Engaging clinicians in quality improvement via clinical audit

Introduction

In 2013 the Healthcare Quality Improvement Partnership (HQIP) commissioned Improvement Science London to analyse and report on engaging clinicians in quality improvement through national clinical audit. The full report, alongside HQIP's narrative response to the report and a summary of actions were published in October 2014.

Read the full report

Read HQIP's summary of actions (pdf)

Why HQIP commissioned this report

The National Clinical Audit and Patient Outcome Programme (NCAPOP) is designed to support healthcare provider and commissioning organisations, clinicians and patients to work together to improve patient outcomes across a wide range of conditions. Its purpose is to engage healthcare professionals in the systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care.

However, the potential of national clinical audits has not been realised universally throughout the NHS. We asked Improvement Science London to research some of the reasons behind this.

The main aims of the project were to:

  • Explore what the challenges and solutions are to using national clinical audit to support local quality improvements
  • Make key recommendations that will enable data driven improvements through national clinical audit

Key findings

Research was carried out through contributions from a range of audiences including clinicians and clinical audit staff, and the suppliers and commissioners of national clinical audit. Thirty participants contributed their views through interviews or focus groups. A number of themes arose, including: technical and practical issues, communication and national and local alignment to quality improvement. These are the six key findings:

  • There is a need to clarify the content and purpose of national clinical audits so that local healthcare providers understand their relevance and importance and can use this data to make improvements to services
  • Support with how to analyse and interpret data and present findings to others in user-friendly ways would help people in provider organisations to engage better with audit findings
  • Incentives to drive improvement can act as both barriers and facilitators. Recognition of good practice was seen as a powerful motivator while financial incentives and named consultant data received mixed responses
  • The right resources, knowledge and skills are needed to encourage engagement. Events were useful for learning and sharing best practice. Dedicated time to interpret and act on findings together with clinical audit team input was felt to be important
  • Organisational structures, governance, staffing and culture all had a strong influence on the take up of clinical audit and on whether data was used to encourage improvement
  • More could be done to engage clinical leads with HQIP. Participants would like to see greater involvement of clinicians and input from patients in the design and reporting of audits.

The recommendations from this project encompass all aspects of national audit from commissioning through development to participation and beyond.  They are intended for the four key groups within the national audit community:

  • Commissioners of national audit (NHS England, HQIP)
  • Suppliers of national clinical audit
  • Healthcare provider organisations
  • Front line staff

What HQIP has done already and what we intend to do next

We are already implementing some of the key recommendations. Some of the remaining challenges we can and will address ourselves; many we will work through in partnership with others.

We have captured this current and planned activity and we have published a summary of our action points alongside this report.

HQIP's Quality Improvement and Development (QID) team are reviewing the recommendations aimed at provider organisations and front line staff in order to develop ways that we can further support clinicians and organisations. This will be done through the active promotion of sharing best practice; developing pertinent, role specific guidance; regional workshops; eLearning programmes and the development and support of improvement networks.

HQIP would like to take this opportunity to thank Martin Marshall and Dominique Allwood of Improvement Science London for their invaluable work on this project.