An information based approach to clinical audit in the UK National Health Service

Abstract

The UK National Health Service (NI-IS) has undergone massive reform over the last ten years. Many of the changes have been connected with the introduction of business and management concepts into a public service. Part of this process has been the introduction of the principles of quality improvement through the process of Clinical Audit.
This thesis proposes that the practice of Clinical Audit is often not resulting in an improvement in the quality of patient care. It suggests that this is due to many audit projects not completing the audit cycle. This failure to complete the audit cycle is attributed to the lack of completeness in many audit approaches and to human failure to actually carry out recommended changes in practice unless there is a mechanism to check that such changes occur. In an effort to address these issues, a conceptual model for a structured method has been evaluated and tested on both historical and live audit projects. The method has been developed into a full audit approach (Clinical Audit Structured Method; CASM) encompassing all four stages of Deming's Process Improvement Cycle. However, some deficiencies have been identified with this method and it has been proposed that a computerised toolset (Clinical Audit Structured Toolset; CAST) be developed in order to address these issues. A conceptual model of such a toolset has been suggested and possible barriers to its development have been identified.
In conclusion, an information based method has been developed for clinical audit in the NHS and the rationale behind its conception has been discussed and supported. The method itself has been tested and the author has supported the supposition that by improving the information management aspects of audit practice, audit practice could be improved thus resulting in an improvement in patient care.