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Published on: February 16, 2011
Clinical audit and quality improvement - time for a rethink?
Paul Bowie1, Nicholas A Bradley, Rosemary Rushmer
1NHS Education for Scotland, Glasgow, Scotland, UK. paul.bowie@nes.scot.nhs.uk
Journal of Evaluation in Clinical Practice
|November 20, 2010
Summary
Clinical audit shows limited patient care benefits due to barriers like workload and lack of support. A debate is needed on audit
Area of Science:
- Healthcare Quality Improvement
- Medical Auditing
- Health Services Research
Background:
- Clinical audit is a long-standing quality improvement (QI) policy but evidence of its patient care benefits is limited.
- Attitudinal, professional, and organizational barriers hinder the effectiveness of clinical audit.
- Clinical audit advisors possess unique insights into the strategic and practical application of audit within healthcare organizations.
Purpose of the Study:
- To explore the views and experiences of clinical audit advisors.
- To understand their role in supporting healthcare teams through the audit process.
Main Methods:
- A qualitative study was conducted using semi-structured and focus group interviews.
- Participants (n=21) were purposively sampled across health sectors in two Scottish NHS Boards.
- Interviews were audio-taped, transcribed, and subjected to thematic analysis.
Main Results:
- Work pressure and lack of protected time are cited barriers, masking deeper issues of non-engagement.
- Professional disparities exist in participation opportunities, with doctors potentially dominating the process.
- Audit is perceived as a burdensome, managerially driven exercise lacking professional rewards, often hampered by management support failures and inter-professional conflicts.
Conclusions:
- Findings align with previous research, indicating clinical audit, as currently practiced, falls short of policy expectations.
- A shift towards systems-based QI methods is occurring, though their impact remains under-researched.
- Overcoming persistent professional, educational, and organizational barriers is crucial, necessitating a discussion on audit's role alongside other QI approaches.
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