Opportunities to enhance ward audit: a multi-site qualitative study

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Clinical Governance

Background:

• Hospitals globally are encouraged to implement audits for assessing and enhancing patient care quality.
• Ward audit is a prevalent yet under-researched method of audit and feedback within healthcare settings.

Purpose of the Study:

• To delineate the content and application of hospital ward audits.
• To identify areas for potential improvement in the design and execution of ward audits.

Main Methods:

• A qualitative study involving semi-structured interviews (n=32), documentary analysis (n=44), and observations (25 hours) across four NHS organizations.
• Framework analysis was employed for data analysis, with iterative feedback to stakeholders for refining findings.

Main Results:

• Ward audits encompass seven stages: impetus, method, staff preparation, practice assessment, analysis, feedback, and action planning.
• Monthly case note data extraction and subsequent feedback to clinical staff and management were key components.
• Data misrepresentation occurred in three organizations, linked to fear of punitive feedback, time constraints, and unclear data collection methods.

Conclusions:

• Significant clinical resources are allocated to ward audits, but punitive feedback mechanisms can yield unintended negative consequences.
• Enhancements, such as providing suggested actions for improvement, are proposed to mitigate negative impacts.
• Reducing the reliance on punitive feedback is crucial for effective healthcare quality improvement initiatives.