Nor is it…
• Buying computers
• Buying software
• Having others put in all the
data and you pushing the
button
• Extra work
• Optional work
If only we
had that
package
Can’t you do
it for me
I’m too
busy
We don’t
need to do
that
What is quality?
Best patient care
More efficient
Least risk
Satisfaction
Least strife
Smooth running
Best care
Rescue principle
Responsive
Empathic
Quick
Patient
Best safest care
Continual improvement
Satisfied patient
Advanced research
Clinical freedom
Responsive support
Managerial
Professional
Safe
Best
Smooth / No gaps
Patient centred
Gap models of service quality
Expected service
Gap 5
Perceived service
Gap 1
Service delivery
Gap 3
Service standards
Gap 2
Company perceptions
of customer expectations
Gap 4
External
communications
Improve patient outcomes
Release money
to provide
better patient care
Improve professional
practice
Promote MDT
working
Professional
education
Identify and
eliminate waste
Select and support
only highest quality care
Identify and stop
bad practice
Identify and promote
good practice
Clinical Audit
Implementation of CA
Define
Measure
Analyse
Traditional improvement projects
Improve
Control
Effectiveness
Information for
research
Detailed, focussed and
minutiae
Info not usually collected
Information for
monitoring
Technical data
Lot of energy in getting
agreement
Information for quality
improvement
Quickly gathered
Rapid cycle
Some misconceptions……
It is not about cook book medicine
Identify Standard
Make appropriate changes
Measure activity
Validate against standard
ACT
Check
ACT
ACT
Check
Check
Do
Plan
Do
Plan
Plan
Do
Framework for clinical audit
Physical attributes of health care
Structure
•Tangible, easily counted
•Presence increases the chance of good
quality care but does not ensure it (appropriate
use…..)
•Examples: equipment; medical records
Care given by a practitioner / service
•Health professionals identify process with quality
Process
Outcome
–It describes what they do
–Reflects their attitudes, knowledge & skills
•Examples: prescribing habits, hospital referral
rates, lab & x-ray use
Changes in patient’s current & future health
status as result of intervention
•Describe effectiveness of care
•Difficult to measure……
•Example – lower incidence of specific disease;
lower mortality; improvement of level of
function, patient satisfaction
Continuous vs. Big Bang
Feedback Intervention Theory
Emphasis on clinical performance task
Specifying performance target
Presenting information on how target can
be reached
Information on progress since last target
Emphasis on recipient
Discouragement
Praise ???
Audit and Feedback
+70%
Change in practice after clinical audit
– measured by adherence to specific guideline
0%
-16%
Jamtvedt et al 2006,
Cochrane Database of Systematic Reviews
Why audit
• Measuring for
compliance
• Win over the sceptics
• Measuring for
research
• Sharing the experience
• Measuring for
improvement
• True short cycle
improvement
Good audit
• The right processes
– Prescribing practice
• The right objectives
– Continual self improvement
• The right measures
– Logistics of the prescribing actions
• The right actions
– Reinforcing concept / reinforming stakeholders
Challenges
• Understanding
• Good audit
• Professional competence
• Measurement of audit
• Sustaining audit
Joining up the dots
• Building CA into a
central plank of
monitoring
• Understanding context of
CA
• Matching CA to strategic
goals
• Making CA comfortable
Motherhood and apple pie
More education
More forms
More awareness
More research
Recommendations
“We (I) will do x, y and z in the
next 6 weeks and we will know
we have succeeded
Implementation of CA
Define
Measure
Analyse
Traditional improvement projects
Improve
Control