Clinical Audit Summit – Key Messages

As predicted in our last blog at the end of last year – 2019 has been very busy for our networks and on Friday as promised I presented back the results of our first survey at the Clinical Audit Summit. The survey (and co-hosting the summit) was a big undertaking on top of our day jobs and I would like to thank those colleagues that helped put the survey and summit together* and everyone (all 308 of you :-)) who completed the survey.

Already the survey has provided a rich source of feedback to help direct our work in line with the above aims and soon we will share the full report with our agreed priorities. In the meantime the presentation I gave at the summit on Friday with the key messages is available to view via our forum.

As chair of the summit I was asked to round-up the whole day with the key take home messages so I thought I would share these in a little more detail via this blog to help share the messages beyond the 90 delegates and speakers at the summit.

Clinical Audit Summit – 9 key messages:

1.Clinical audit is a Quality Improvement (QI) tool

• NICE defined it as such in 2002 but still i’m hearing that a lot of people are missing this point and clinical audit is being forgotten in the wider QI agenda. Let’s continue to challenge this if its happening as we are finding that this is often down to lack of understanding (see point 5). Let us know if you need our support to do this.

2. Importance of common purpose

• Working in healthcare – as Don Berwick nicely points out – we all come to work to do our job and improve our job – in terms of outcomes and experience for our patients. Therefore it is important for us to focus on this when undertaking an improvement project and work together with patients and carers wherever possible. It was great to hear from the epilepsy 12 how they have done this successfully.

3. Lets make Clinical Audit data count

• Following on from our work with NHS Improvement on linking the making data count guide to clinical audit – the summit certainly highlighted the importance of using run charts in local and national clinical audit for both assurance or improvement analysis.

4. National Clinical Audits (NCA) are evolving

• Although the speed of this is slower than some would like to see – there is growing evidence that NCA’s are evolving and improving in terms of structure, process, culture for reporting and as a result the outcomes. Delegates enjoyed Mirek’s tennis ball group exercise to help explain this point (link) in terms of the approach HQIP are taking to encourage trusts to use NCA data to stimulate local QI.
• Further work is needed however to spread the NCAs across providers and whole patient pathways which was supported by the findings of latest CASC clinical audit survey. It was great to have the NHS England Medical Director for Clinical Effectiveness Celia Ingham Clark confirm at the end of the summit that they (NHS England) are keen to work with local trusts and our networks to develop this going forward.
• Prof Keenan, HQIP Medical Director also confirmed that NCA Benchmarking will be rolled out to the whole NCAPOP over the next 12 months and encouraged local trusts to use these key indicators as the basis for local improvement.

5. We need to break down the barriers to Clinical Audit 

• One of the biggest findings from our survey was the number of barriers there are in local trusts that hinder effective clinical audit (see below). I think it would be useful for all trusts to review these barriers and any additional ones that you have and see what can be done to break these down and help staff complete the clinical audit cycle more easily and effectively.

6. We are all leaders and we need to make sure our voice is heard

• I wasn’t in the excellent session lead by Mr Perbinder Grewal but this was a clear message speaking to colleagues at lunchtime who were in the session. We will try and do our bit to make sure our community is heard going forward and provide guidance as to how we can do this best.

7. We need to think differently to improve our outcomes

• A key part of any Quality Improvement is to listen and learn from others and then see if you can adopt or adapt this for your area or if not discard. The summit saw some great case studies from trusts that had taken a different approach to clinical audit recently which have resulted in improvements so thanks to all who shared.
• For example Deb Kershaw spoke about Stockport NHS Foundation Trust journey of  successfully implementing a management and tracking tool for their clinical audit programme to help provide more ownership and transparency. Vicky Patel shared Sheffield Teaching Hospital NHS Foundation Trust success of linking clinical audit results more closely with risk management and the risk register.
• So lets continue to share successes and apply the QI principles to our clinical audit processes if we want better outcomes from our projects.

8. Development of staff is key

• We (N-QI-CAN) have agreed to set up a training resource library to help signpost colleagues to existing training and identify where there are gaps in resources and look at developing these if required. Only 42% of the respondents to our survey said they had received any certified training in the last year so this is something we need to improve on as a community.

9. Network and make time to share
Finally it was great that so many found the time and finances to attend the summit – however networking doesn’t have to be just at summits or regional meetings anymore – we can do this all year round now with twitter, our forum and other technologies making the world a small place so lets keep up the momentum.

I hope this blog helps share these key messages –  there were lots of tweets during the summit so just search for #clinicalaudit2019 on twitter and see what other messages were shared. Please post your views below or on the forum. I look forward to continuing our work together through our networks to help improve patient care.

Carl Walker

N-QI-CAN chair

* The NQICAN Task & Finish Group I’d like to thank are Denise Thompson, Sarah Chessell, Vicky Patel, Julie Hancock (and myself) and also thanks to Amanda Tracey, from my team in Leicester who designed the survey for us. Thanks to HCUK for co-hosting the summit and providing avoidable rates for our members to attend.