#CAAW blog – Diary of an audit lead day 4

Published: 13 Nov 2015

In the fourth of his Clinical Audit Awareness Week blogs, Michael Spry (Countess of Chester Hospital FT audit lead, Mersey Clinical Audit Network chair and NQICAN member) gives his views on audit by observation

We were lucky enough to have Martin Bromiley visit our Trust today to deliver a masterclass. You may well have heard of Martin, who runs the campaign group Clinical Human Factors Group, which he established after his wife died following an anaesthetic for a routine procedure, to try and make health services safer. Martin is an airline pilot by profession, and as such is used to carrying out a multitude of daily checks and the scrutiny that comes with that industry, to prevent accidents.

In his talk, Martin said the best audits are done by observation. Understandably, clinical staff don’t enjoy being watched, and if you have ever been subject to a hand hygiene audit, or indeed are observed doing anything, it’s a strange experience.

But as he said, it’s about moving away from placing all our faith in the checklist alone. It’s frustrating when you get audits where the results appear good, but the evidence, through incident reporting etc, suggests the issue persists. But either by observing, or getting some qualitative evidence, the picture emerges can seem so much clearer.

An audit we have done for the WHO Safety checks recently recorded a staff member who told the auditor that they now turned off the radio that they had, before every sign in, as a means of getting the quiet and concentration needed to run through the list. That gave us such a perfect snapshot of the thought processes involved with these small changes which help make these perceptible improvements to the theatre environment.

I am aware of the kind of irony here, praising qualitative outcomes of an audit of a checklist! Nothing makes my blood pressure rise more than when audit is cited as nothing more than a ‘tick box’ exercise. We know that its more than that, it’s about helping to make improvements to patients, and to the staff who care for them. We do exist in a world of tick boxes, where Trusts have to evidence what they do and don’t have in place, but good audit should help bring some quality and flesh into this frame.

I’d love to hear your thoughts too: @mspry on Twitter