of care that it aspires to. “Building a community of practice is really important to this scheme,” Dr Yeoman told the attendees.

“You need leadership,” he continued. “If there is not clear leadership at every single level, it shows very quickly, so you need ownership across the whole team. You also need a clear shared vision that has to be shared with everyone, including the management structure.”

He concluded: “Quality assurance within services cannot occur without continuous improvement, and IQILS accreditation – indeed, any service accreditation – should be a supportive process, and not a binary inspection event.

“We are trying to build this community of practice, where we have shared learning and we share better practice to keep driving that continuous improvement… and ultimately, we have to practice what we preach,” he told the conference.

“We are continuing to develop the scheme [IQILS] to… improve what we offer to the services that engage with us to make sure we do it better.”