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Setting the standard in healthcare
Clinical audit: Ten simple rules
for NHS Boards
based on ‘Clinical audit: A simple guide for NHS Boards and partners’
produced by HQIP and the Good Governance Institute, 2010.
The clinical audit cycle
Background
Clinical audit is:
– A key element of clinical governance
– Crucial in assessing the quality of clinical care
– Vital to achieving efficiency savings while
improving the quality of service
– A requirement for CQC registration and to meet
NHSLA standards
– A required element of Quality Accounts
Background
But Trust Boards have been criticised:
– Failure to use clinical audit in a systematic way to
address risks
– Little evidence of Board level discussion or
challenge of data quality
– Separating cost and quality
– Detailed criticism in the Mid Staffordshire report
Clinical audit and commissioning
Commissioners have a duty to monitor the conduct of
clinical audit in providers:
– They should participate in setting the local clinical
audit agenda
– Contracts should include clinical audit requirements
– PECs should facilitate interface audit
– Providers should report audit progress and outcomes
– Commissioners require assurance about the
implementation of action plans.
HQIP guidance
The guide describes:
– How the board can gain assurance about quality
of service from clinical audit
– What questions board members should ask
– Acceptable answers
– Where to go for further guidance and support
– Ten simple rules for boards to follow
Rule 1
Use clinical audit as a tool in strategic
management; ensure the clinical audit strategy is
allied to broader interests and targets that the
board needs to address.
– Do we have a clinical audit strategy based on national and
local priorities?
– Do we engage with our providers to ensure their clinical
audit strategies meet our requirements for quality
assurance?
Rule 2
Develop a programme of work which gives
direction and focus on how and which clinical audit
activity will be supported in the local health
economy.
– Is our board assurance framework supported by clinical
audit as assurance?
– How can we be assured that the technical quality of clinical
audit undertaken by our providers is high and that key
issues that affect data quality are addressed?
Rule 3
Ensure all providers have appropriate processes
for instigating clinical audit as a direct result of
adverse clinical events, critical incidents and
breaches in patient safety.
– Is there a clear link between our processes for dealing with
such events and our clinical audit strategy?
– Who is responsible for ensuring this link works?
– What assurance do we have that providers consider such
events when developing their clinical audit programmes?
Rule 4
Check the clinical audit programme for relevance
to board strategic interests and concerns. Ensure
that results are turned into action plans, followed
through and re-audit completed.
– Has the board agreed what constitutes materially
unacceptable variation in clinical audit results?
– For all clinical audits that identify unacceptable variation is
there an action plan?
– Have we assurance that clinical audits have led to
improved service delivery?
Rule 5
Ensure there is a lead clinician who manages
clinical audit within every provider, with partners /
suppliers outside, and who is clearly accountable
at board level.
– What proportion of approved clinical audits do our
providers complete to time and budget?
– Do our contracts with suppliers / providers require
cooperation in clinical audits e.g. in CQUIN regime?
Rule 6
Ensure patient involvement is considered in all
elements of clinical audit, including priority setting,
means of engagement, sharing of results and plans
for sustainable improvement.
– Is there an explicit link between our clinical audit strategy
and our patient and public engagement strategy?
– Do we enable patients and carers to influence clinical audit
and other quality improvement activities?
Rule 7
Build clinical audit into planning, performance
management and reporting.
– Do we have an explicit process for reviewing national
clinical audit reports and quality accounts from providers?
– Do we have an explicit process for using the outcomes of
clinical audits to inform commissioning decisions?
– What assurance do we have that our providers
performance is accurately reflected in the assessments of
the regulatory bodies?
Rule 8
Ensure with others that clinical audit crosses care
boundaries and encompasses the whole patient
pathway.
– Do we have clear lines of communication with other local
health and social care providers to facilitate cross boundary
clinical audit?
– Are any areas such as mental health or primary care
neglected in local clinical audit programmes?
Rule 9
Agree the criteria of prioritisation of clinical audits,
balancing national and local interests, and the
need to address specific local risks, strategic
interests and concerns.
– Do we have a relevance test to approve commitment of
resources?
– Does our focus on national clinical audits mean we have no
resource to advise on local priorities?
Rule 10
Check if clinical audit results evidence complaints
and if so, develop a system whereby complaints
act as a stimulus to review and improvement.
– Is there a clear link between our processes for dealing with
complaints and our clinical audit strategy?
– Are complaints taken into account when approving local
clinical audit programmes?
HQIP website
Contact us
Healthcare Quality Improvement Partnership
Email :
lqit@hqip.org.uk
Website:
www.hqip.org.uk
Promoting quality improvement for better healthcare