Presentation on theme: "Dr Dominique Allwood Public Health Registrar"— Presentation transcript:
1 Engaging Clinicians in Quality Improvement using National Clinical Audit Dr Dominique AllwoodPublic Health RegistrarImprovement Science FellowE:Tw: DrDominiqueAllw
2 The Project Background Despite being well organised and reasonably well funded, large scale audits are undervalued as a potential resource to support improvementThe Francis Inquiry report highlighted the need for trusts to focus more on qualityHQIP commissioned ISL to undertake a project to understand moreAimProject aimed to better understand the barriers and facilitators in using NCA to support local quality improvementMethodThirty participants contributed their views through interviews or focus groups conducted in 2013
4 Themes 1. Technical and Practical Issues Analysis Interpretation PresentationRecoursesKnowledgeSkills2. CommunicationContent and purposeEngagement3. National and local alignment to quality improvementMotivations and incentivesStructures, systems, staffing and culture
5 Key Findings (1)There is a need to clarify the content and purpose of some national clinical audits so that local healthcare providers understand the relevance and importance of audit and can use this data to make improvements to servicesSupport with how to analyse and interpret data and present findings to others in user-friendly ways would help people to engage better with audit findingsIncentives to drive improvement could act as both barriers and facilitators. Recognition of good practice was seen as a powerful motivator while financial incentives received a mixed response
6 Key Findings (2)The right resources, knowledge and skills are needed to encourage engagement with clinical audit. Face to face events were seen as one of the best tools for building understanding and sharing best practiceOrganisational structures, governance, staffing and culture all had a strong influence on the take up of clinical audit and on whether data was used to encourage improvementMore could be done to engage clinical leads with HQIP. Participants would like to see greater involvement of clinicians and input from patients in the design and reporting of clinical audits
7 1. Technical and practical issues AnalysisMethodologyComparisons – case mix, adjustmentUncertaintyData vs. informationPresentationTimelinessInteractivity/ IT systemsCustomisationInterpretationKnowledge and skillsEducation, training and abilityInterpretation of dataPresentational skillsChangeAccess to skillsInterpretative and analyticalEngagementTimeDuplicationPrioritisationData collectionParticipate in learningEventsConferenceWorkshopsPeer groups/ networksSharing best practiceGuidance and toolsHQIPProfessional bodies and audit suppliers
8 2. Communication Content and Purpose Communication and reporting Data collection vs. auditAudit vs. improvement & Improvement vs. judgementEvidence-based standards vs. aspirational targetsRelevanceMechanism for improvementCommunication and reportingBetween clinical audit leads and clinical teamsBetween clinical audit leads and local audit teamBetween suppliers and trustsExternal reportingEngagement and DialogueBetween HQIP and local audit teamsBetween HQIP and clinical leadsBetween HQIP and suppliersInterpretation
9 3. National and local alignment to quality improvement Incentives and motivationsRecognition, competition, clinical excellence awardsRegulatory – appraisal/ revalidation, Quality AccountsFinancial – BPT, resource allocationPublic disclosureAudienceOwnershipAwarenessNational Clinical AuditHQIPOrganisationStaffing of clinical audit teamsBuy-in from Boards and Medical DirectorsCulture and organisationsLeadership
10 StagesUnderstanding why there is a need to changeEngagement with content, relevance and relationship to recognised standardsUnderstanding what to changeTechnical elements of analysis, presentation and interpretationUnderstanding how to changePrioritising, action planning and learning from others, implementation
11 Discussion – variation in views Some areas focused on more heavilyMixed views in many areasWhether factors were barriers or facilitatorsPerspectives on mechanisms that drive improvementProcesses and practices of individual, organisationsFocus, timeliness, output, content and presentation of audit and support providedHow much suppliers should be responsible for vs local clinician ownershipPresentation, interpretation and summarisingHighlighting areas for improvement
12 Recommendations Commissioners of audit (HQIP) Suppliers of audit Both commissioners and suppliers of auditProvider organisationsIndividual clinicians and audit teams
13 Recommendations (1)Commissioners of national clinical audit: HQIP and NHS EnglandConsider developing a strategy that places national clinical audits in the context of a vision for improvementConsider a balance of data on clinical effectiveness, patient experience and safety when commissioning auditsFurther work could be undertaken to evaluate the effectiveness of specific mechanisms and drivers for improvementSuppliers of national clinical auditAudits should include clear objectives about quality improvement, explanation of the purpose of data itemsLinking to evidence-based standards and differentiating non-evidence-based targets from descriptive dataConsider ways to provide real-time feedback to support continuous improvementCustomisable outputs that can be manipulated for local analysis.Involvement of clinicians and patients in design and reporting
14 Recommendations (2)Both commissioners and suppliers of national clinical audit:Consider a dual approach to interpreting data focusing on:ensuring data is analysed and presented in a way that is meaningful with adjustment to allow valid comparisonssupporting the user population to gain the relevant skill sets to interpret the dataExplore streamlining data collection methods and alignment with informatics developmentsResources and opportunities for clinicians to discuss findings, share best practice, and compare performanceStrengthen communication strategies to improve engagement and recognitiondialogue with clinical leads, medical directors and clinical commissioners as well as the mediaHighlighting and celebrating improvements and providing support to manage local and national media.
15 Recommendations (3) Provider organisations: Support clinical audit teams and clinicians to undertake national clinical audit and focus on ensuring adequate skills and resources (skills in collection, interpretation, analysis and presentation of data, quality improvement, change management, and clinical leadership)Trusts should ensure appropriate processes are in place use national clinical audit proactively in improvement and share best practice for management of national clinical audit processes and ensure this is integrated within the quality agenda of the organisation.
16 Recommendations (4) Front-line staff: clinicians and audit teams Greater ownership of and engagement with national clinical audits may be fostered by increasing understanding of local and national approaches to improving quality and the role of audit in the broader development of knowledge and skills for measurement and improvement of quality from undergraduate training onwards.Clinicians should explore available resources to support them in using national clinical audit for improvement and utilise forums to learn from and share good practiceStrengthen relationships between the medical director, clinical audit teams, and clinical leads and managers