The Healthcare industry is such a dynamic and ever changing system, there is constant drive for improving quality to benefit our patients. The time has come for everyone in the NHS to take this very seriously.
As from 2010, all healthcare organisations are required to publish a yearly quality report to the public about the quality of services. Part of this include clinical audit and quality improvement activities within trust. External monitoring groups include Care Quality Commission (CQC), NICE, NCEPOD and NHS Litigation Authority, NCAPOP
The General Medical Council’s document, Good Medical Practice, makes clear doctors’ obligations to participate in clinical audit.
Clinical audit plays an important part in the drive to improve quality of patient care and thus forms a cornerstone of clinical governance. On the surface this has been dealt with through the compulsory involvement of junior doctors in clinical audit, as one of the pillars of clinical governance.
Having taken part in audits in several different departments and hospitals in the last few years, I started to question the value of clincialaudits, and whether I was making any real contribution to patient care, or it is instead a data collection and tick-box exercise. I then realised that many doctors around the country share the same frustrations. http://www.bjmp.org/content/uk-junior-doctors-experience-clinical-audit-foundation-programme
2 years ago, after presenting my audit work at a Quality improvement conference hosted by The Network, and sharing experiences with people passionate about QI, my views on clinical audits changed…
I realised that clinical audits are a part of the wider goal of quality improvement. Instead of conducting audits to mealy collect data to measure against a standard. True quality improvement is about investigating real problems, identify solutions, and working in a team to raise standards.
I begin to see so many things happening everyday at work that can be improved… As much as we would like to improve quality, it all just seems like a blurry dream. The amount of support varies greatly between departments.
Severalmonths ago, I had an interesting twitter conversation with a gastroenterologist about QI projects. I asked her how support there are to help juniors make changes in clinical practice, and I was really inspired about her comment here… and thought, why can’t all departments have a supportive and encouraging environment like this? A QI corner for each department.
As all these doctors are required to do clinical audits, it is logical to engage junior doctors directly to support the trust’s and clinical services’ clinical audit programmes. – HQIP Guide to involving junior doctors in clinical audit.Junior doctors’ clinical audits can contribute directly to meeting the external requirements and expectations of an NHS trust. (CQC, NHSLA)
Collating the data from several “Audits of clinical audits”, the rate of completion of audit cycles are shockingly low. The question is, what happened to the 83%. What have we gained or learnt from them?
With such a low rate of project completion, it is not surprising that only a small amount of projects led to any change.
So what is going on?
There are 3 key elements to which barriers to undertaking valuable projects.
The question is: Is there good resources for doctors to come up with project ideas? Sometimes, the idea has already been done, and simply forgotten or discontinued because it didn’t work. Sometimes great project ideas are done in other hospitals which are reproducableWe just don’t have a easily accessible way to find out what has been done locally.
Important matters in clinical practice are more likely to lead to change in practice. When a doctor rotates into the new clinical environment, it takes a significant amount of time working in that environment before they can identify areas to improve. It is not easy to find the priorities of a department and formulate a project that is important enough to drive positive change.
Whenintiating a project. It is important to ask if similar projects has been done in the past to prevent “reinventing the wheel”. But without a simple way to find out whats been done in the past, we cannot grow and improve from prior knowledge.
Our telephone survey of 10 hospital audit department showed that all departments are required to take part in audits / QI.
Whilst BSUH have developed a clinical audit database, we believe this is underutilized because it is not accessible on the internet, it lacks follow up and feedback.
We need cohorts to pick up from previous projects, but this does not always happen. It needs to be driven by the leader of the project, and there needs to be more robust way to monitor of audit activities within each department so that projects can be recorded and handed over for later cohorts.
If all projects were strictly entered and monitored on an online data base. It would be easier to monitor and ensure projects are continued and completed.
If projects are not registered on a database, there is no record of it ever happening. Important learning points from these are simply lost.
