PROGRAMMEPROGRAMME

Audits for the PGA in Professional SkillsAudits for the PGA in Professional SkillsThursday 26 August, CSB UHCWThursday 26 August, CSB UHCW

2.30 – 3.15pm2.30 – 3.15pm PGA and Audit PGA and Audit Dr Paul O’HareDr Paul O’Hare

3.15 – 3.30 pm3.15 – 3.30 pm BreakBreak3.30 – 4.30pm3.30 – 4.30pm Workshops to review previous audits andWorkshops to review previous audits and

reflective diariesreflective diariesDr Paul O’HareDr Paul O’HareDr David Bennett-Dr David Bennett- JonesJones

4.30 – 5.00pm4.30 – 5.00pm Discussion of auditDiscussion of auditQuestions and ideasQuestions and ideas Dr Paul O’Hare Dr Paul O’HareDr David Bennett-Dr David Bennett- JonesJones

POSTGRADUATE AWARD IN POSTGRADUATE AWARD IN PROFESSIONAL SKILLSPROFESSIONAL SKILLS

A stand alone qualification or 1 module (20 CATS) A stand alone qualification or 1 module (20 CATS) towards towards

Masters (MSc) in Health SciencesMasters (MSc) in Health Sciences

Can use MRCP, FRCS, etc., as 2 modules (40) for Can use MRCP, FRCS, etc., as 2 modules (40) for Masters in Health SciencesMasters in Health Sciences

Designed around curriculum for generic and acute Designed around curriculum for generic and acute skills of Foundation Year 2.skills of Foundation Year 2.

Course attendance and involvement recorded in Course attendance and involvement recorded in reflective diary/personal development plan (1,000 reflective diary/personal development plan (1,000 words)words)

Assessment – PGA Professional SkillsAssessment – PGA Professional Skills

Communication Skills (40%) (exam)Communication Skills (40%) (exam)

Audit – written assignment (40%) (2,000 – 3,000 words)Audit – written assignment (40%) (2,000 – 3,000 words)

Reflective Diary/PDP (20%) (1,000 words)Reflective Diary/PDP (20%) (1,000 words)

Deadlines for assessmentsDeadlines for assessments

Audit – Wednesday, 25 May 2011Audit – Wednesday, 25 May 2011

Reflective diary – Wednesday, 27 July 2011Reflective diary – Wednesday, 27 July 2011

Audit -Audit -

F2 curriculum “. Has been actively involved in F2 curriculum “. Has been actively involved in undertaking a clinical audit, and recognises how it undertaking a clinical audit, and recognises how it relates to the improvement of clinical standards relates to the improvement of clinical standards and addresses the clinical governance agenda”.and addresses the clinical governance agenda”.

Assessment of AuditAssessment of Audit

1.1. Plan and carry out. Keep simple in area Plan and carry out. Keep simple in area interestedinterestedManageableManageable

2.2. Write up – 2,000 – 3,000 wordsWrite up – 2,000 – 3,000 wordsStructuredStructured

3.3. Follow criteria in writing up audit assignmentFollow criteria in writing up audit assignment4.4. Meet deadline – May 26 2010Meet deadline – May 26 2010

Present as soon as completePresent as soon as completeNeed written agreement before if lateNeed written agreement before if late

Assessment of Audit (1)Assessment of Audit (1)

1.1. Justify relevance and rationale of audit, clearly stating the Justify relevance and rationale of audit, clearly stating the reasons with reference to current clinical practice and reasons with reference to current clinical practice and literatureliterature

2.2. Clearly state objectivesClearly state objectives3.3. Show evidence of teamwork in preparation, planning and Show evidence of teamwork in preparation, planning and

carrying out audit and in discussion and presentation of carrying out audit and in discussion and presentation of findingsfindings

4.4. Justify your standards by clearly linking them to references Justify your standards by clearly linking them to references in the scientific literature or to agreed written policies. Use in the scientific literature or to agreed written policies. Use clear, explicit, measurable quality criteria.clear, explicit, measurable quality criteria.

