About the Global Rating Scale
The GRS is a tool that enables units to assess how well they provide a patient-centred service. It is a web-based assessment tool that makes a series of statements requiring a yes or no answer. From the answers the system automatically calculates the GRS scores, which provides a summary view of a service. The scale tries to strike a balance between being comprehensive but not too complicated. To achieve this, the scale has three different layers: domains, items and measures.
Refers to a broad aspect of care. In this case there are four domains: quality and safety (Clinical Quality); customer care (Quality of Patient Experience); Workforce and Training.  Customer care might also be referred to as patient-centred care. Patients tend to be more familiar with the customer care dimension than the items in the quality and safety dimension.
The items within each dimension provide a more detailed picture of what the dimension consists of. The items are qualitatively different and therefore no item is more or less important than another. However, a patient may regard one item to be more important than another. At this level there is no measure of how well a unit is doing with this aspect of care.
Measures are statements that are intended to be unambiguous. In other words a unit has either achieved them or it hasn't. In the GRS a measure requires either a yes or no answer. Creating unambiguous statements is quite a challenge therefore most descriptors have several measures to reduce the chance of miscoding an item.
Levels begin to create a more complete picture of what is going on by describing in words the different levels of achievement for an item. These levels vary from basic (D) to excellent (A). While scoring an item with levels gives an accurate picture of what is going on, the scoring process can be subject to bias. To minimise bias all descriptors have been underpinned with measures.