The difficulty of questioning clinical practice: experience of facility‐based case reviews in Ouagadougou, Burkina Faso

Richard, Fabienne; Ouédraogo, Charlemagne; Zongo, V.; Ouattara, Fatoumata; Zongo, Sylvie; Gruénais, Marc-Éric; Brouwere, Vincent De

doi:10.1111/j.1471-0528.2008.01741.x

Cited by 60 publications

(94 citation statements)

References 22 publications

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“…Staff attending hospital reviews in Burkina Faso developed a helpful code of conduct for participating in local meetings, 16 which was also successfully adopted throughout the WHO European regional Beyond the Numbers programme. 17 …”

Section: Reviewing Individual Cases At Facility-based Meetingsmentioning

confidence: 99%

The cultural environment behind successful maternal death and morbidity reviews

Lewis

2014

BJOG

108

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This paper discusses some of the background principles which, through wide experience of instituting reviews of maternal deaths or near‐misses around the world, appear common to their successful introduction. A supportive culture at personal, institutional and national level underpinned by the fostering of professionalism and the development of an ethos of safety against a wider supportive environment is needed. Reviews undertaken at a local level are as beneficial as those at a regional or population level and should be encouraged as a routine part of the quality improvement agenda for each and every healthcare facility.

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Section: Reviewing Individual Cases At Facility-based Meetingsmentioning

confidence: 99%

The cultural environment behind successful maternal death and morbidity reviews

Lewis

2014

BJOG

108

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“…So the process of clinical audit itself must be critically evaluated. The paper by Richard et al 5 in this month's BJOG is part of this process. They focus on the practical difficulties encountered when introducing clinical audit and the perceptions the healthcare providers have of the process.…”

mentioning

confidence: 99%

Audit for maternal and newborn health services in resource‐poor countries

Kongnyuy

Broek

2008

BJOG

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Please cite this paper as: Kongnyuy E, van den Broek N. Audit for maternal and newborn health services in resource-poor countries. BJOG 2009;116:7-10. Each year more than 536 000 women worldwide die from complications of pregnancy and childbirth. 1 Many more survive but will suffer ill health and disability as a result of these complications. In addition, an estimated 4 million neonatal deaths occur each year, accounting for almost 40% of all deaths in children younger than 5 years. 2 The key strategies that have been identified to reduce this global burden are the presence of skilled birth attendants, 3 the availability of essential (or emergency) obstetric care 4 and newborn care.To have major effects on maternal outcomes, it is crucial that these elements are not just available but also of high quality. And assessment of quality requires effective clinical audit. However, anyone who has undertaken a clinical audit will realise that the practice is not as simple as the theory, and 'closing the loop' (to achieve the desired endpoint of improvements in clinical care) is often difficult. So the process of clinical audit itself must be critically evaluated. The paper by Richard et al. 5 in this month's BJOG is part of this process. They focus on the practical difficulties encountered when introducing clinical audit and the perceptions the healthcare providers have of the process. Although most health professionals (77%) agreed that audit had a positive influence on professional practice, they also highlighted a number of difficulties. Those in charge of audit used it almost as a disciplinary tool, staff felt that audit highlighted only the negative aspects of case management, anonymity was not respected, not all levels of healthcare providers were involved in the audits, and there was a perception that the selection of cases to be audited was biased. There was also a difficulty common to many resource-limited countries: a shortage of qualified staff to carry out the audit, with those present already working in difficult circumstances without much support or supervision. For them, audit was seen as simply a further burden, or as a form of inspection or criticism rather than support.The assumption behind audit is that when health professionals receive feedback about the care given to patients and areas of suboptimal care, they will self-correct and improve their practice. A Cochrane systematic review on audit and feedback (72 studies, over 13 500 participants) concluded that although audit can improve professional practice, the effects are generally small to moderate. 6,7 Audit was more likely to show significant improvement in the quality of care if the baseline compliance to good practice was poor; if the care was already reasonable or good, there is obviously less room for improvement.The effectiveness of audit in improving the quality of care probably depends to a large extent on the method and intensity of feedback and whether this leads to the required actions, rather than on the specific audit process used...

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“…However, it is a useful tool for improving quality of clinical care (Richard et al 2008). If used with sensitivity, women's views on their personal experiences of accessing health facilities and their views about the attitudes of health personnel may be rewarding.…”

Section: Resultsmentioning

confidence: 99%

“…In the Burkina maternity ward at stake, audit sessions were organized as follows (Richard et al 2008). Cases to be audited were selected by midwives and doctors during staff meetings.…”

Section: Case Review Audits For Improving Quality Of Care For Deliverymentioning

confidence: 99%

Anthropological Insights about a Tool for Improving Quality of Obstetric Care: The Experience of Case Review Audits in Burkina Faso

Gruénais¹,

Ouattara²,

Richard³

2012

Anthropology in Action

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The ratio of maternal morbidity and mortality in developing countries is high. The World Health Organization (WHO) and public health specialists promote case review audits as a means of improving quality of obstetric care. This refl ects the need for high reactivity in health personnel's management of obstetric complications. Within an action-research programme in Burkina Faso, a trial of case review audits was implemented in a maternity ward. This was designed to help health personnel bett er align their practice with clinical standards and to enable more consideration of pregnant women's needs. Social anthropologists were involved in these case review audits in order to collect data about pregnant women's lifestyles and circumstances. They also worked to train health personnel to conduct interviews. Although it is important to take account of women's circumstances within audit sessions, conducting interviews in 'anthropological ways' (at women's homes, with observations) is time consuming and may sometimes be bett er replaced with interviews in hospital contexts. Anthropologically informed interviews may pinpoint socio-economic situations as key reasons for problems in healthcare, but health personnel are usually powerless to address these. However, anthropology contributes an awareness of the relevance of these issues for broader healthcare planning.

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The difficulty of questioning clinical practice: experience of facility‐based case reviews in Ouagadougou, Burkina Faso

Cited by 60 publications

References 22 publications

The cultural environment behind successful maternal death and morbidity reviews

The cultural environment behind successful maternal death and morbidity reviews

Audit for maternal and newborn health services in resource‐poor countries

Anthropological Insights about a Tool for Improving Quality of Obstetric Care: The Experience of Case Review Audits in Burkina Faso

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