Assessment of Audit (2)Assessment of Audit (2)

5.5. Use clear methods, data collection and correct sampling Use clear methods, data collection and correct sampling strategiesstrategies

6.6. Explain clearly and fully what you have learnt in Explain clearly and fully what you have learnt in completing the auditcompleting the audit

7.7. Conclusions – include thoughtful logical conclusions that Conclusions – include thoughtful logical conclusions that demonstrate reflections on what you have learnt from the demonstrate reflections on what you have learnt from the auditaudit

8.8. References – all material should be properly referenced References – all material should be properly referenced using Vancouver system (BMJ) (preferred) or Harvard using Vancouver system (BMJ) (preferred) or Harvard formatsformats

Reflection on experienceReflection on experience(NHS Foundation Learning Portfolio)(NHS Foundation Learning Portfolio)1.1. Describe interesting, difficult or uncomfortable Describe interesting, difficult or uncomfortable

experiences. Try to record both positive and not experiences. Try to record both positive and not so positive elements. What made the experience so positive elements. What made the experience memorable?memorable?

2. How did it affect you?2. How did it affect you?

3. How did it affect the patient?3. How did it affect the patient?

4. How did it affect the team?4. How did it affect the team?

5. What did you learn from this experience and what 5. What did you learn from this experience and what (if anything) would you do differently next time?(if anything) would you do differently next time?

What do you understand by clinical audit?What do you understand by clinical audit?

Defining clinical audit (post Bristol)Defining clinical audit (post Bristol)

““A quality improvement process that seeks to A quality improvement process that seeks to improveimprove patient care and outcomes through systematic review patient care and outcomes through systematic review of care against of care against explicit criteriaexplicit criteria and the and the implementation of change”……aspects of the implementation of change”……aspects of the structure, process and outcome of care are selected structure, process and outcome of care are selected and and systematically evaluated against explicit criteria.systematically evaluated against explicit criteria. Where indicated changes are implemented at an Where indicated changes are implemented at an individual team, or service level and further individual team, or service level and further monitoring is used to confirm improvement in monitoring is used to confirm improvement in healthcare delivery”healthcare delivery”

What do you understand by the audit cycle?What do you understand by the audit cycle?

In audit what do you understand as:In audit what do you understand as:

– AimsAims– ObjectivesObjectives– Standards?Standards?

What is the aim of the audit?What is the aim of the audit?

Aims are broad statements of intentAims are broad statements of intent

- - e.g., to improve local practice in the management of e.g., to improve local practice in the management of leg ulcersleg ulcers

- e.g. to improve the referral process top smoking - e.g. to improve the referral process top smoking cessation servicescessation services

- e.g. to improve the reporting process of laboratory - e.g. to improve the reporting process of laboratory resultsresults

- e.g., to improve the management of observations- e.g., to improve the management of observations

After topic comes your aim and objectiveAfter topic comes your aim and objectiveAlways know your aim and objective!Always know your aim and objective!

““a project without clear objectives cannot achieve anything: a clear a project without clear objectives cannot achieve anything: a clear sense of purpose must be established before appropriate sense of purpose must be established before appropriate methods for audit can be considered……methods for audit can be considered……

……..once the topic for audit a clinical audit project has selected the ..once the topic for audit a clinical audit project has selected the purpose of the project musty be clearly defined so that your purpose of the project musty be clearly defined so that your method chosen is the most suitable for your project”method chosen is the most suitable for your project”

Objective of audit = quality of careObjective of audit = quality of care

Common questionCommon question

But isn’t audit the same as But isn’t audit the same as research?research?

…………what’s the difference?what’s the difference?

Why does audit get confused with Why does audit get confused with research?research?

