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Clinical Audit and the Audit Cycle

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Clinical Audit and the Audit Cycle What we are going to cover today The audit cycle What we are going to cover today The audit cycle Criteria and standards What we ... – PowerPoint PPT presentation

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Title: Clinical Audit and the Audit Cycle


1
Clinical Audit and the Audit Cycle
2
What we are going to cover today
  • The audit cycle

3
What we are going to cover today
  • The audit cycle
  • Criteria and standards

4
What we are going to cover today
  • The audit cycle
  • Criteria and standards
  • Structure, process and outcome

5
What we are going to cover today
  • The audit cycle
  • Criteria and standards
  • Structure, process and outcome
  • An audit example

6
What we are going to cover today
  • The audit cycle
  • Criteria and standards
  • Structure, process and outcome
  • An audit example
  • Problems with audit

7
What we are going to cover today
  • The audit cycle
  • Criteria and standards
  • Structure, process and outcome
  • An audit example
  • Problems with audit
  • How audit fits into Clinical Governance

8
A definition of audit
  • The systematic critical analysis of the quality
    of medical care, including the procedures used
    for diagnosis and treatment, the use of resources
    and the resulting outcome and quality of life for
    the patient
  • Working for Patients 1989

9
Reactions to audit
  • Enthusiasm
  • Cynicism
  • Obligation
  • Doubt
  • Exhaustion

10
Types of audit
  • Managerial

11
Types of audit
  • Managerial
  • Financial

12
Types of audit
  • Managerial
  • Financial
  • Clinical

13
Types of audit
  • Managerial
  • Financial
  • Clinical Multi-disciplinary

14
Types of audit
  • Managerial
  • Financial
  • Clinical Multi-disciplinary
  • Cross boundary

15
Types of audit
  • Managerial
  • Financial
  • Clinical Multi-disciplinary
  • Cross boundary
  • Cohort based

16
Types of audit
  • Managerial
  • Financial
  • Clinical Multi-disciplinary
  • Cross boundary
  • Cohort based
  • Comparative

17
Types of audit
  • Managerial
  • Financial
  • Clinical Multi-disciplinary
  • Cross boundary
  • Cohort based
  • Comparative
  • Significant event based

18
Effective audit
  • An educational activity

19
Effective audit
  • An educational activity
  • Promotes understanding

20
Effective audit
  • An educational activity
  • Promotes understanding
  • Resource effective

21
Effective audit
  • An educational activity
  • Promotes understanding
  • Resource effective
  • Raises standards

22
Effective audit
  • An educational activity
  • Promotes understanding
  • Resource effective
  • Raises standards
  • Promotes change

23
Effective audit
  • An educational activity
  • Promotes understanding
  • Resource effective
  • Raises standards
  • Promotes change
  • Source of information

24
Effective audit
  • An educational activity
  • Promotes understanding
  • Resource effective
  • Raises standards
  • Promotes change
  • Source of information
  • Peer led

25
Effective audit
  • An educational activity
  • Promotes understanding
  • Resource effective
  • Raises standards
  • Promotes change
  • Source of information
  • Peer led
  • Involves patients

26
The audit cycle
Problem or objective identified
27
The audit cycle
Problem or objective identified
Criteria agreed and standards set
28
The audit cycle
Problem or objective identified
Criteria agreed and standards set
Audit (Data collected)
29
The audit cycle
Problem or objective identified
Criteria agreed and standards set
Audit (Data collected)
Identify areas for improvement
30
The audit cycle
Problem or objective identified
Criteria agreed and standards set
Make necessary changes
Audit (Data collected)
Identify areas for improvement
31
The audit cycle
Problem or objective identified
Criteria agreed and standards set
Re-audit
Make necessary changes
Audit (Data collected)
Identify areas for improvement
32
The audit cycle
Problem or objective identified
Criteria agreed and standards set
Re-audit
Make necessary changes
Audit (Data collected)
Identify areas for improvement
33
Another way of expressing the audit cycle
34
Another way of expressing the audit cycle
  • Determine which aspects of current work are to be
    considered

35
Another way of expressing the audit cycle
  • Determine which aspects of current work are to be
    considered
  • Describe and measure present performance

36
Another way of expressing the audit cycle
  • Determine which aspects of current work are to be
    considered
  • Describe and measure present performance
  • Develop explicit standards

37
Another way of expressing the audit cycle
  • Determine which aspects of current work are to be
    considered
  • Describe and measure present performance
  • Develop explicit standards
  • Decide what needs to be changed

38
Another way of expressing the audit cycle
  • Determine which aspects of current work are to be
    considered
  • Describe and measure present performance
  • Develop explicit standards
  • Decide what needs to be changed
  • Negotiate change

39
Another way of expressing the audit cycle
  • Determine which aspects of current work are to be
    considered
  • Describe and measure present performance
  • Develop explicit standards
  • Decide what needs to be changed
  • Negotiate change
  • Mobilise resources for change

40
Another way of expressing the audit cycle
  • Determine which aspects of current work are to be
    considered
  • Describe and measure present performance
  • Develop explicit standards
  • Decide what needs to be changed
  • Negotiate change
  • Mobilise resources for change
  • Review and renew the process

41
Criteria and standards
42
Criteria and standards
  • Criteria are those aspects of care that you wish
    to examine

43
Criteria and standards
  • Criteria are those aspects of care that you wish
    to examine
  • Standards are the pre-stated or implicit levels
    of success that you wish to achieve

44
Structure, process and outcome
45
Structure, process and outcome
  • Structure refers to resources you have available
    (including current knowledge, skills and
    attitudes)

46
Structure, process and outcome
  • Structure refers to resources you have available
    (including current knowledge, skills and
    attitudes)
  • Process refers to what you actually do, e.g. a
    protocol

