Dr Mark Charny answers some frequently asked questions on clinical audit in general practice
How do you change behaviour through audit?
Q How can you ensure that audit results in improvements in practice?
A Anyone who has been involved in an audit only to find that nothing happens as a result of it shares the frustration underlying this question. Why spend time and effort on an audit when nothing improves?
Although there is no simple answer to the question, there is good evidence for several elements of audit that tend to promote change.
- Feeding back information in a form that is relevant, timely, and personal to the individuals responsible for the care being audited
- Creating a positive learning environment for individuals to consider the results
- Providing a supportive organisational environment for individuals to make any changes that seem appropriate having considered the results. This support may be personal (for example training or counselling) or environmental (for example changing record-keeping and systems)
- Feeding back further information following the initial change to confirm that the position has improved and that the improvement is maintained
- Assigning responsibility to an individual for ensuring that the data are carefully considered at a peer review meeting and that action is taken as a result
- Creating a culture in which everyone takes responsibility for acting on information and deals honestly with problems, such as having too many priorities and too little time.
There is a science to the management of change, and some people are better at leading change than others. However, it is always helpful to ask what would promote change in your own practice, and then apply those insights to the group with which you are working on the audit.
Is outside help needed to review audit results?
Q Can a team peer review audit results without external input?
A This question is based on a correspondent°s experience of peer review in which some more dominant members of the group used the results to defend robustly their own practice and to denigrate others°.
Certainly, peer review cannot take place unless the group is functioning well: members should respect one another, and should have come together to help each other examine and - where necessary - improve their practice rather than to score points.
When a group is not functioning well, it is probably wise to bring in an external facilitator or moderator; but this should be done in the context of helping the group to function better.
Involving an external person to help peer review to succeed when people°s relationships are poor will help - but is rather like treating the symptom instead of the cause.
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