Medical Audit

1. Medical Audit What does it mean? How does it help me?

2. Archimedes Pump

3. What is Audit Audit is the process used by health professionals to assess, evaluate and improve the care of patients in a systematic way in order to enhance their health and quality of life. Making Sense of Audit D & S Irvine

4. What does it mean? What am I doing? What do I think I am doing? What should I be doing? Am I doing that? Is anyone else doing that?

5. What�s the Jargon Terminology of Audit "When I use a word, it means just what I choose it to mean - neither more nor less" H Dumpty.

6. What�s the Jargon Structure Physical and personnel resources Buildings, Staff, Equipment. Process The actions taken by those involved in the activity being Audited/health care. Consultation Rates, Recording of Risk Factors.

7. What�s the Jargon Outcome The results of health care. Very often these are not possible to measure in Primary Care and we may use "proxy outcome measures" i.e. control of BP rather than reduction in the number of deaths from strokes.

8. What�s the Jargon Criterion A definable and measurable item of health care which describes quality and can be used to assess it Females of child bearing age should be immune to rubella Standard The level of care to be achieved for any particular criterion 80% of females of child bearing age should be immune to rubella

9. The Audit Cycle

10. Archimedes Pump

11. 8 Point Audit for Assessment Reason for choice of audit Criterion/Criteria Chosen Standards set Preparation and Planning Data Collection (1) Change(s) to be evaluated Data Collection (2) Conclusions

12. 8 Point Audit for Assessment Reason for choice of audit Potential for change Relevant to the practice Criterion/Criteria Chosen Relevant to audit subject and justifiable, eg. Current literature Standards set Targets towards a standard with a suitable timescale Preparation and Planning Evidence of teamwork and adequate discussion where appropriate

13. 8 Point Audit for Assessment Data Collection (1) Relevant to audit subject and justifiable, eg. Current literature Change(s) to be evaluated Actual example described Data Collection (2) Comparison with Data collection (1) and standard Conclusions Summary of main issues learned

14. How hard is it to Change?

15. Sir Nick Faldo

16. The Hero-innovator: �This then is the myth of the Hero-innovator: the idea that you produce, by training, a knight in shining armour who, loins girded with new techniques and beliefs, will assault the organisational fortress and institute changes in himself and others at a stroke�

17. The Hero-innovator: �The fact of the matter is that organisations � will, like dragons, eat the hero-innovator for breakfast!!� (Giorgiades and Phillmore, 1980)

18. Change Management Different people react differently to change . Problems arise when a stability-oriented person finds that circumstances are changing quite rapidly, or a change-oriented person finds that everything is the same and there is nothing new

19. Change Management

20. Change Management strong dissatisfaction stress negative attitudes towards individuals with preferences at the other end of the spectrum (eg: distrust, dislike) resistance (to change, or to the status quo) intense emotions loss of rational judgement

21. Change Management Everyone has fundamental needs that have to be met The need for Control The need for Inclusion The need for Affection (Openness) William Schutz

22. Change Management Change often involves a loss, and people go through the "loss curve"

23. Change Management S-hock A-nger R-ejection A-cceptance H-ealing

24. Change Management Expectations need to be managed realistically

25. Change Management Fears have to be dealt with