1. Intro to Qualitative Research & Audit @UWE_JT9 @dave_lush Scientific Practice

2. Where We Are/Where We Are Going Quantitative research is centred around numerical measurement of systems unambiguous information about the system studied numbers analysed using parametric and non- parametric statistical tests Qualitative research seeks to understand meaning and context human-oriented (sociological, people/environments) not usually amenable to statistical analysis Eg: How does diabetic diet affect blood sugar? vs How do diabetics conceptualise their diet? Audit seeks to improve current practice not regarded as ‘research’ (new knowledge)

3. Quantitative vs Qualitative Research Clearly defined vs subject matter is unfamiliar Minor measurement problems vs exploratory research, when unknown concepts or definitions unclear Detailed numerical description of sample vs meaning, not numerical ‘model’, sought Repeatability of measurements important vs flexibility of approach to allow for discovery Extrapolation of results across populations vs study selected issues/cases/events in detail

4. Qualitative Methods Individual interviews unstructured, structured, semi-structured Group interviews focus groups and non-focus groups Observation participant, unstructured, structured Document and archive reviews

5. Qualitative Study Design Research question & theoretical framework Qualitative research study design and methods sampling approach non-random, purposive, theoretically-based gaining access ethical considerations choosing data collection methods interviews, documents, observation, etc validity Analysis Reporting

6. Clinical Audit Systematic and critical analysis of the quality of clinical care Includes procedures used for… diagnosis and treatment use of associated resources effect of care on outcome and quality of life Ties in with Clinical Governance ie improving standards Informally… Noting what we do Learning from it Changing it, if necessary All driven by the aim of improving care

7. Why is it Done? Development of professional education and self regulation Improving quality of patient care Increasing accountability Improving motivation and teamwork Assessment of needs A stimulus to research To lead to an improvement in the quality of service providing:- Improved care of patients Enhanced professionalism of staff Efficient use of resources Aid to continuing education Aid to administration Accountability to those outside the profession

8. What Audit Isn’t Competition between staff Performance Appraisal of staff Categorising professionals as good/bad Disciplinary process Needs assessment An exercise in computing and statistics Research ie establishing new knowledge

9. Audit vs Research Defines good practice Assess degree of good practice Might allocate patients to treatment groups Does not involve ‘treatment groups’ May involve placebo Does not involve placebo use Patients ‘disturbed’ beyond normal Normal clinical management New treatment might be used New treatments not involved One off process (!) Ongoing

10. The Audit Cycle Ideally, a continuous process? RE-AUDIT HAS IT WORKED? CHOOSE TOPIC SET STANDARD COLLECT DATA ANALYSE & COMPARE WITH STANDARD IMPLEMENT CHANGES

11. Audit Cycle: Choosing a Topic High volume High cost High risk Gut feeling (experience!) Interesting area Benefit the patient Sources Clinical events Patients' complaints Personal observation Observations of staff External subjects (eg NICE )

12. Audit Cycle: Setting a Standard A standard should have specific criteria and values Criteria should be definable and be able to be measured eg Criterion: All children under 2 years should be immunised against tetanus and polio eg Standard: 90% of registered patients under the age of 2 years should have been immunised against polio and tetanus a minimum level of acceptable performance for the criterion

13. Audit Cycle: Collecting Data Example sources: computer records review of contents of medical records questionnaires – patients, staff or GPs data collection sheets Sampling Random vs systematic Only collect essential information Use of computers vs data collection forms Delegation to/involve other staff Set a deadline

14. Audit Cycle: Analysis/Presentation Collect results Analyse results Summarise results Present results to the team Simple arithmetic calculations eg percentages Results of 2 nd data collection (re-audit) presented in the same way as the 1 st

15. Audit Cycle: Implement Change Most challenging stage Audit can tell you whether changes are needed, but cannot tell you what methods to use Changes to be implemented via team discussion and decision What to do at the Practice Meeting… Emphasise what has been achieved What are we proud of? What are we not so proud of? How can we correct any deficiencies?

16. Audit Cycle: Re-audit Re-evaluate to ensure that any remedial action has been effective Audit is a continuous cycle standards not met? implement changes standards met? should aim higher next time? repeat audit