Transcript Clinical audit in Trusts: the need for a new vision

Clinical audit in Trusts:
a new vision
Nick Black
Chair
National Advisory Group for Clinical Audit & Enquiries
Healthcare Conferences UK
London
13 February 2013
Outline
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NAGCAE’s enquiry: why and how?
Concerns of audit staff in Trusts
Underlying problems
A new vision for audit staff in Trusts
Proposal apropos Francis Inquiry report
NAGCAE’s enquiry: why and how?
• Surveys by CASC and HQIP
• Identified as NAGCAE priority (May 2011)
• Roundtable discussion (April 2012)
– Local audit staff, national audit staff, medical
directors, clinical audit support organisations
• Consultation on draft report (July-Sept 2012)
– 66 responses (54 from audit staff in Trusts)
– considered by NAGCAE (Dec 2012)
• Recommendations to NHS CB (March 2013)
NAGCAE’s concern and interest
• Focus is the role and function of audit staff in
Trusts and not the ability and achievements of
existing staff.
• We share the positive views of many Trust
CEOs as to the calibre and contribution of
staff.
• Our aim is to help facilitate and support that
contribution in the future.
Consultation response
• Widespread support (70-80% of respondents) for
most views and recommendations
– Others reported that nothing new being
suggested...already organised and operating in ways
suggested.
• Some thought NAGCAE aiming to establish ‘rules’
– we are purely advisory; aim is to stimulate innovation
– we recognise that Trusts vary and specific
arrangements will vary; aim to provide a ‘vision’ which
we think will strengthen clinical audit and audit staff
roles in Trusts
Concerns of audit staff in Trusts
- don’t all apply in every Trust
• Too many demands from numerous sources with a lack of clarity as
to which are mandatory and how to determine priorities
• External requirements over-ride local priorities
• Priorities focus on financial needs of Trusts (CQUIN, QUIP)
• Insufficient resources and skills (reduction on consultants’ PAs)
• Insufficient support from management, senior executives and Trust
Boards
• Insufficient support on how to use national audit output
• Value of some (many) audits questioned (both national and local)
• Insufficient ownership and engagement by clinicians
• Diverted to undertake other activities
Conclusion: Unsatisfactory and unsustainable (74% agreed)
Features of vision for audit staff in Trusts
• Explicit definition and recognition of the two key
components of achieving quality (78%)
– quality assessment; quality improvement
• Greater recognition of multiple approaches to quality
improvement (70%)
– service redesign; education; incentives; regulation
• Greater integration (80%)
– data collection; clinicians, managers and audit staff;
organisational structure; funding
• Support to enhance roles and responsibilities of audit staff
(92%)
– will require support, training and guidance
• Sharing experiences: learning from the best (86%)
– new opportunities with regional organisations (eg AHSNs)
Proposal: five components
• Recognition and acceptance of some fundamental
issues (86%)
– advantage of distinguishing the two key aspects of
achieving high quality services: quality assessment and
quality improvement
– complementary benefits of and need for both local and
national clinical audits
– quality is the collective responsibility of clinicians,
managers and audit staff
– clinicians and managers are responsible for assessing
and improving the quality of the clinical service they
run
• Development of Quality Departments (or
Facilities) in Trusts (70%)
– audit staff , clinicians and managers (full-time or
part-time; permanent or temporary)
– good leadership (based on ability not occupation)
– direct access to the Trust Board via an executive
director
– provide specialist advice, facilitate activities and
guide quality assessment and improvement
• Training opportunities for audit staff (AND
clinicians and managers) (98%)
– Technical skills in quality assessment and
improvement (improvement science)
– Understanding of national and local policies
affecting quality agenda
– Behavioural skills in quality improvement
(including leadership, change management,
facilitation)
• Establishment of multi-Trust initiatives (91%)
– create and contribute to ‘regional’ and national
activities
– active in emerging regional organisations
• Improvement in service from NCA suppliers
(100%)
– improve feedback to Trusts on quality (based on
rigorous data)
– stimulate quality improvement (eg regional
events, websites, webinars etc)
Francis Inquiry Report (February 2013)
Health & Safety
Executive
Deanery/University
Local community
Trust Board
HCC/CQC
DH
GMC/NMC
Clinical audit?
GPs
PCTs/CCGs
Health Protection
Agency
RCN
NPSA
Monitor
SHAs
Many issues identified but key one...
• Need to bring together assessment of different
dimensions of quality
– Safety
• Patient incident reporting (NRLS)
• Health care associated infections
– Experience (humanity)
• Patient experience surveys
• Waiting times
– Effectiveness
• Outcomes (morbidity, disability QoL)
• Processes (adherence to guidelines)
Many issues identified but key one...
• Need to bring together assessment of different
dimensions of quality
– Safety
• Patient incident reporting (NRLS)
• Health care associated infections
– Experience (humanity)
• Patient experience surveys
• Waiting times
– Effectiveness
• Outcomes (morbidity, disability QoL)
• Processes (adherence to guidelines)
Clinical audit
Key recommendations
• Information on performance and outcomes
– must be made available to patients for treatment choice,
understanding of outcomes (1.219), & to compare relative
performance (1.220)
• All providers should publish performance on
consultants & specialist teams
– Mortality, morbidity, outcome, satisfaction (1.222)
– Professional duty to collaborate (1.223)
• Designated Board member as Chief Information Officer
(1.225)
• Quality Accounts
– to show compliance with standards (1.226) & comparisons
between organisations of outcomes (1.227)
– signed by all Board directors
• Wilful or reckless falsehood a criminal offence (1.228)
The vision
Wonderful opportunities for audit staff in Trusts
to contribute to the transformations in clinical
services and pathways
Clinical audit staff are an essential part of
wider quality management
Quality management cannot be achieved
without audit staff