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Introduction for speaker only. Please see speaker notes below for details of the format of this presentation and suggestions on how it might be used. Clinical audit: Ten simple rules for NHS Boards based on ‘Clinical audit: A simple guide for NHS Boards and partners’
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Introduction for speaker only Please see speaker notes below for details of the format of this presentation and suggestions on how it might be used
Clinical audit: Ten simple rules for NHS Boards based on ‘Clinical audit: A simple guide for NHS Boards and partners’ produced by HQIP and the Good Governance Institute, 2010.
Background Clinical audit is: • A key element of clinical governance • Crucial in assessing the quality of clinical care • Vital to achieving efficiency savings while improving the quality of service • A requirement for CQC registration and to meet NHSLA standards • A required element of Quality Accounts
Background But Trust Boards have been criticised: • Failure to use clinical audit in a systematic way to address risks • Little evidence of Board level discussion or challenge of data quality • Separating cost and quality • Detailed criticism in the Mid Staffordshire report
Clinical audit and commissioning Commissioners have a duty to monitor the conduct of clinical audit in providers: • They should participate in setting the local clinical audit agenda • Contracts should include clinical audit requirements • PECs should facilitate interface audit • Providers should report audit progress and outcomes • Commissioners require assurance about the implementation of action plans.
HQIP guidance The guide describes: • How the board can gain assurance about quality of service from clinical audit • What questions board members should ask • Acceptable answers • Where to go for further guidance and support • Ten simple rules for boards to follow
Rule 1 Use clinical audit as a tool in strategic management; ensure the clinical audit strategy is allied to broader interests and targets that the board needs to address. • Do we have a clinical audit strategy based on national and local priorities? • Do we engage with our providers to ensure their clinical audit strategies meet our requirements for quality assurance?
Rule 2 Develop a programme of work which gives direction and focus on how and which clinical audit activity will be supported in the local health economy. • Is our board assurance framework supported by clinical audit as assurance? • How can we be assured that the technical quality of clinical audit undertaken by our providers is high and that key issues that affect data quality are addressed?
Rule 3 Ensure all providers have appropriate processes for instigating clinical audit as a direct result of adverse clinical events, critical incidents and breaches in patient safety. • Is there a clear link between our processes for dealing with such events and our clinical audit strategy? • Who is responsible for ensuring this link works? • What assurance do we have that providers consider such events when developing their clinical audit programmes?
Rule 4 Check the clinical audit programme for relevance to board strategic interests and concerns. Ensure that results are turned into action plans, followed through and re-audit completed. • Has the board agreed what constitutes materially unacceptable variation in clinical audit results? • For all clinical audits that identify unacceptable variation is there an action plan? • Have we assurance that clinical audits have led to improved service delivery?
Rule 5 Ensure there is a lead clinician who manages clinical audit within every provider, with partners / suppliers outside, and who is clearly accountable at board level. • What proportion of approved clinical audits do our providers complete to time and budget? • Do our contracts with suppliers / providers require cooperation in clinical audits e.g. in CQUIN regime?
Rule 6 Ensure patient involvement is considered in all elements of clinical audit, including priority setting, means of engagement, sharing of results and plans for sustainable improvement. • Is there an explicit link between our clinical audit strategy and our patient and public engagement strategy? • Do we enable patients and carers to influence clinical audit and other quality improvement activities?
Rule 7 Build clinical audit into planning, performance management and reporting. • Do we have an explicit process for reviewing national clinical audit reports and quality accounts from providers? • Do we have an explicit process for using the outcomes of clinical audits to inform commissioning decisions? • What assurance do we have that our providers performance is accurately reflected in the assessments of the regulatory bodies?
Rule 8 Ensure with others that clinical audit crosses care boundaries and encompasses the whole patient pathway. • Do we have clear lines of communication with other local health and social care providers to facilitate cross boundary clinical audit? • Are any areas such as mental health or primary care neglected in local clinical audit programmes?
Rule 9 Agree the criteria of prioritisation of clinical audits, balancing national and local interests, and the need to address specific local risks, strategic interests and concerns. • Do we have a relevance test to approve commitment of resources? • Does our focus on national clinical audits mean we have no resource to advise on local priorities?
Rule 10 Check if clinical audit results evidence complaints and if so, develop a system whereby complaints act as a stimulus to review and improvement. • Is there a clear link between our processes for dealing with complaints and our clinical audit strategy? • Are complaints taken into account when approving local clinical audit programmes?
Contact us Healthcare Quality Improvement Partnership Email : lqit@hqip.org.uk Website:www.hqip.org.uk Promoting quality improvement for better healthcare