Audit Cycle

Clinical Audit and the Audit Cycle
Gloucestershire PCCAG
What we are going to cover today

The audit cycle

The audit cycle Criteria and standards

The audit cycle Criteria and standards Structure, process and outcome

The audit cycle Criteria and standards Structure, process and outcome An audit example

The audit cycle Criteria and standards Structure, process and outcome An audit example Problems with audit

The audit cycle Criteria and standards Structure, process and outcome An audit example Problems with audit How audit fits into Clinical Governance
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
Reactions to audit
Enthusiasm Cynicism Obligation Doubt Exhaustion
Types of audit
Managerial
Types of audit
Managerial Financial
Types of audit
Managerial Financial Clinical
Types of audit
Multi-disciplinary
Types of audit
Multi-disciplinary Cross boundary
Types of audit
Multi-disciplinary Cross boundary Cohort based
Types of audit
Multi-disciplinary Cross boundary Cohort based Comparative

Types of audit
Multi-disciplinary Cross boundary Cohort based Comparative Significant event based

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

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

Audit (Data collected)
The audit cycle

Audit (Data collected) Identify areas for improvement

The audit cycle

Make necessary changes

The audit cycle

Problem or objective identified Re-audit Criteria agreed and standards set

The audit cycle

Problem or objective identified Re-audit Criteria agreed and standards set

Another way of expressing the audit cycle

Determine which aspects of current work are to be considered

Determine which aspects of current work are to be considered Describe and measure present performance

Determine which aspects of current work are to be considered Describe and measure present performance Develop explicit standards

Determine which aspects of current work are to be considered Describe and measure present performance Develop explicit standards Decide what needs to be changed

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

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

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
Criteria and standards

Criteria are those aspects of care that you wish to examine

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
Structure, process and outcome

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

Structure refers to resources you have available (including current knowledge, skills and attitudes) Process refers to what you actually do, e.g. a protocol

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
The great coffee audit

Problem The doctors feel that their coffee isnt hot enough after slogging through morning surgery

Problem The doctors feel that their coffee isnt hot enough after slogging through morning surgery The coffee shall be hot and satisfying to the hard pressed docs
Criteria

Problem The doctors feel that their coffee isnt 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 85-90rC on 80% of occasions and there will be 90% satisfaction level expressed by the docs
Criteria Standards

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 Tescos and interview the manager about the availability, costs, quality and sell-by dates of the coffee brands available

Review After a rather tense audit team meeting it was found that the coffee temperature fell below 37rC 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 Tescos visit.

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

Re-audit For a further two weeks it was agreed to measure the coffee temperature and recirculate the questionnaire. It was gratifying to find 100% correlation with agreed standards with the exception of one partner who didnt like coffee anyway.

Re-audit For a further two weeks it was agreed to measure the coffee temperature and recirculate the questionnaire. It was gratifying to find 100% correlation with agreed standards with the exception of one partner who didnt like coffee anyway. Cost implications of standard maintenance Cholesterol assays for partners
Future audit
Contents of an audit
Background
Background Literature review
Background Literature review Criteria and standards
Background Literature review Criteria and standards Methods or protocol
Background Literature review Criteria and standards Methods or protocol Results
Background Literature review Criteria and standards Methods or protocol Results Recommendations for change
Background Literature review Criteria and standards Methods or protocol Results Recommendations for change Recommendations for further audit
Why audit
Why audit
Useful clinically
Why audit
Useful clinically Encourages teamwork
Why audit
Useful clinically Encourages teamwork Improves patient care
Why audit
Useful clinically Encourages teamwork Improves patient care Financial benefits (sometimes!)
Why audit
Useful clinically Encourages teamwork Improves patient care Financial benefits (sometimes!) Becoming contracturally an obligation with the arrival of PCGs
Problems with audit
Problems with audit

Audit and research
Problems with audit

Audit and research Statistical verification
Problems with audit

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

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

Audit and research Statistical verification Outcome measures and proxies Protocols Closing the loop - introducing change and re-audit
A word about clinical governance
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
Clinical Governance
Clinical Governance
Clinical Governance
Research
Clinical Governance
Research
Audit
Clinical Governance
Research
Audit
Evidence based medicine
Clinical Governance
Research
Audit Dissemination of guidelines
Evidence based medicine
Clinical Governance
Research Practice development plans Audit Dissemination of guidelines Evidence based medicine
Clinical Governance
Personal development plans
Clinical Governance
Postgraduate medical education Personal development plans
Clinical Governance
Practice accreditation Research Practice development plans Audit Dissemination of guidelines Evidence based medicine Postgraduate medical education Personal development plans
Clinical Governance
Practice accreditation Research Special interest groups Practice development plans Audit Dissemination of guidelines Evidence based medicine Postgraduate medical education Personal development plans
Clinical Governance
Accountability

Audit Cycle

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Clinical Audit and the Audit Cycle

What we are going to cover today

What we are going to cover today

What we are going to cover today

What we are going to cover today

What we are going to cover today

What we are going to cover today

Multi-disciplinary Cross boundary

Multi-disciplinary Cross boundary Cohort based

Multi-disciplinary Cross boundary Cohort based Comparative

Multi-disciplinary Cross boundary Cohort based Comparative Significant event based

The audit cycle

The audit cycle

The audit cycle

Audit (Data collected)

The audit cycle

Audit (Data collected) Identify areas for improvement

The audit cycle

Make necessary changes

Audit (Data collected) Identify areas for improvement

The audit cycle

Make necessary changes

Audit (Data collected) Identify areas for improvement

The audit cycle

Make necessary changes

Audit (Data collected) Identify areas for improvement

Another way of expressing the audit cycle

Another way of expressing the audit cycle

Another way of expressing the audit cycle

Another way of expressing the audit cycle

Another way of expressing the audit cycle

Another way of expressing the audit cycle

Another way of expressing the audit cycle

Another way of expressing the audit cycle

Criteria and standards

Criteria and standards

Criteria and standards

Structure, process and outcome

Structure, process and outcome

Structure, process and outcome

Structure, process and outcome

The great coffee audit

The great coffee audit

The great coffee audit

The great coffee audit

The great coffee audit

The great coffee audit

The great coffee audit

The great coffee audit

The great coffee audit

Problems with audit

Problems with audit

Problems with audit

Problems with audit

Problems with audit

Problems with audit

A word about clinical governance

A word about clinical governance

Evidence based medicine

Audit Dissemination of guidelines

Evidence based medicine

Personal development plans

Postgraduate medical education Personal development plans