It is very important to share the successes in our work, but failures are just as important lessons to be learnt. When a project didn’t go as planed, the department should learn from this so there is a better strategy in the future. http://careers.bmj.com/careers/advice/view-article.html?id=20003642
Similar identified problems are faced in the workplace at different departments and hospitals, however sharing of lessons learnt from local projects nationally tend to be poor. Collaboration and shared learning are key elements of successful projects.
Networking between departments and trust is the important part of the bigger picture. As healthcare become more standarlised, we can certainly learn a lot from what others are doing.
There are many ways to share ideas and form collaborations. However, these are prone to selection and publication bias. Negative results have just an important role in our learning and improving quality.
We went to the NHS hackday last year and realised how much innovative potentials, IT can have on improving our healthcare system.
And we really felt that we should embrace technology and
Perhaps there is a way using IT to provide a solution
We went to NHS hackday 2014 at Cardiff University and started building OpenQI.. And we will show you a demo of what our team has built in 2 days.
OpenQI - Brighton innovation forum presentation Jan 2014
MANAGE, SHARE, COLLABORATE
Dr Conrad Lee (BSUHT)
Dr Michael George (PHT)
The NHS strives for continued quality
improvement and innovations
The Care Quality
Commission requires all
organisations to submit a
“You must take part in
systems of quality assurance
and quality improvement to
promote patient safety.”
- GMC Good Medical Practice 2013
It is now compulsory for clinicians to
participate in clinical audits, as one of
the pillars of clinical governance.
“It is a bold agenda. We need to not just
innovate, but also be sure that we are
sharing those innovations all across the
– From innovation to Action: The
First Report of the Health Care
Innovation Working Group
Current collaboration methods
The Sharing Good Practice event
KSS prize day
Clinical Audit Support
Centre (CASC) annual
junior doctor clinical
The Clinical Audit Support
Centre , Leicester
National Clinical Audit
Senior involvement and MDT approaches are
key to bringing change in clinical practise
• An electronic platform for storing and
sharing ideas / projects
• Facilitate ease for healthcare professionals
to monitor and manage QI projects
• Readily and freely available on the
• Online support and collaboration
Benefits - in summary
• Increase and streamline
• Greater control of QI
• Improve continuity and
completion of projects
• Encourages collaboration
and sharing of ideas
• Software compatibility
• First step in regional collaboration
• Resources and expertise to help develop and
maintain this online platform
• Senior / trust involvement in educating
doctors in QI and increase awareness of the
• Structuring responsibilities
"Our vision is that someday, through OpenQI,
each hospital can share, learn, and be proud of
every single Quality Improvement project they
Craig Thomas (Web developer, Cardiff)
Dr Sebastian Yuen (Consultant Paediatrician, Bristol)
Jo Carter (Director of SatoriLab, Cardiff)
Nick Theodorou (Project manager, London)
Mark Renshaw (Deputy Chief of Safety)
Eirwen Record (Clinical audit facilitator)
Tom Roper (Clinical Librarian)
Mr Anil Ghosh (General Surgical Registrar)
•“Audit of audits in an orthopaedic university teaching hospital:
eight and a half years of experience” R Singh et al; Ann R Coll
Surge Engl (Suppl) 2013; 95: 59-61
•“Auditing orthopaedic Audit” E Guryel, K Acton, S Patel; Ann R
Coll Surge Engl; 90: 675-678
•“Going beyond audit” Dharamshi, T Hillman; BMJ careers 2011
•“The way we see it: Quality improvement” T
Hillman, A Roueche
•Venkatesan M,Amin RB,Armitage A. Standards and
effectiveness of the orthopaedic quality improvement process:
review of a decade of audit database. OJCA 2011; 3(2).
•Gnanalingham J, Gnanalingham MG, Gnanalingham KK. An audit
of audits: are we completing the cycle? J R Soc Med 2001; 94:
•C M John, D E Mathew, M G Gnanalingham. An audit of paediatric
audits Arch Dis Child 2004;89:1128–1129.
Dr Michael George @drmgeorge87
Dr Conrad Lee @ckwl1