What is audit?

1. What is audit? • Audit is when you compare how well a service is performing against an agreed and specific benchmark of what the service should be doing in that situation. For example: • care of a particular health or social problem • amount and level of user involvement • what training opportunities staff get • Audit work is commonly used to determine the need for service improvement • It can be repeated at a later time to check how well a service has gone with making changes 1A

2. Why is audit important? • The overall aim is to improve patient outcomes, professional practice and the general quality of services delivered by: • identifying and promoting good practice in health and social services so people can continue and strengthen it • identifying problems to fix or areas to develop so the service makes plans and then does this work • providing training and education opportunities so people learn about audit, but also learn about areas that the audit says need to be improved • helping to make sure that resources are being used well and properly • improving relationships between staff, service users and agencieswhen problems are fixed or areas improved 1B

3. CHAI - The Commission for Healthcare Audit and Improvement • CHAI’s job is to: • be an independent and reliable voice on how well the NHS is providing quality patient care • identify and ask services to address areas where care could be improved • identify good practice and share it across the NHS • It put patient’s experiences at the centre of its work by: • how patients, carers and service users are involved in the NHS – such as the planning and running of services • how well people are involved in their own care • patients’ experience of the NHS: quality of care and treatment 1C

4. National audits • National audits focus on a particular health or social problem • NHS services are assessed on how well they meets the national clinical guidelines for providing care for that problem • Recommendations are made about the quality of service that patients should expect from a specific area of health or social care, and what can happen to achieve that if it is not being met - two national audit examples are: • Paediatric cardiac surgery audit: Monitors heart surgery carried out on children and the standards of care, with particular attention paid to mortality rates and major complications • Venous leg ulcers: Provides guidance for staff on the appropriate management of patients’ venous leg ulcers, as well as measuring the standards of care 1D

5. CHAI-led Trust audits • When CHAI audits individual NHS trusts they call these clinical governance reviews. • Trust’s are reviewed against a set of benchmarks that have been agreed at a national level to represent good or best practice in health and social service delivery in seven areas: • Patient, service user, carer and public involvement • Risk management • Clinical audit • Staffing and management • Education and training • Clinical effectiveness • Use of information (this also covers confidentiality) 1E

6. CHAI-led Trust audits • All areas are evaluated on a scale of 1 to 4: • 1 = Little or no progress at strategic or operational level • 2 = Worthwhile progress • 3 = Good strategic grasp and substantial implementation • 4 = Excellence • Trusts aim to get as many scores of 3 and 4 as they can – they have Departments of Clinical Audit to help prepare them for CHAI audits and create plans for improvement 1F

7. CHAI-led Trust audit • The clinical governance review is done by a review team set up by CHAI - it usually to has 6-8 members: • a NHS doctor • Nurse • professional related to health, e.g. a pharmacist or occupational therapist • a lay member • an NHS manager • a CHAI review manager • additional service user and carers may be included • They are trained for the role, spend time preparing for the audit, visit the Trust for a full week, and then help with writing up the report 1G

8. Local audits • Can use national guidelines to assess a service’s performance • May decide that to set up their own criteria for a specific issue – if so, this is the perfect place for user involvement as users, carers and the public can • identify or suggest areas where they think audit is needed • help set up the plan for how to do the audit • guide the Trust on good ways to reach users and carers • help design interview guides or surveys for users and carers • comment on the outcomes and what needs to improve • be involved in planning how to make improvements • be part of those improvements and monitor their progress 1H

9. Why have user involvement in audit? • There are several reasons for user involvement in audit: • patients and the public have a right to be involved in improving the quality of care they receive • their priorities may differ from those of health and social services staff • constructive involvement can better focus audit and enhance implementation of improvements that are needed • constructive involvement can improve patient and public understanding of the challenges in health and social care and increase their involvement elsewhere in services 1I

10. Case example – North Bristol NHS Clinical Audit Department • They have set up a Clinical Audit Patient Panel: • there is no restriction on numbers of people as they want to make sure that there are enough people to share the tasks and represent a variety of different views • Members of the panel are past or current patients or carers who have an interest in improving the quality of care and can talk about their experiences at the Trust • The Department discusses the audit work they are planning with panel members • The Department encourages panel members to be self-confident so they are not afraid to say what they think 2A

11. Case example – North Bristol NHS Clinical Audit Department • Panel members are asked to: • attend Trust committees regularly to discuss possible and existing audit projects, including planning for and monitoring them, and other user involvement issues in the Trust: • Clinical Audit and Effectiveness Committee every 2 months • Clinical Audit Quality Review Group every month • the Trust’s Patient Partnership Committee every 3 months • write a section in the Trust annual report on the work of the Patient Panel 2B

12. Case example – North Bristol NHS Clinical Audit Department • They are also asked to: • talk with the Trust’s Patient Advice & Liaison Service to help gain other patient’s views on the issues being explored through audits • promote user and carer involvement in audit projects and develop appropriate patient-centred tools to use in them • contribute to the information on the Trust web site about user involvement in general as well as in audit • write short articles about the work of the Patient Panel in the quarterly Clinical Audit Newsletter 2C

13. Case example – North Bristol NHS Clinical Audit Department • The Clinical Audit Department supports panel members by: • reimbursing travel expenses and any other appropriate costs they you might have from helping the Trust • provide training through a one-day course to help them to understand what clinical audit is all about • personal support from Clinical Audit Manager as needed • holding a half yearly seminar to review the panel, give feedback on experiences and discuss how to improve and develop user involvement in audit 2D

14. Thinking about practical issues – what does it mean for you? • Number of user consultants involved • Costs of involvement • What is the user consultant role description? • Being prepared for the role • At what stage are user consultants involved? • Office space or equipment • Number of methods for gaining user involvement used 3A

15. Thinking about practical issues – what does it mean for you? • How much information you receive • Handling confidential information • Training • Mentoring • Your connection to a network of other users, carers, the public • Debriefing opportunities or support • Opportunity to reflect on what you learn • Dealing with personal difficulties 3B