One thing that has struck me as I have been browsing blogs, reviewing links on twitter, and talking to colleagues across different organisations, is that there is a lot of negativity around national clinical audits. Some of this is well founded – some do take too long to report, some are just continuous data collection, some don’t have robust standards. However, there are some criticisms, which I find very hard to accept – the biggest one being that national audits don’t do enough to support local change.
Before you shout at your tablet/computer/phone, let me clarify… I accept that national audits don’t always provide a neat toolkit of change that we as audit facilitators should go away and implement (but some do – for example the tools that are provided by the Prescribing Observatory for Mental Health). National audit don’t always provide an opportunity for staff to meet, discuss and reflect on findings at a national or bench-marked level (but some do – for example the IBD National audit).
The problem comes with a lack of consistency over national audits and what we as local audit staff can expect from them. This can only be rectified by outstanding commissioning processes, an ability to effectively scrutinise these (audit if you like), and change the practice of the national audit providers – in an enforced manner if needs be. Call me naive, but if you called a decorator into your home and asked them to paint the room blue, you wouldn’t accept it and pay if they painted it purple ‘because it’s almost the same colour’. You would expect blue. A transparent and consistent expectation of what the national audits should deliver, and holding them to account for this, is the only way that local audit staff will receive a consistent offer to support them to effect change.
Which takes me back to my first point – some of the negativity is well founded, but actually some of it isn’t! Why should we as local staff be waiting for national audits to provide us with the tools to change practice? Why shouldn’t we be facilitating change ourselves? The recent blog post from CASC re: their “Clinical Audit Summit for Mental Health and Community professionals” noted in the SWOT analysis that “results may not be as high impact as local audit” and that national audit “takes the focus away from local audit”. My question back would be – so what have you (staff working in audit, not CASC!) done about it? We each have a responsibility to drive change – if the results aren’t high impact as local audit, why is that? Is that because they haven’t been given enough support from facilitators? Did they have good clinical engagement from the outset? Was the right clinical lead in place? Did we use improvement tools once we had the findings – such as root cause analysis, five whys, PDSAs? Have we asked those questions (and more) of ourselves and our teams. To paraphrase the words of Ghandi we have to be the change we want to see…
Audits (be they local or national) will never be valued if they don’t deliver improvement. And they won’t deliver improvement if they don’t get to the bottom of what isn’t right about current practice and implement a change to improve this. The national audits have come a long way in the last 5 years, but they still have a way to go. They aren’t going to go away though, so it is up to each of us to work together – through organisations like NQICAN and regional networks, alongside HQIP to commission methodologically sound, consistent projects which we can then act upon the findings of, and deliver the end result of improving care for patients.
Footnote from Editor – Carl Walker, NQICAN Chair
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