Service evaluation and development: experience of a paediatric disability team

Classical audit frameworks encourage the use of audit cycles, with performance being evaluated against predefined quality targets and modified accordingly. This approach has obvious validity in clinical settings where treatments have very clear endpoints and outcome measures can be prioritized with ease. The situation becomes more complex in disability service settings, where the impact of clinical intervention is often qualitative rather than quantitative, and where management strategies are dependent on working in partnership with families, purchasers and other professional colleagues. There is thus a danger of neglecting aspects of service delivery which are of major importance to one sector of this extensive network. To ensure that service goals and standards comprehensively reflect the specific concerns of all parties, it is proposed that measures of service quality should be defined within the context of a dynamic multi-user framework. Development of such a framework is dependent on collating information on specific needs from parents, referrers, purchasers and other involved professionals, and determining areas of overlap, as well as areas of potential conflict. Audit techniques for key issues can then be devised, alongside a timetable to revisit these issues at appropriate intervals. Application of this approach is illustrated by reference to our own paediatric disability service.