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Clinical Audit and the Audit Cycle
Gloucestershire PCCAG
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What we are going to cover today
The audit cycle Gloucestershire PCCAG
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What we are going to cover today
The audit cycle Criteria and standards Gloucestershire PCCAG
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What we are going to cover today
The audit cycle Criteria and standards Structure, process and outcome Gloucestershire PCCAG
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What we are going to cover today
The audit cycle Criteria and standards Structure, process and outcome An audit example Gloucestershire PCCAG
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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
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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
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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
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Gloucestershire PCCAG
Reactions to audit Enthusiasm Cynicism Obligation Doubt Exhaustion Gloucestershire PCCAG
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Gloucestershire PCCAG
Types of audit Managerial Gloucestershire PCCAG
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Gloucestershire PCCAG
Types of audit Managerial Financial Gloucestershire PCCAG
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Gloucestershire PCCAG
Types of audit Managerial Financial Clinical Gloucestershire PCCAG
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Gloucestershire PCCAG
Types of audit Managerial Financial Clinical Multi-disciplinary Gloucestershire PCCAG
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Gloucestershire PCCAG
Types of audit Managerial Financial Clinical Multi-disciplinary Cross boundary Gloucestershire PCCAG
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Gloucestershire PCCAG
Types of audit Managerial Financial Clinical Multi-disciplinary Cross boundary Cohort based Gloucestershire PCCAG
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Gloucestershire PCCAG
Types of audit Managerial Financial Clinical Multi-disciplinary Cross boundary Cohort based Comparative Gloucestershire PCCAG
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Gloucestershire PCCAG
Types of audit Managerial Financial Clinical Multi-disciplinary Cross boundary Cohort based Comparative Significant event based Gloucestershire PCCAG
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Gloucestershire PCCAG
Effective audit An educational activity Gloucestershire PCCAG
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Gloucestershire PCCAG
Effective audit An educational activity Promotes understanding Gloucestershire PCCAG
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Gloucestershire PCCAG
Effective audit An educational activity Promotes understanding Resource effective Gloucestershire PCCAG
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Gloucestershire PCCAG
Effective audit An educational activity Promotes understanding Resource effective Raises standards Gloucestershire PCCAG
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Gloucestershire PCCAG
Effective audit An educational activity Promotes understanding Resource effective Raises standards Promotes change Gloucestershire PCCAG
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Gloucestershire PCCAG
Effective audit An educational activity Promotes understanding Resource effective Raises standards Promotes change Source of information Gloucestershire PCCAG
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Gloucestershire PCCAG
Effective audit An educational activity Promotes understanding Resource effective Raises standards Promotes change Source of information Peer led Gloucestershire PCCAG
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Gloucestershire PCCAG
Effective audit An educational activity Promotes understanding Resource effective Raises standards Promotes change Source of information Peer led Involves patients Gloucestershire PCCAG
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The audit cycle Problem or objective identified Gloucestershire PCCAG
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The audit cycle Problem or objective identified
Criteria agreed and standards set Gloucestershire PCCAG
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The audit cycle Problem or objective identified
Criteria agreed and standards set Audit (Data collected) Gloucestershire PCCAG
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The audit cycle Problem or objective identified
Criteria agreed and standards set Audit (Data collected) Identify areas for improvement Gloucestershire PCCAG
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The audit cycle Problem or objective identified
Criteria agreed and standards set Make necessary changes Audit (Data collected) Identify areas for improvement Gloucestershire PCCAG
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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
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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
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Another way of expressing the audit cycle
Gloucestershire PCCAG
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Another way of expressing the audit cycle
Determine which aspects of current work are to be considered Gloucestershire PCCAG
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Another way of expressing the audit cycle
Determine which aspects of current work are to be considered Describe and measure present performance Gloucestershire PCCAG
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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
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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
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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
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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
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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
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Criteria and standards
Gloucestershire PCCAG
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Criteria and standards
Criteria are those aspects of care that you wish to examine Gloucestershire PCCAG
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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
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Structure, process and outcome
Gloucestershire PCCAG
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Structure, process and outcome
