Case study (Innovation): Using Audit Data and Quality Improvement to Transform End of Life Care Across a Hospital
25 Aug 2026
Excellence in Clinical Audit Awards, part of Clinical Audit Awareness Week 2026, Innovation category runner-up
End of Life Care (EOLC) Champions: Using Audit Data and Quality Improvement to Transform End of Life Care Across a Hospital
This innovative project was designed to address limited specialist capacity using audit results. With multiple interventions and a monthly dashboard to track progress and sustain improvement, it used co-produced stories to explain why care mattered, helping to shift learning from passive compliance to reflective practice. The result was measurable improvements in EOLC and staff confidence and increased positive feedback from bereaved families.
Discover much more about the impact of this work in the case study below:
The programme was led by the by the EOLC Facilitator at Whipps Cross Hospital, Barts Health NHS Trust, in partnership with the Quality matron, the multidisciplinary EOLC champions and psychologists supporting communication simulation. Most importantly, patients and bereaved relatives were central to the programme, with their experiences shaping the improvement work.
Building on an established EOLC Champion Network created in 2019, the Trust launched a data-driven quality improvement programme in 2024. Using ward-level audit data, National Audit of Care at the End of Life (NACEL) findings and bereaved relatives’ feedback, champions were supported to lead evidence-based improvements across every adult ward.
Who is the project designed to support?
The project was designed to support adult inpatients approaching the end of life, their families and carers, and the Multidisciplinary Teams (MDTs) providing their care across all adult wards.
Why was the project needed?
The Trust recognised that providing consistently high-quality EOLC was increasingly challenging. The patient population was predominantly older adults from a highly diverse community, with a significant proportion of patients from ethnic minority backgrounds. Unlike many organisations, the hospital does not have a local hospice and has only one EOLC facilitator supporting all adult inpatient wards. A different model was required to build sustainable improvement across the organisation.
Findings were used from the NACEL audit, local ward audits and feedback from bereaved relatives to understand where improvements were needed. Although compassionate care was evident, the data identified opportunities to strengthen holistic assessment, pain assessment, nutrition and hydration documentation, communication, advance care planning and staff confidence when having difficult conversations.
Rather than relying solely on specialist teams, the Trust decided to develop improvement capability within frontline clinical teams.
What did it set out to achieve?
The programme aimed to:
- Improve the quality and consistency of EOLC across every adult ward
- Increase staff confidence and capability in delivering compassionate, person-centred care
- Use clinical audit data to drive continuous quality improvement.
- Improve documentation of holistic assessment, symptom management and advance care planning
- Ensure patients’ wishes were recognised, documented and communicated effectively
- Create a sustainable improvement model that could be delivered despite limited specialist resources.
How was the project implemented?
Every adult ward identified an EOLC champion who became the local improvement lead for their clinical area.
More than 40 nurses, healthcare assistants and allied health professionals completed a bespoke two-part First Steps in Quality Improvement Programme. Champions then applied these methods within their own wards, designing small tests of change based on their own audit findings.
To support this work, ward-specific dashboards were developed using audit data. These dashboards displayed run charts for key measures including:
- Advance Care Planning (ACP)
- Pain assessment
- Holistic needs assessment
- Nutrition assessment
- Hydration assessment.
“The dashboards showed us where we needed to improve, but the patient and family stories reminded us why the work mattered. Together they changed the way we think about end-of-life care.” EOLC Champion, Whipps Cross Hospital
Instead of receiving static reports, teams could monitor progress in near real-time, identify variation between wards and rapidly test improvements.
Regular ward huddles, safety briefings, six-monthly champion forums and quality improvement support sessions enabled successful ideas to spread quickly across the organisation.
A major innovation was combining traditional clinical audit data with what the team called ‘human data’. Alongside quantitative audit findings, bereaved relatives’ experiences were transformed into powerful co-produced stories that became central to education sessions, Grand Rounds, Board presentations and communication workshops. This helped staff understand not only where care could improve but also why improvement mattered.
The programme moved learning away from compliance with documentation towards reflective practice and compassionate care.
Recognising that difficult conversations remain one of the greatest challenges in EOLC, the team also introduced two simulation programmes:
- Breaking Bad News
- Picking Up the Pieces
These multidisciplinary simulation sessions allowed staff to practice realistic conversations within a psychologically safe environment while developing confidence, communication skills and emotional resilience. They were also co-delivered with a palliative care psychologist, providing staff with practical strategies for managing emotionally complex situations.
Did the project succeed and, if so, what is the evidence?
The programme demonstrated measurable improvements across multiple aspects of EOLC, including early results showing sustained improvement in:
- Pain assessment
- Nutrition and hydration assessment
- Advance care planning discussions
- Documentation of holistic needs
- Staff confidence when communicating with patients and families.
Ward dashboards have made improvement visible to frontline teams, encouraging ownership, accountability and friendly competition between wards.
Bereaved relatives’ feedback also demonstrates improvements in communication, compassion and the overall experience of care.
Importantly, the programme has created a culture where staff actively seek opportunities to improve care rather than viewing audits as a retrospective exercise.
Other insights
Ongoing sustainability has been built into the programme from the outset and is supported through:
- Monthly ward dashboards
- Regular documentation audits
- Champion forums every six months
- Quality coaching
- Repeatable champion training
- Succession planning for future champions.
This ensures improvement continues beyond the life of the original project.
Learning points
One of the greatest lessons from this programme has been that data alone rarely changes behaviour.
Combining robust clinical audits with patient stories, quality improvement methods, and empowered frontline staff created a culture where improvement became everyone’s responsibility.
The champion model has demonstrated that meaningful organisational change can be achieved at scale, even where specialist resources are limited.