Both involve collecting/accessing Both involve collecting/accessing information to achieve an objectiveinformation to achieve an objective

Both involve observing practice to Both involve observing practice to achieve an objectiveachieve an objective

Both have a data analysis componentBoth have a data analysis component Both produce written Both produce written

reports/findings/summariesreports/findings/summaries

Audit versus research (1)Audit versus research (1)

Calling something “audit” does not make it an Calling something “audit” does not make it an audit: it’s the audit: it’s the objectiveobjective of the project that of the project that countscounts

ObjectiveObjective is the most useful factor for is the most useful factor for distinguishing between the two activitiesdistinguishing between the two activities

For example, research answers the questions For example, research answers the questions “what should we do?”:“what should we do?”: the objective of the objective of research is to create new knowledge, e.g., test a research is to create new knowledge, e.g., test a hypothesishypothesis

Audit versus research (2)Audit versus research (2)**Audit answers the question Audit answers the question “are we doing what we “are we doing what we

should beshould be doing in the way we should be doing it”doing in the way we should be doing it” e.g., e.g., Objective is to measure the quality of care provided against Objective is to measure the quality of care provided against

agreed ways of working/evidence based agreed ways of working/evidence based medicine/guidelines/standardsmedicine/guidelines/standards

**Audit is not “poor” or “weak” research it is a totally different Audit is not “poor” or “weak” research it is a totally different activityactivity

**Audit is not a quick fix for research to avoid ethical Audit is not a quick fix for research to avoid ethical implicationsimplications

**Audit is not an easy way to conduct researchAudit is not an easy way to conduct research

Audit versus research (3)Audit versus research (3)

In general, the objective of audit is to evaluate In general, the objective of audit is to evaluate the quality the quality of local practiceof local practice; by sharing findings ; by sharing findings locallylocally one can improve one can improve local practiceslocal practices

Local audit would not necessarily benefit the Local audit would not necessarily benefit the wider health economy as wider health economy as it relates to a Trust it relates to a Trust and the practices of that Trustand the practices of that Trust

In general, the objective of research is to In general, the objective of research is to createcreate new knowledgenew knowledge that can be that can be shared with shared with othersothers

Sharing this information (research) may benefit Sharing this information (research) may benefit the the wider health economywider health economy

Summary: what makes an audit a Summary: what makes an audit a good audit?good audit?

Involve all concerned e.g., other departments, Involve all concerned e.g., other departments, professional groupsprofessional groups

Clear rationale/purposeClear rationale/purpose Explicit aims and objectivesExplicit aims and objectives Measurement against which to compare – evidence Measurement against which to compare – evidence

base/standardsbase/standards Sound methodology – best approach, sampling Sound methodology – best approach, sampling

techniques, proforma designtechniques, proforma design Data analysis that reflects the aims & objectivesData analysis that reflects the aims & objectives Reported and presented to reflect aims & objectivesReported and presented to reflect aims & objectives Reported & presented to reflect measures/standards Reported & presented to reflect measures/standards

utilisedutilised Birmingham Clinical Audit Assessment FrameworkBirmingham Clinical Audit Assessment Framework More likely to change practice if methodologically More likely to change practice if methodologically

rigorous*rigorous*Spurgeon P, Walshe K (1997). Birmingham Clinical Audit Assessment framework. HSMC: Spurgeon P, Walshe K (1997). Birmingham Clinical Audit Assessment framework. HSMC:

University of BirminghamUniversity of Birmingham*Walshe, K (1999). BRI Inquiry on medical and clinical audit in the NHS. HMSO: London*Walshe, K (1999). BRI Inquiry on medical and clinical audit in the NHS. HMSO: London

What makes audit change practice?What makes audit change practice?

Perception, attitude, motivationPerception, attitude, motivation Organisation and environmental factorsOrganisation and environmental factors Choice of audit topic, adequacy of audit method and Choice of audit topic, adequacy of audit method and

understanding the reasons for deficiencies identifiedunderstanding the reasons for deficiencies identified Extent to which audit is systematically integrated into Extent to which audit is systematically integrated into

routine management ofroutine management of carecare Involve/Inform the “Change Makers”Involve/Inform the “Change Makers”

Walshe, K (1999). BRI Inquiry on medical and clinical audit in the NHS. HMSOI: LondonWalshe, K (1999). BRI Inquiry on medical and clinical audit in the NHS. HMSOI: London