All the news from Clinical Audit and Improvement 2015
From 3-4 March 2015, the CASC team attended Healthcare Conference UK’s annual clinical audit and improvement conference in London. The event is well established and is probably only rivaled by the HQIP annual conference in terms of enabling delegates to access national speakers and experts working in the field of clinical audit and improvement. Given the importance of the conference CASC have decided to dedicate our entire electronic newsletter for March to feeding back valuable information from the event. We hope you find the updates useful and ‘normal service’ will be resumed with the CASC April newsletter looking at a range of topics.
Prof Black: ‘the future of clinical audit is bright’
Prof Nick Black (Chairman of NAGCAE) chaired Day 2 of the event and provided similar messages to those he has given in previous years: for example: people at the ‘top’ in the NHS now understand what clinical audit is and value it, national audits must continue to improve with a particular need to make NCAs more valuable at a local level and ‘I think the future of clinical audit is bright’. Prof Black also re-iterated his personal viewpoint that all Trusts should have a board-level Chief Quality Officer and asked ‘what would the public think if they knew few Trusts had non-executive directors with experience of managing quality’? Nick also queried the impact of the National Quality Board stating ‘I’m not quite sure what the NCB have contributed’. He also identified that the make-up of NAGCAE is changing with 3 new members for statistics, lay representation and NHS management recently recruited. We also understand that after two back-to-back four-year tenures as NAGCAE chair Nick will step-down from his role later in 2015.
Prof Keenan outlines the challenges ahead
Over the course of the conference, Professor Keenan (HQIP Medical Director) delivered a number of excellent and honest keynote talks. Highlights included his overview of the recent HQIP ‘Audit of audits’ that has enabled NCA suppliers to self-assess their products. Danny noted that this initiative has identified many themes including ‘patchy patient involvement in NCAs’, ‘only 10% of NCAs relevant to primary care’, etc. He stressed that HQIP are working hard to improve the quality of NCAs and one major change for NCAs in future will be shorter reports that focus on headline messages for local stakeholders. Aside from national audits, Danny stated that HQIP ‘want Trust boards to have a defined clinical audit committee’ and he noted that the HQIP website is being updated and will offer better search functions later this year. Finally, Danny stated that local audit professionals have a vital role to play in terms of helping HQIP: (a) suggesting feedback and ideas to improve national audits and (b) suggesting ideas in terms of how HQIP can help local clinical audit professionals.
NHS England keynote sparks a lively debate!
On Day 1 of the conference, Cathy Hassell delivered the keynote presentation from NHS England. Cathy stated that national audits represent a significant investment of public funds circa. £15 million per year and she affirmed that clinical audit is a powerful QI tool that gives many stakeholders the opportunity to review and assess services. Cathy mapped out NHS England’s future plans and these include: exploring the opportunities to extend NCAs into primary care and the broadening of the consultant and unit-level outcomes programme. The presentation sparked a valuable debate with delegates raising questions in relation to: current NCAs not meeting requirements of community Trusts, local clinical audit champions requiring more support, nurses needing to be better engaged in national audits and the observation that although Sir Liam Donaldson requested the broadening of NCAs via his White Papers in 2006/7, the vast majority of current national audits continue to focus on hospital care with settings such as social care not engaged in national audits.
Key messages in relation to the CQC
Sadly the CQC did not provide an employed representative to address the conference, but instead the audience heard from Dr. Linda Patterson (who has chaired three CQC inspections) and Peter Hinstridge (ST7 from Barking, Havering and Redbridge University Hospitals). Arguably the key message from the two talks was that the CQC are looking at national clinical audit data via their intelligent monitoring system that ‘assesses three levels of risk to quantify care offered by the provider and prioritise inspection’. Dr. Patterson also stated that the CQC look for evidence of local and national audits and she pointed out that CQC inspectors could ask staff for their feedback on how findings of NCAs have been reported and subsequent actions implemented.
Top 5 things CASC learned from the event
As part of the event the CASC team delivered two masterclass sessions, listened to talks and networked with delegates. Our main observations were as follows: 1. Numbers at the event compared to previous years were down with virtually no primary care or social care delegates, 2. While clinical audit remains the main focus of the event it is clear that audit is being increasingly aligned with other techniques, e.g. PDSA, run charts, LEAN etc., 3. The number of national audits will continue to expand in coming years, but it is not clear if local clinical audit has been truly re-invigorated, 4. Great local clinical audit and improvement work is being carried out but sharing could be much better and 5. A huge amount of work is going on behind the scenes to improve the quality of national clinical audits.
Join the new clinical audit twitter list
One of the noticeable differences about this year’s conference was that many more delegates than ever before were tweeting their thoughts on the event. Indeed, if you are familiar with Twitter and wish to see relevant tweets then please search using #clinicalaudit2015. In addition, the CASC team would like to thank Sam McIntyre (formerly of HQIP and now working with the College of Emergency Medicine) who has set up a clinical audit twitter list. This is a quick and simple way of linking to those in clinical audit and improvement who use twitter. To find out more, click here. There are already over 40 twitter members on the list so please join if you are on twitter.
Useful resources highlighted via the conference
As usual delegates at the conference were made aware of lots of useful resources to look at in their own time. These included: the new Good Governance Handbook, Clinical Audit guide and matrices, available here, the Royal College of Physicians ‘learning to make a difference’ work aimed at empowering junior doctors to learn about quality improvement, available here, the Institute for Healthcare Improvement’s Open School which features a wide range of materials relating to quality improvements (e.g. run charts, forcefield analysis, pareto analysis, etc.) available here and if you would like to access the presentations from the conference via Healthcare Conferences UK website, please click here.
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