{"id":40701,"date":"2017-11-23T14:58:20","date_gmt":"2017-11-23T13:58:20","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=40701"},"modified":"2017-12-01T15:01:02","modified_gmt":"2017-12-01T14:01:02","slug":"billy-boland-clinical-audit-is-not-dead","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2017\/11\/23\/billy-boland-clinical-audit-is-not-dead\/","title":{"rendered":"Billy Boland: Clinical audit is not dead"},"content":{"rendered":"

\"billy_boland\"<\/a>While Quality Improvement (QI) is enjoying a surge in popularity in health services, it can also suffer from an image problem. I\u2019ve been told that it\u2019s a fad, a management trend, and not evidenced based. I generally don\u2019t quite get what these objections are about. Often in medicine when we come up against problems, these are rooted in issues of communication. Sometimes I wonder if objections are borne out of that. The Quality Improvement field is filled with jargon and differing branding and methodologies. I think they can be confusing and alienating. It takes a bit of work to get under the skin of what QI is all about. At its heart though, is the simple mission found in its name\u2014it\u2019s about improving the quality of care.<\/span><\/p>\n

Think then of what can often get overlooked as the poor cousin of quality improvement: clinical audit. If QI is the slick, new, sexy end of service development, then clinical audit can seem old fashioned, a fuddy duddy. In the world of health providers it can get ensconced with regulation and “assurance”\u2014the province of bean counters and distant from the front line. In a rapidly changing world that thrives on innovation, “just” doing audit can seem trivial and out of touch. <\/span><\/p>\n

It\u2019s perceived relevance can suffer through endless cycles of audits where change doesn\u2019t occur. Annual audits can generate significant activity for clinicians with actions planned, only to discover that when re-audit happens again the next year, little has changed. It is easy to see how monumental effort for little gain can be demotivating. People can become disconnected.<\/span><\/p>\n

That is why the current <\/span>clinical audit awareness<\/span><\/a> week <\/span>is so important. It seeks to put clinical audit in the spotlight and celebrate the positive difference it can make. We need to re-assert why clinical audit is a good thing, shout about the value that it adds for patients, and show that change is possible. Clinicians need to be helped to understand that Quality Improvement and Clinical Audit aren\u2019t necessarily separate things. They can be two sides of the same coin. High quality clinical audit can lead to high quality improvement if it is done right.<\/span><\/p>\n

Both rely on measurement to assess change, and both broadly use a <\/span>Plan, Do, Study, Act cycle<\/span><\/a> to get their work done. For me, the key is in the action planning. After a large scale piece of data collection for audit, I\u2019ve often found people feel chuffed to get there, relieved that their hard work has paid off. And they can think they\u2019re done\u2014action planning can be a bit of an afterthought. In my experience, when a piece of work is focused on action planning and improvement, people place more emphasis on making change. Action planning becomes the journey, and data collection serves a purpose. QI can help with action planning as it promotes “rapid experimentation,” or PDSA cycles in quick succession. This can encourage people to stay engaged rather than wait for the annual audit wheel to turn around until next year.<\/span><\/p>\n

In both Clinical Audit and QI we need to celebrate having a consistent and methodical approach to looking at problems in clinical practice and committing to making positive contributions. QI and clinical audit can support each other and both work towards the same goal: improving patient care. What could be sexier than that?<\/span><\/p>\n

Billy Boland<\/strong>\u00a0is a consultant psychiatrist and associate medical director for quality and safety at Hertfordshire Partnership University NHS Foundation Trust. You can follow him on Twitter\u00a0@originalbboland<\/a>.<\/em><\/p>\n

Competing interests<\/strong>:\u00a0I am vice chair of the general adult\u00a0psychiatry faculty at the Royal College of Psychiatrists.<\/p>\n","protected":false},"excerpt":{"rendered":"

While Quality Improvement (QI) is enjoying a surge in popularity in health services, it can also suffer from an image problem. I\u2019ve been told that it\u2019s a fad, a management trend, and not evidenced based. I generally don\u2019t quite get what these objections are about. Often in medicine when we come up against problems, these […]<\/p>\n

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