47
Structure, process and outcome
  • Structure refers to resources you have available
    (including current knowledge, skills and
    attitudes)
  • Process refers to what you actually do, e.g. a
    protocol
  • Outcome refers to the health benefits, cost
    effectiveness or patient satisfaction

48
The great coffee audit

49
The great coffee audit
  • Problem
  • The doctors feel that their coffee isnt hot
    enough after slogging through morning surgery

50
The great coffee audit
  • Problem
  • Criteria
  • The doctors feel that their coffee isnt hot
    enough after slogging through morning surgery
  • The coffee shall be hot and satisfying to the
    hard pressed docs

51
The great coffee audit
  • Problem
  • Criteria
  • Standards
  • The doctors feel that their coffee isnt hot
    enough after slogging through morning surgery
  • The coffee shall be hot and satisfying to the
    hard pressed docs
  • The coffee shall be served at a temperature of
    85-90?C on 80 of occasions and there will be 90
    satisfaction level expressed by the docs

52
The great coffee audit
  • Methods
  • The junior receptionist shall check the
    temperature of the coffee daily for two weeks and
    circulate a questionnaire to the partners asking
    them to score a coffee satisfaction level between
    1 and 10. The practice manager shall visit
    Tescos and interview the manager about the
    availability, costs, quality and sell-by dates of
    the coffee brands available

53
The great coffee audit
  • Review
  • After a rather tense audit team meeting it was
    found that the coffee temperature fell below 37?C
    on at least 33 of occasions and reached the
    standard on only 10 of occasions. The doctors
    scored the coffee at an average 3/10 and two
    expressed it undrinkable. The practice manager
    reported the results of her Tescos visit.

54
The great coffee audit
  • Change
  • It was agreed to replace the aged coffee maker (
    after agreeing suitable redundancy terms for the
    senior receptionist) with a shiny new machine
    from Argos. As an additional quality
    initiative, cream cakes would be served after
    surgery. The coffee contract would be switched
    from the corner shop to Tesco PLC Trust

55
The great coffee audit
  • For a further two weeks it was agreed to measure
    the coffee temperature and re-circulate the
    questionnaire. It was gratifying to find 100
    correlation with agreed standards with the
    exception of one partner who didnt like coffee
    anyway.
  • Re-audit

56
The great coffee audit
  • Re-audit
  • Future
  • audit
  • For a further two weeks it was agreed to measure
    the coffee temperature and re-circulate the
    questionnaire. It was gratifying to find 100
    correlation with agreed standards with the
    exception of one partner who didnt like coffee
    anyway.
  • Cost implications of standard maintenance
  • Cholesterol assays for partners

57
Contents of an audit
58
Contents of an audit
  • Background

59
Contents of an audit
  • Background
  • Literature review

60
Contents of an audit
  • Background
  • Literature review
  • Criteria and standards

61
Contents of an audit
  • Background
  • Literature review
  • Criteria and standards
  • Methods or protocol

62
Contents of an audit
  • Background
  • Literature review
  • Criteria and standards
  • Methods or protocol
  • Results

63
Contents of an audit
  • Background
  • Literature review
  • Criteria and standards
  • Methods or protocol
  • Results
  • Recommendations for change

64
Contents of an audit
  • Background
  • Literature review
  • Criteria and standards
  • Methods or protocol
  • Results
  • Recommendations for change
  • Recommendations for further audit

65
Why audit
66
Why audit
  • Useful clinically

67
Why audit
  • Useful clinically
  • Encourages teamwork

68
Why audit
  • Useful clinically
  • Encourages teamwork
  • Improves patient care

69
Why audit
  • Useful clinically
  • Encourages teamwork
  • Improves patient care
  • Financial benefits (sometimes!)

70
Why audit
  • Useful clinically
  • Encourages teamwork
  • Improves patient care
  • Financial benefits (sometimes!)
  • Becoming contracturally an obligation with the
    arrival of PCGs

71
Problems with audit
72
Problems with audit
  • Audit and research

73
Problems with audit
  • Audit and research
  • Statistical verification

74
Problems with audit
  • Audit and research
  • Statistical verification
  • Outcome measures and proxies

75
Problems with audit
  • Audit and research
  • Statistical verification
  • Outcome measures and proxies
  • Protocols

76
Problems with audit
  • Audit and research
  • Statistical verification
  • Outcome measures and proxies
  • Protocols
  • Closing the loop - introducing change and re-audit

77
A word about clinical governance
78
A word about clinical governance
  • A framework through which NHS organisations are
    accountable for continuously improving the
    quality of their services and safeguarding high
    standards by creating an environment in which
    excellence in clinical care will flourish
  • A First Class Service 1998

79
Clinical Governance
80
Clinical Governance
81
Clinical Governance
Research
82
Clinical Governance
Research
Audit
83
Clinical Governance
Research
Evidence based medicine
Audit
84
Clinical Governance
Research
Evidence based medicine
Audit
Dissemination of guidelines
85
Clinical Governance
Practice development plans
Research
Evidence based medicine
Audit
Dissemination of guidelines
86
Clinical Governance
Practice development plans
Research
Evidence based medicine
Audit
Personal development plans
Dissemination of guidelines
87
Clinical Governance
Practice development plans
Research
Postgraduate medical education
Evidence based medicine
Audit
Personal development plans
Dissemination of guidelines
88
Clinical Governance
Practice accreditation
Practice development plans
Research
Postgraduate medical education
Evidence based medicine
Audit
Personal development plans
Dissemination of guidelines
89
Clinical Governance
Practice accreditation
Practice development plans
Research
Postgraduate medical education
Special interest groups
Evidence based medicine
Audit
Personal development plans
Dissemination of guidelines
90
Clinical Governance
Accountability
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