#CAAW18 – a successful re-audit – but how do we sustain the improvement?

Welcome to our latest N-QI-CAN blog. Ahead of the forthcoming festive break and new year I would like to take this opportunity to reflect on 2018 and highlight our key priorities for 2019.

Lets start as promised in our last blog by highlighting some of the successes from Clinical Audit Awareness Week 2018 aka #CAAW18. If we look at the week as a repeat Clinical Audit cycle we would conclude that our interventions across the Clinical Audit Community since last year produced a positive outcome and the week had more impact than previously. However #CAAW18 is a one-off week (special cause variation if you like) and Clinical Audit is not just for CAAW – its 365 days of the year. So what can we take from the week and build on going forward?

Firstly there were so many events across the country and beyond which was brilliant to see and I thoroughly recommend spending 20 minutes reviewing some of these tweets/events. To make this easier @gmacscotland (Thanks Dr Mackenzie) has kindly provided various reports to highlight the spread of events & tweets across the country and beyond (link) plus top tweets throughout the week (link to report). There were also lots shared on the NNSF. A lot of this work can be carried out at any time in the year so lets plan to hold more promotional clinical audit events in 2019 and share on twitter and the NNSF.

Looking at these events, heros, tweets, posts and stats its clear that there is a lot of passion for Clinical Audit at the local level from those directly involved in the Quality Improvement (QI) process. It is also clear that there is a lot of work to do to ensure Clinical Audit is carried out as its designed and produces the improvements to patient care we aim for. As part of #CAAW18 we asked our NNSF members to share Clinical Audit successes on the forum and we agreed at N-QI-CAN last week that this is something we should continue to encourage all year. So we will be leaving this section live on the forum and holding quarterly awards for the best projects shared and then an overall winner during #CAAW19. QI is all about learning from others so we need to encourage more people to share successes (and failures) both national and local across our networks and our patients.

Underneath the hard work and dedication there are some fundamental issues that need to be addressed if Clinical Audit is to be considered by all as an effective process. There is a feeling talking to colleagues as I attend meetings / events around the country that Clinical Audit appears to have lost a level of identity and its importance as a quality improvement tool with clinicians and also key stakeholders including CQC, NHSI & NHSE.  This is a concern and we have already started to tackle this as part of our 2018/19 priorities.

In terms of local trusts anecdotally we are hearing that Clinical Audit is often overlooked when it comes to QI or that it is not being properly integrated into the wider QI strategy. Also that perhaps clinical audit staff are not being supported & developed adequately in order for Clinical Audit to fully develop its potential. To this end we have agreed to lead a consultation across our networks on local Clinical Audit (with a focus on resources, staff & professionalisation, training, & infrastructure) with the aim to provide a strategy and solutions going forward. We will be sending out our consultation early in the new year and holding a clinical audit summit on March 29th to feedback the results and agree a way forward with as many key national organisations and network members in the room as possible. To help the later we have agreed an excellent discount rate for the summit which we will be sharing across our networks in the new year.

We feel that these interventions will give us a better chance to see a sustained improvement in Clinical Audit so when it comes to #CAAW19 it will be clearer to all involved what clinical audit is and how it can support the NHS to provide safe care for our patients.

As the NHS was 70 this year I will sign off by sharing the fitting image below that I took recently at a local church Christmas Tree festival.

May I wish you all a Merry Christmas and look forward continuing our work in 2019.

Carl Walker

N-QI-CAN Chair

NB Well done to the various trusts that caught my eye during #CAAW18 in terms of implementing our CAAW epack – (as detailed on twitter during the week and this NNSF post) we will be posting you some NQICAN goodies as promised in the new year.