News and updates from today's conference focusing on improving quality through the effective use of clinical audit.
Opening address: Clinical Audit Leadership: Driving Improvement
Dr Jane Youde, Clinical Director, National Clinical Audit and Accreditation Programme, Royal College of Physicians, London. Consultant Physician, Medicine for the Elderly, University of Derby
Jane discussed her own experience of using Clinical Audit for improvement in Derby and went on to discuss the RCP Audit Programmes - falls and fragility fracture audit programme, National lung cancer audit and the national audit of copd and asthma.
Jane said "to deliver high quality national audits there is requirement to have high quality specific data, expert analysis and then dissemination. The data must be reported in a timely way. There have been significant improvements in care using the data and theinformation from national audits at local and national level but these are not always seen as delivered at the pace and level required by the NHS."
Jane discussed the GIRFT - Getting it Right First Time programme - a peer review programme using one off visits with an action plan to drive improvement. Jane also updated delegates on the RCP specialty accreditation programmes using the NACAP as an example of moving from audit to improvement to accreditation.
Jane said "Audit is integral to clinical practice. How the data is collected and analysed and then used to improve patient care is subject to variability. It can be seen as a 'tick box' exercise but is vital for QI, GIRFT and accreditation. Challenges in how high quality audits are delivered at a national level but unclear as to whether routinely collected NHS data is of sufficient robustnes."
Leading change based on local or national clinical audit findings
Priti Naik, Lead for Quality and CQC Standards, Liz Cheal, Quality and Audit Specialist and Emma Lofthouse, Quality and Audit Specialist Oxford Health NHS Foundation Trust
Summary of Presentation:
This presentation outlines how Oxford Health NHS Foundation Trust has excelled in implementing the change which was found necessary to improve the purpose of the clinical audit function.
The slides explain how the need for change was identified and gives examples of various initiatives taken by the Clinical Audit team to improve responsiveness, engagement and quality of clinical audit work overall. This initial step has helped the Trust in bringing the clinicians together to identify areas for improvement based on national and clinical audit findings and leading necessary changes for improving the quality of patient care and outcomes. In this presentation, you will come across numerous examples of measures taken by the Trust to implement changes based on national, CQUIN and local audits findings. The improvements made in the clinical audit function would not have been possible without the commitment and support from Trust Board and senior leaders. Robust governance arrangements, quality focused reports and linking the audit work with CQC requirements and NICE best practice guidelines has helped in gaining continuous support and encouragement from Board and senior leaders. This certainly has changed the perception of clinical audit from assurance to quality improvement.
Full PowerPoint Presentation
Assessing Clinical Audit Practice: How CQC uses national clinical audit to support quality improvement through monitoring and inspection
Laura Crosby, Analyst Team Leader, Strategy and Intelligence, Care Quality Commission
The role of the CQC is to act as an independent regulator of health and adult social care in England. And to ensure that health and social care services provide people with safe, effective, compassionate, and high-quality care.
We focus on four priorities to deliver this – encourage improvement, innovation, and sustainability in care; deliver an intelligence-driven approach to regulation; promote a single shared view of quality; and improve our efficiency and effectiveness.
National clinical audit (NCA) data closely supports CQC’s strategic priorities to encourage local improvement and to be an intelligence-driven regulator. By using audit data as published by the audit and benchmarking against NICE and audit standards CQC is promoting a shared view of quality across the system. The key functions of CQC’s regulatory model for registered providers are monitoring, inspection and rating services to ensure that they are safe, effective, caring, responsive and well led. Audit data is used for each of these key functions, primarily to inform key question of effectiveness in hospitals.
CQC maintains partnerships with HQIP and a range of national audit bodies to optimise the use of audit data. Currently there are approximately 40 NCAs engaged with CQC and most are used routinely for monitoring and regulatory planning about where to focus inspection.
CQC expects providers to monitor their performance locally and to benchmark their performance nationally. In practice, this means that a good and effective clinical service is one in which local staff understand data from national audits and uses this information to drive local QI work and monitor improvements in patient care and safety. Some audits, such as SSNAP and the National Emergency Laparotomy Audit, now provide statistical process control charts to support local quality improvement over time. Efforts by trusts to drive quality improvement is seen as a marker of being well-led. This should ideally by driven by front line staff.
Full PowerPoint Presentation
Ensuring your Clinical Audit leads to changes in practice: Overcoming the barriers and challenges to changing clinical practice
Nancy Dixon, Healthcare Quality Consultant, Healthcare Quality Quest
Pre Conference Abstract:
Ensuring your clinical audit leads to changes in practice — Overcoming the barriers and challenges to changing clinical practice
A key barrier to implementing changes in practice based on clinical audit findings is misunderstanding of the clinical audit process. Many clinicians still see clinical audit as ‘ending’ with feedback of the data followed by ‘recommendations’, which may or may not be implemented. Some people talk about integrating clinical audit with the concept of quality improvement (QI). However, over the last two decades in the UK, clinical audit should have been seen as a QI process from the start.
A number of other challenges to implementing changes in clinical practice are recognized in the evidence base, including reference to the interaction of a large number of factors that determine whether or not implementation of change will be successful. The factors can include: the change itself; the group involved; the social and practice setting; the financial, administrative or organizational context; and the strategies and methods used for implementation of the change. (See the References).
In the presentation, new research evidence about what’s involved in successful change in clinical settings will be explained, including what ‘theory of change’ means, factors that influence change, how context affects the implementation of change, and what’s involved in ‘dosing’ actions that make up a change process.
Practical suggestions on a variety of change strategies, strong versus weak actions, and how to set priorities among possible actions to achieve sustained change will be provided.
Full PowerPoint Presentation