1. Welcome Main title slide page
Co-brand logo here
Welcome
Bringing a QI perspective to Clinical Audit and NICE
Devon Partnership Trust

2. Welcome Clinical Audit and QI Game (shamelessly stolen from CASC!!)
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Identify the missing word!
Big
Collection
George
Practice
Urine
Size
Inputting
Margin
Patient
Monkey
NCA
Tarts
Home
Charts
Simply
Amber, Green
Data
Best
Sample
Error
Survey
POP
Run
Red

3. Situation
Welcome
In April 2017, Clinical Audit and NICE were moved to sit within the QI team portfolio
The aim was to close the loop between NICE, Clinical Audit and Quality Improvement work
It required a significant culture shift in the organisation
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4. Welcome Background Clinical Audit and NICE are mandatory
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Clinical Audit and NICE are mandatory
CQC monitors compliance with both processes
Recent internal audit reports for both processes identified areas for improvement
Historically, Clinical Audit and NICE were held within the Clinical Audit department

5. Welcome Benefits to others
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Improvements in assurance levels against NICE and other areas of evidence based practice
Leading to improvements in quality of care delivered to people who use our services
Leading to less variation in quality and standards of care delivered to people who use our services
Clinicians are able to have focused time on key clinical audit areas
Improvements in assurance levels against NICE and other areas of Evidence Based Practice and Leading to improvements in quality of care delivered to people who use our services - we now have confidence that we have compliance against the high standards as recommended by NICE etc. In our local audits best practice is measured locally and we have done this by listening to the feedback from the people who use our services and their families
Leading to less variation in quality and standards of care delivered to people who use our services - it is really important to us that the people who use our services have confidence in our abilities to deliver the same high standards of care wherever they happen to experience our care / service. It is important that it doesn’t change from place to place.
Assessing ourselves against the evidence based practice with audit and with QI. We now have a robust process in place (identifying the standards, doing the audit, improvement work) so closing the loop. We use Clinical audit to assess ourselves against the ebp and the use QI work to address the gaps.

6. Assessment
Welcome
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7. Assessment
Welcome
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8. Welcome What have we changed? Main title for slide set
‘The most important part of the audit cycle is making change’ - Professor Richard Baker et al
Welcome
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NICE
Excel tracker system and dashboard
Directorate level tracker system
CEAG meeting
Methods of completion
Team level
Cross directorate workshop programme
Link with ICP bundles
Starting to use clinical audits as a way to evidence compliance – still areas for improvement
Clinical Audit
Restructure of clinical audit programme (reprioritising based on HQIP)
Flow chart, resource pack and registration form process
Visual tracker
Training programme
Different levels of QI team support – adapt our approach to the need of the individual
Clinical audit sitting in a QI process
To make these changes we have had to be:
- Enthusiastic to gain buy-in
Resilient and tenacious
Strong and see the bigger picture
Reflective
Good communicators

9. Welcome What are we measuring? Clinical Audit NICE
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Clinical Audit
Number of audits registered on central programme
Number of audits completed (to include improvement work)
Number of staff trained in Clinical Audit for Improvement
NICE
Total guidance with a compliance statement
Guidance completed in a workshop
Now have a measurement plan in place and this is what we are measuring….

10. Welcome Recommendations Main title for slide set
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Learning
Importance of role modelling and being visible
Have the difficult conversations
Power of coaching conversations
Break it down into small chunks
Make it relevant
Challenges
Culture change
Decrease in clinical audits registered
Continued challenges engaging clinicians in National Audit Programme and recognising the benefit of it / how it can be used to improve services
Sitting the National Audit Programme within a QI process – we should be using the National audit data to drive improvement work
Some of the challenges include:
Culture change
Through our new process we have found that there are now less audits being registered due to the change in process but the quality of the audits are better due to clinicians completing them.
Continued challenges engaging clinicians in National Audit Programme and recognising the benefit of it / how it can be used to improve services
Sitting the National Audit Programme within a QI process – we should be using the National audit data to drive improvement work
Our learning includes:
The importance of role modelling and being visible – we now have good representation at our CEAG – from Board members, senior directorate leads, physical health lead, meds optimisation team and the central QI team
Having those difficult conversations but providing coaching has helped support and overcome these
Breaking it down into small chunks and making it relevant – it is important to translate the theory around clinical audit and the data that comes out of the audit to then translate it into practice. If there is a gap then we should be doing something about it!

11. Welcome The key improvement message we have learnt!
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Our key improvement message that we have taken away from this work is that by having robust proactive processes and ensuring the narrative includes the impact on people who use our services and their families and carers, we can ensure that we continue to improve and provide services that keeps them safe and well and at the centre. If we get it wrong then it is them that suffer.