Healthcare Auditing - A Waste Of Time?

September 4, 2023

A recent "Huddle" as part of The Care Connector Network discussed the topic of auditing in healthcare and whether it was a waste of time or not. The topic was met with some great debate and examples of the good and the bad on both sides of the fence. Here are my thoughts on the matter.

Introduction

Clinical audits are a fundamental component of modern healthcare systems, aimed at improving patient care and safety by assessing and enhancing clinical practices. While clinical audits have played a crucial role in healthcare quality improvement, they are not without their shortcomings. In this blog, we will focus on four key shortcomings in clinical audits, shedding light on areas that require attention and improvement.

1 - The Process Is Broken

Most organisations now have a sweet of audit tools that they complete over time. The process for completing these audits is different from organisation to organisation. Those who rely on paper or spreadsheet-based audit processes often struggle to learn from and close out on important issues found in their audits.

Why is this? Well, a common reason is the people administrating the audit processes often spend 95% of their time chasing colleagues for information before having to sit down and try and create "colourful" reports for their senior leadership teams. By the time they have the reports collated, the next audit cycle has begun and they find themselves back in the "chasing" phase.

The problem with this is the admin or quality teams are not getting to the root of the issues found in their audits, not having the time to learn what has gone wrong, and more importantly create and close out on corrective actions to fix the issues so they can improve over time.

We have seen the best audit processes are those that have automated the collection and collation phase, allowing them to spend more time focusing on audit findings and actions, closing them out, learning from them, and improving as they go.

2 - Lack of Standarisation

Clinical audits often lack standardisation in terms of audit criteria, methodologies, and reporting formats. This lack of uniformity can make it challenging to compare audit results across different institutions or even within the same organisation over time.

To overcome this shortcoming, there is a need for the development and implementation of standardised audit protocols and reporting frameworks. Such standards can enable better benchmarking and facilitate the sharing of successful strategies for quality improvement.

Healthcare accreditation bodies and professional organisations can play a pivotal role in promoting standardisation within the industry. One example is the Irish Mental Health Commission who recently launched a digital self-assessment tool, free of charge, so regulated entities can easily complete standarised self-assessments and improve over time prior to being inspected.

3 - Limited Scope and Focus

One of the most significant shortcomings of clinical audits is their often limited scope and focus. Audits tend to concentrate on specific clinical processes or outcomes, which can lead to a narrow perspective on healthcare quality. For instance, an audit might assess compliance with antibiotic prescribing guidelines for a particular condition, but it may overlook broader aspects of patient care, such as communication, patient experience, or the holistic impact of treatment choices.

To address this issue, healthcare organisations should consider incorporating a more comprehensive approach to clinical audits. This could involve evaluating the entire patient journey, including pre-admission processes, inpatient care, and post-discharge follow-up. The CQC's new Single Assessment Framework is one example of a regulator that will be focusing on the patient's experience and feedback as part of the regulatory approach.

4 - Limited Stakeholder Engagement

Effective clinical audits require the active participation and engagement of all stakeholders, including clinicians, nurses, administrators, and patients. However, in many cases, the involvement of these key actors is limited. Clinicians may view audits as an administrative burden, and patients may not be aware of their rights or opportunities to provide feedback.

To address this issue, healthcare institutions should prioritise stakeholder engagement and training throughout the audit process. This can include involving clinicians in audit planning and implementation, encouraging patient feedback, and fostering a culture of continuous improvement. When all stakeholders are engaged, clinical audits can become a collaborative effort aimed at delivering patient-centered care.

Conclusion

Clinical audits are invaluable tools (and not a waste of time) for improving healthcare quality, but they are not without their shortcomings. These shortcomings described above must be addressed to maximise the impact of clinical audits on patient care and safety. By recognising and actively working to mitigate these challenges, healthcare organisations can enhance the effectiveness and relevance of clinical audits in the pursuit of continuous quality improvement.