All the news from Clinical Audit and Improvement 2014
In a break with tradition, CASC have decided to dedicate the majority of our March eNewsletter to feeding back on the Clinical Audit and Improvement event held in London from 26-27 February. Hence, the first eight articles relate to the conference with the final two focusing on the work of CASC. As many of you will be aware, the event is organised by Healthcare Conferences UK and has been a regular feature of the clinical audit and quality improvement calendar for over 10 years. As usual, the conference featured a number of high profile keynote speakers and eight interactive masterclass sessions. Sadly, it was noticeable that numbers attending were down significantly on previous years with less than 100 delegates at Hallam Conference Centre over the two days. Indeed, resourcing for local clinical audit was a key theme at the conference.
Prof Black: much better recognition for clinical audit
Professor Nick Black (Chair of the National Advisory Group for Clinical Audit and Enquiries) used his keynote speech at the start of Day 2 to celebrate how far clinical audit has come in the last 5/6 years. Prof Black noted that when he became Chair of NAGCAE many were uncertain of the value and effectiveness of clinical audit. Prof Black stated ‘you couldn’t imagine now a government saying audit is not important or we need to reduce funding’. Prof Black also commended the hard work of those working in local clinical audit and stated ‘the first and most important achievement is the continued improvement in local clinical audit’. Prof Black noted that the national audit programme has been expanded and improved since he took his position at NAGCAE, but also acknowledged that some national clinical audits (NCAs) need to be improved further and that NCA’s need to extend into areas such as maternity, arthritis, primary and social care in future. He re-iterated his personal view that Trusts should employ a Chief Quality Officer at board-level to make sure quality of care maintains a high profile within healthcare organisations and his final message was ‘we have achieved a lot in the last six years’.
CASC survey results help focus minds
At the end of Day 1, the CASC Directors delivered a short presentation feeding back to conference the results of their 2013 survey. An overview of the report can be found by clicking here. The presentation noted that there has been a slight improvement in terms of the perceived value of NCA's and 40% stated they felt 'more positive' about clinical audit than a year ago (previously 38% in the 2012 survey). However, some ongoing challenges and concerns continue, for example: for the fourth consecutive year less than 20% of respondents stated they had more resources for audit than 12 months previously, local audits were once again seen as the most effective audits for improving patient care and for the second year running just 6% rated patient involvement in clinical audit as ‘good’. Professor Danny Keenan (HQIP Medical Director and pictured) referenced the presentation a number of times during his keynote talk on day 2 stating ‘we must start to address the local/national issues raised by the CASC survey’. Prof Keenan also noted that while many NCA’s are internationally acclaimed there is further work needed to improve them. He also noted that HQIP have created a new assessment framework for NCA’s that is available via the HQIP website.
Key points from NHS England Clinical Audit Lead
Richard Arnold delivered the first keynote presentation of the event and described clinical audit as a ‘pivotal lever’ to help improve healthcare (from the perspective of NHS England). He noted that local and national audits play a crucial role in helping to measure quality and stated that there are plans to expand the NCA programme into primary care. His talk also focused on his personal review of Quality Accounts and Richard made it clear that the length of quality accounts is not the decisive factor in determining their value (i.e. shorter documents are often more valuable than those exceeding 100 pages). Richard noted that prioritisation criteria exist for the NCAPOP and that audits are selected in relation to: alignment with wider NHS England priorities, impact/value for money, need and appetite (in terms of professional and patient support). In response to a question after his talk, Mr. Arnold stated that he was not aware of reasons why the annual spend on individual NCA’s could not be made public but he would clarify this in case there was a commercial sensitivity.
Local speakers deliver vital messages
A striking theme from this year’s conference was the number of powerful messages from speakers working at the sharp-end of practice. Mr. Cormac Kelly (Orthopadaedic Surgeon) delivered a frank and honest overview of clinical audit at a local level noting that many junior doctors still see audit as a chore, NCA’s are creating an increased workload, highlighting disillusionment of some clinical audit staff and questioning if clinical audit had been truly re-invigorated since 2008. Mr. Kelly also provided suggestions on how improvements could be made, including: better education, fewer audits of high quality, better sharing of good quality audit projects, etc. Dr Martin Farrier (Consultant Paediatrician) described the locally-driven innovative quality improvement work carried across his Trust in Wigan and showcased a number of small simple projects that had dramatically improved patient care. He advocated that a small number of enthusiasts trained in key QI skills can have a significant impact and explained how his Trust had looked inwardly to assess care and generate appropriate solutions. To view Dr. Farrier’s presentation, click here.
Sir Mike gives the CQC perspective
Sir Mike Richards (Chief Inspector of Hospitals) explained the work of the Care Quality Commission in detail and described the format for announced and unannounced visits to hospitals. He explained that the role of the CQC is to ‘encourage organisations to improve, but not to implement the improvements’. Sir Mike noted that he is 'a great believer in the value of clinical audit' and he stated he is keen to hear from those working in the field in terms of the key indicators from NCA's they feel the CQC should most focus their attention on in terms of evaluating patient care. Sir Mike raised concerns that some Trusts are unable to find their NCA results when undergoing a CQC visit and he also suggested that his preference is for clinical audit data that can be compared across a number of healthcare providers. If you have any suggestions that you would like to make to Sir Mike you can contact him directly via this link.
Around the conference: in other news
The CASC team were unable to attend all of the sessions over the two day event, but among our highlights were: Mandy Smith’s insightful overview of the Francis, Berwick and Keogh reports, plus updates on HQIP’s forthcoming plans, e.g. upgrades to their website and the criteria and indicators for best practice in clinical audit document. We heard positive feedback from those who attended Nancy Dixon’s Action Planning workshop and Kate Hill’s Legal Masterclass. Day two’s workshop on expanding clinical audit into social care had few attendees but the case studies presented were very useful. Berkshire Healthcare also explained how they have improved communicating the results of serious incidents and showcased simple screen-savers that help staff focus on patient safety matters.
Want to have your say?
Whether you attended the event or not, CASC have created a thread on the Clinical Audit Tools website discussion board to encourage debate. A recurring theme across the conference was that those involved in clinical audit and QI face a wide range of inter-related barriers and challenges and that wider discussion is needed to generate shared ideas and solutions. Many of those working in the sector have limited resources available to them and therefore online discussion boards could be used to debate key issues and share materials. To take part in the debate, click here.
Book now for CASC accredited training
A recurring theme at this year’s annual conference is that to do clinical audit and quality improvement projects effectively, staff need appropriate training. Since 2006 CASC have offered a wide range of accredited courses and you can find out more by clicking here. Many clinicians and governance professionals have studied for either our one-day Advanced Clinical Audit course or our distance learning course. We also offer training in Significant Event Audit and Root Cause Analysis plus a one-day leadership course. CASC are also working on developing a wider QI qualification for those working as quality improvement facilitators and we hope to have further details available very soon. Please contact the team for more details.
Request your CASC information pack
CASC have developed a series of promotional materials that provides you with more details of the work that we support. The wallet of information includes a set of inserts: Introducing CASC, training and accreditation, support and consultancy, sharing best practice, event management and CASC case studies. The materials provide a great overview of how we work with healthcare professionals to improve the care that they deliver and there are a number of excellent case studies that show how our work has enabled organisations and teams to collaborate with us on ventures that have improved care, assured best practice and saved money. If you would like to receive your copy please email us via firstname.lastname@example.org
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