Clinical Audit and the Audit Cycle Gloucestershire PCCAG

What we are going to cover today The audit cycle Gloucestershire PCCAG

What we are going to cover today The audit cycle Criteria and standards Gloucestershire PCCAG

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

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

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

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’ Gloucestershire PCCAG

Gloucestershire PCCAG 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 Gloucestershire PCCAG

Gloucestershire PCCAG Reactions to audit Enthusiasm Cynicism Obligation Doubt Exhaustion Gloucestershire PCCAG

Gloucestershire PCCAG Types of audit Managerial Gloucestershire PCCAG

Gloucestershire PCCAG Types of audit Managerial Financial Gloucestershire PCCAG

Gloucestershire PCCAG Types of audit Managerial Financial Clinical Gloucestershire PCCAG

Gloucestershire PCCAG Types of audit Managerial Financial Clinical Multi-disciplinary Gloucestershire PCCAG

Gloucestershire PCCAG Types of audit Managerial Financial Clinical Multi-disciplinary Cross boundary Gloucestershire PCCAG

Gloucestershire PCCAG Types of audit Managerial Financial Clinical Multi-disciplinary Cross boundary Cohort based Gloucestershire PCCAG

Gloucestershire PCCAG Types of audit Managerial Financial Clinical Multi-disciplinary Cross boundary Cohort based Comparative Gloucestershire PCCAG

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

Gloucestershire PCCAG Effective audit An educational activity Gloucestershire PCCAG

Gloucestershire PCCAG Effective audit An educational activity Promotes understanding Gloucestershire PCCAG

Gloucestershire PCCAG Effective audit An educational activity Promotes understanding Resource effective Gloucestershire PCCAG

Gloucestershire PCCAG Effective audit An educational activity Promotes understanding Resource effective Raises standards Gloucestershire PCCAG

Gloucestershire PCCAG Effective audit An educational activity Promotes understanding Resource effective Raises standards Promotes change Gloucestershire PCCAG

Gloucestershire PCCAG Effective audit An educational activity Promotes understanding Resource effective Raises standards Promotes change Source of information Gloucestershire PCCAG

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

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

The audit cycle Problem or objective identified Gloucestershire PCCAG

The audit cycle Problem or objective identified Criteria agreed and standards set Gloucestershire PCCAG

The audit cycle Problem or objective identified Criteria agreed and standards set Audit (Data collected) Gloucestershire PCCAG

The audit cycle Problem or objective identified Criteria agreed and standards set Audit (Data collected) Identify areas for improvement Gloucestershire PCCAG

The audit cycle Problem or objective identified Criteria agreed and standards set Make necessary changes Audit (Data collected) Identify areas for improvement Gloucestershire PCCAG

The audit cycle Problem or objective identified Criteria agreed and standards set Re-audit Make necessary changes Audit (Data collected) Identify areas for improvement Gloucestershire PCCAG

The audit cycle Problem or objective identified Criteria agreed and standards set Re-audit Make necessary changes Audit (Data collected) Identify areas for improvement Gloucestershire PCCAG

Another way of expressing the audit cycle Gloucestershire PCCAG

Another way of expressing the audit cycle Determine which aspects of current work are to be considered Gloucestershire PCCAG

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

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 Gloucestershire PCCAG

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 Gloucestershire PCCAG

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 Gloucestershire PCCAG

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 Gloucestershire PCCAG

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 Gloucestershire PCCAG

Criteria and standards Gloucestershire PCCAG

Criteria and standards Criteria are those aspects of care that you wish to examine Gloucestershire PCCAG

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 Gloucestershire PCCAG

Structure, process and outcome Gloucestershire PCCAG

Structure, process and outcome Structure refers to resources you have available (including current knowledge, skills and attitudes) Gloucestershire PCCAG

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 Gloucestershire PCCAG

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 Gloucestershire PCCAG

Gloucestershire PCCAG The great coffee audit Gloucestershire PCCAG

Gloucestershire PCCAG The great coffee audit Problem The doctors feel that their coffee isn’t hot enough after slogging through morning surgery Gloucestershire PCCAG

Gloucestershire PCCAG The great coffee audit Problem Criteria The doctors feel that their coffee isn’t hot enough after slogging through morning surgery The coffee shall be hot and satisfying to the hard pressed docs Gloucestershire PCCAG

