Improving quality of care through national clinical audit

Stewart, Kevin; Bray, Ben; Buckingham, Rhona

doi:10.7861/futurehosp.3-3-203

Cited by 24 publications

(15 citation statements)

References 13 publications

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“…In the NHS, as in health systems worldwide, patients are exposed to risks of avoidable harm 1 and unwarranted variations in quality 23 4 But too often, problems in the quality and safety of healthcare are merely described, even “admired,”5 rather than fixed; the effort invested in collecting information (which is essential) is not matched by effort in making improvement.…”

mentioning

confidence: 99%

How to improve healthcare improvement—an essay by Mary Dixon-Woods

Dixon‐Woods¹

2019

BMJ

149

190

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confidence: 99%

How to improve healthcare improvement—an essay by Mary Dixon-Woods

Dixon‐Woods¹

2019

BMJ

149

190

View full text Add to dashboard Cite

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“…Similar to our findings from a national survey of attitudes of farm animal veterinarians towards clinical audit [ 25 ], time burden was often raised as an area of concern. Within the NHS, clinical audit is government-supported through both hospital and national audit infrastructure and personnel [ 34 , 37 , 38 ]. However, even with institutional support, post-graduate medical trainees still view clinical audit as an additional time burden [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing the Feasibility of Retrospective and Prospective Clinical Audit in Farm Animal Veterinary Practice

Waine

White

Dean³

et al. 2021

Veterinary Sciences

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As a quality improvement tool, clinical audit has been extensively described in the medical literature. There is scant literature on the use of clinical audit in the farm animal veterinary setting. This study describes the process and feasibility of prospective and retrospective data collection for farm animal clinical audit performed at three different farm animal practices in the United Kingdom. Retrospective clinical audit was difficult in all three practices due to barriers in establishing diagnosis and patient identity from clinical records. Prospective data collection proved feasible but depended on adequate case accrual and practitioner engagement. The decision to conduct clinical audit retrospectively or prospectively will depend on the topic to audit, the availability of data and the wishes of the team members involved. Further work is required looking at the use of clinical coding and alternatives to using practice management software to improve retrospective data availability for clinical audit.

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“…Therefore, interactions with NCA feedback can be limited to assurance (compliance that performance is in line with certain standards) rather than contributing to a continued effort to improve outcomes, which typically characterises quality improvement [ 27 , 28 ]. This finding has particular implications for well-established audits, such as MINAP and PICANet, where more substantial change efforts in response to NCA feedback have been successfully established historically [ 2 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the United Kingdom's (UK) National Health Service (NHS) such strategies include audit and feedback, a type of which are National Clinical Audits (NCAs). NCAs intend to stimulate quality improvement by systematically measuring care quality for different clinical specialities and patient groups [2]. They are well established in the NHS; first introduced in the 1990s, there are now over 50 that are either managed centrally by the Healthcare Quality Improvement Programme (HQIP), or by independent organisations [2,3].…”

Section: Introductionmentioning

confidence: 99%

Exploring variation in the use of feedback from national clinical audits: a realist investigation

Alvarado

McVey

Greenhalgh

et al. 2020

BMC Health Serv Res

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Background National Clinical Audits (NCAs) are a well-established quality improvement strategy used in healthcare settings. Significant resources, including clinicians’ time, are invested in participating in NCAs, yet there is variation in the extent to which the resulting feedback stimulates quality improvement. The aim of this study was to explore the reasons behind this variation. Methods We used realist evaluation to interrogate how context shapes the mechanisms through which NCAs work (or not) to stimulate quality improvement. Fifty-four interviews were conducted with doctors, nurses, audit clerks and other staff working with NCAs across five healthcare providers in England. In line with realist principles we scrutinised the data to identify how and why providers responded to NCA feedback (mechanisms), the circumstances that supported or constrained provider responses (context), and what happened as a result of the interactions between mechanisms and context (outcomes). We summarised our findings as Context+Mechanism = Outcome configurations. Results We identified five mechanisms that explained provider interactions with NCA feedback: reputation, professionalism, competition, incentives, and professional development. Professionalism and incentives underpinned most frequent interaction with feedback, providing opportunities to stimulate quality improvement. Feedback was used routinely in these ways where it was generated from data stored in local databases before upload to NCA suppliers. Local databases enabled staff to access data easily, customise feedback and, importantly, the data were trusted as accurate, due to the skills and experience of staff supporting audit participation. Feedback produced by NCA suppliers, which included national comparator data, was used in a more limited capacity across providers. Challenges accessing supplier data in a timely way and concerns about the quality of data submitted across providers were reported to constrain use of this mode of feedback. Conclusion The findings suggest that there are a number of mechanisms that underpin healthcare providers’ interactions with NCA feedback. However, there is variation in the mode, frequency and impact of these interactions. Feedback was used most routinely, providing opportunities to stimulate quality improvement, within clinical services resourced to collect accurate data and to maintain local databases from which feedback could be customised for the needs of the service.

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Improving quality of care through national clinical audit

Cited by 24 publications

References 13 publications

How to improve healthcare improvement—an essay by Mary Dixon-Woods

How to improve healthcare improvement—an essay by Mary Dixon-Woods

Assessing the Feasibility of Retrospective and Prospective Clinical Audit in Farm Animal Veterinary Practice

Exploring variation in the use of feedback from national clinical audits: a realist investigation

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