The "physician-led chart audit: " engaging providers in fortifying a culture of safety

Engaging physicians in quality and patient safety initiatives is a well-described challenge. Barriers include time constraints, lack of defined common purpose and leadership support, poorly communicated goals, and scarcity of supporting data (references 1, 2, 3).With reference to strengthening a culture of safety while meeting regulatory and performance standards, health-care systems face a difficult twin objective: educate the medical staff and its trainees and maintain high levels of compliance across inpatient, ambulatory clinic, and procedural areas.In 2010, our institution identified opportunities for improvement in physician performance related to several important patient safety standards. These issues had not been previously corrected by didactic sessions, written communication, and the chain of command.

To help address these general and site-specific problems, we developed and deployed a set of medical record audit tools entitled "physician-led audits" (PLAs). We trained providers in leadership positions to use the tools and to teach their use to others. We designed a system to capture data on frequency of use and results. The PLA process is distinctive in that it holds physicians accountable for the auditing and for follow-up afterward.

With support from department chairs, division chiefs, residency program directors, and other leaders, close to 2000 PLAs were performed over a 10-month study period.

The audits engaged physician leaders and the at-large medical staff, making them key participants in a system-wide improvement campaign. The tool was customized for use in a broad range of clinical settings and was widely and rapidly adopted, leading to important dialogue and a substantive contribution to our safety culture.