Gloucestershire PCCAG The great coffee audit Problem Criteria Standards The doctors feel that their coffee isn’t 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 Gloucestershire PCCAG

Gloucestershire PCCAG 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 Tesco’s and interview the manager about the availability, costs, quality and sell-by dates of the coffee brands available Gloucestershire PCCAG

Gloucestershire PCCAG 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 Tesco’s visit. Gloucestershire PCCAG

Gloucestershire PCCAG 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 Gloucestershire PCCAG

Gloucestershire PCCAG 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 didn’t like coffee anyway. Re-audit Gloucestershire PCCAG

Gloucestershire PCCAG 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 didn’t like coffee anyway. Cost implications of standard maintenance Cholesterol assays for partners Gloucestershire PCCAG

Gloucestershire PCCAG Contents of an audit Gloucestershire PCCAG

Gloucestershire PCCAG Contents of an audit Background Gloucestershire PCCAG

Gloucestershire PCCAG Contents of an audit Background Literature review Gloucestershire PCCAG

Gloucestershire PCCAG Contents of an audit Background Literature review Criteria and standards Gloucestershire PCCAG

Gloucestershire PCCAG Contents of an audit Background Literature review Criteria and standards Methods or protocol Gloucestershire PCCAG

Gloucestershire PCCAG Contents of an audit Background Literature review Criteria and standards Methods or protocol Results Gloucestershire PCCAG

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

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

Gloucestershire PCCAG Why audit Gloucestershire PCCAG

Gloucestershire PCCAG Why audit Useful clinically Gloucestershire PCCAG

Gloucestershire PCCAG Why audit Useful clinically Encourages teamwork Gloucestershire PCCAG

Gloucestershire PCCAG Why audit Useful clinically Encourages teamwork Improves patient care Gloucestershire PCCAG

Gloucestershire PCCAG Why audit Useful clinically Encourages teamwork Improves patient care Financial benefits (sometimes!) Gloucestershire PCCAG

Gloucestershire PCCAG Why audit Useful clinically Encourages teamwork Improves patient care Financial benefits (sometimes!) Becoming contracturally an obligation with the arrival of PCG’s Gloucestershire PCCAG

Gloucestershire PCCAG Problems with audit Gloucestershire PCCAG

Gloucestershire PCCAG Problems with audit Audit and research Gloucestershire PCCAG

Gloucestershire PCCAG Problems with audit Audit and research Statistical verification Gloucestershire PCCAG

Gloucestershire PCCAG Problems with audit Audit and research Statistical verification Outcome measures and proxies Gloucestershire PCCAG

Gloucestershire PCCAG Problems with audit Audit and research Statistical verification Outcome measures and proxies Protocols Gloucestershire PCCAG

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

A word about clinical governance Gloucestershire PCCAG

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 Gloucestershire PCCAG

‘Clinical Governance’ Gloucestershire PCCAG

‘Clinical Governance’ Gloucestershire PCCAG

‘Clinical Governance’ Research Gloucestershire PCCAG

‘Clinical Governance’ Research Audit Gloucestershire PCCAG

‘Clinical Governance’ Research Evidence based medicine Audit Gloucestershire PCCAG

‘Clinical Governance’ Research Evidence based medicine Audit Dissemination of guidelines Gloucestershire PCCAG

‘Clinical Governance’ Practice development plans Research Evidence based medicine Audit Dissemination of guidelines Gloucestershire PCCAG

‘Clinical Governance’ Practice development plans Research Evidence based medicine Audit Personal development plans Dissemination of guidelines Gloucestershire PCCAG

‘Clinical Governance’ Practice development plans Research Postgraduate medical education Evidence based medicine Audit Personal development plans Dissemination of guidelines Gloucestershire PCCAG

‘Clinical Governance’ Practice accreditation Practice development plans Research Postgraduate medical education Evidence based medicine Audit Personal development plans Dissemination of guidelines Gloucestershire PCCAG

‘Clinical Governance’ Practice accreditation Practice development plans Research Postgraduate medical education Special interest groups Evidence based medicine Audit Personal development plans Dissemination of guidelines Gloucestershire PCCAG

‘Clinical Governance’ Accountability Gloucestershire PCCAG