Clinical audit: integrating the management of quality

The recent implementation of clinical audit by the Department of Health seeks to both integrate existing professional audit activities, and to integrate the resulting multi-professional audit more closely with other quality-assurance activities developed by corporate management and purchasers. This paper, which is based on studies of medical and clinical audit undertaken over the past 3 years, examines the potential for integration in the light of, first, the history and characteristics of the different forms of quality assurance initiative and, second, a comparison of their different properties. In many ways clinical audit appears to stand between domination by both professional and managerial influences, which may enhance its potential for integrating different approaches. If, however, clinical audit is to succeed it is suggested that it requires a strong managerial infrastructure; with clearly delineated responsibilities related to the different modes of quality assurance.