Opportunities to enhance ward audit: a multi-site qualitative study

Abstract

Background Hospitals in many countries are encouraged to develop audits to assess and improve the quality of care. Ward audit is a specific form of audit and feedback that is commonly used but little studied. The aim of this study is to describe the content and application of hospital ward audit in order to identify potential enhancements to such audits. Methods Multiple qualitative methods were used to study a diversity sample of four English National Health Service organisations over a 16-month period. We undertook semi-structured interviews (n = 32), documentary analysis (n = 44) and 25 h of observations of healthcare workers involved in the design and implementation of ward audit. Data were analysed using framework analysis. Findings were presented iteratively to stakeholders who used them to develop a description of the content and delivery of ward audit. Results Ward audit consisted of seven stages: impetus; method; preparation of staff; assessing practice; analysis; feedback; and decide on action to improve. Two key stages were the monthly assessment of practice using case note data extraction, and the resulting feedback to clinical staff, ward managers, matrons and directors of nursing. At three organisations, the case note data were extracted by staff and there was evidence that this resulted in misrepresentation of the clinical performance audited. The misrepresentation appeared to be associated with the anticipation of punitive feedback from directors of nursing and matrons, as well as time pressures and a lack clarity about the method of audit data collection. Punitive feedback was reported to occur if no data were collected, if data demonstrated poor performance or if performance did not improve. Conclusions Organisations invest considerable clinical resources in ward audit, but such audits may have unintended, potentially negative, consequences due to the impacts from punitive feedback. We discuss potential enhancements to ward audit (e.g. providing feedback recipients with suggested actions for improvement) and discuss implications for theory. There is a need to reduce the use of punitive feedback.

Disseminating implementation science: Describing the impact of animations shared via social media

“…We studied the impact of animations to increase the frequency with which two open-access papers [ 42 , 43 ] were accessed. In designing the intervention, we drew upon McGuire’s Persuasive Communication Matrix [ 22 ] to consider the source, channel, message, audience, and setting.…”

“…The source was an applied health researcher, describing work undertaken as part of a PhD to describe and enhance audit and feedback. The work was undertaken with a supervisory team, and involved substantial stakeholder involvement through co-production and advisory groups [ 42 , 43 ]. The message of the first animation was a multisite description of what currently happens when a national audit reaches the hospital and how it could be enhanced through an intervention to support recipients to analyse performance, select strategies and generate commitment.…”

“…It was anticipated that they would be viewing social media in work, home or travel settings. In this paper, we describe the effect of the animation upon the frequency with which particular open-access papers [ 42 , 43 ] were accessed.…”

Measured and perceived effects of audit and feedback on nursing performance: A mixed methods systematic review

“…Most studies used team-level or unit-level measures (29,33,34,(39)(40)(41)(42)(43)(44)(45)(46)(47), facility-level measures (31,48,49) or practice-level measures (50). Six studies reported using individual-level data as feedback indicators (30,32,35,(51)(52)(53).…”

“…In some studies, feedback was provided in both written and verbal form, although very little detail was provided on the delivery (32,43,45,46,48,51). Three studies reported providing feedback only verbally (47,50,53). Two studies reported that feedback was provided in changing forms over the study period (44,57).…”