Structure refers to resources you have available (including current knowledge, skills and attitudes) Gloucestershire PCCAG
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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
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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
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Gloucestershire PCCAG
The great coffee audit Gloucestershire PCCAG
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Gloucestershire PCCAG
The great coffee audit Problem The doctors feel that their coffee isn’t hot enough after slogging through morning surgery Gloucestershire PCCAG
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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
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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 85-90C on 80% of occasions and there will be 90% satisfaction level expressed by the docs Gloucestershire PCCAG
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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
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Gloucestershire PCCAG
The great coffee audit Review After a rather tense audit team meeting it was found that the coffee temperature fell below 37C 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
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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
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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
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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
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Contents of an audit Gloucestershire PCCAG
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Contents of an audit Background Gloucestershire PCCAG
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Contents of an audit Background Literature review Gloucestershire PCCAG
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Contents of an audit Background Literature review Criteria and standards Gloucestershire PCCAG
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Contents of an audit Background Literature review Criteria and standards Methods or protocol Gloucestershire PCCAG
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Contents of an audit Background Literature review Criteria and standards Methods or protocol Results Gloucestershire PCCAG
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Contents of an audit Background Literature review Criteria and standards Methods or protocol Results Recommendations for change Gloucestershire PCCAG
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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
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Gloucestershire PCCAG
Why audit Gloucestershire PCCAG
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Gloucestershire PCCAG
Why audit Useful clinically Gloucestershire PCCAG
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Gloucestershire PCCAG
Why audit Useful clinically Encourages teamwork Gloucestershire PCCAG
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Gloucestershire PCCAG
Why audit Useful clinically Encourages teamwork Improves patient care Gloucestershire PCCAG
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Why audit Useful clinically Encourages teamwork Improves patient care Financial benefits (sometimes!) Gloucestershire PCCAG
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Why audit Useful clinically Encourages teamwork Improves patient care Financial benefits (sometimes!) Becoming contracturally an obligation with the arrival of PCG’s Gloucestershire PCCAG
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Gloucestershire PCCAG
Problems with audit Gloucestershire PCCAG
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Gloucestershire PCCAG
Problems with audit Audit and research Gloucestershire PCCAG
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Gloucestershire PCCAG
Problems with audit Audit and research Statistical verification Gloucestershire PCCAG
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Problems with audit Audit and research Statistical verification Outcome measures and proxies Gloucestershire PCCAG
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Problems with audit Audit and research Statistical verification Outcome measures and proxies Protocols Gloucestershire PCCAG
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Problems with audit Audit and research Statistical verification Outcome measures and proxies Protocols Closing the loop - introducing change and re-audit Gloucestershire PCCAG
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A word about clinical governance
Gloucestershire PCCAG
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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
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‘Clinical Governance’
Gloucestershire PCCAG
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‘Clinical Governance’
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‘Clinical Governance’
Research Gloucestershire PCCAG
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‘Clinical Governance’
Research Audit Gloucestershire PCCAG
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‘Clinical Governance’
Research Evidence based medicine Audit Gloucestershire PCCAG
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‘Clinical Governance’
Research Evidence based medicine Audit Dissemination of guidelines Gloucestershire PCCAG
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‘Clinical Governance’
Practice development plans Research Evidence based medicine Audit Dissemination of guidelines Gloucestershire PCCAG
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‘Clinical Governance’
Practice development plans Research Evidence based medicine Audit Personal development plans Dissemination of guidelines Gloucestershire PCCAG
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‘Clinical Governance’
Practice development plans Research Postgraduate medical education Evidence based medicine Audit Personal development plans Dissemination of guidelines Gloucestershire PCCAG
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‘Clinical Governance’
Practice accreditation Practice development plans Research Postgraduate medical education Evidence based medicine Audit Personal development plans Dissemination of guidelines Gloucestershire PCCAG
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‘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
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‘Clinical Governance’
Accountability Gloucestershire PCCAG
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