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Our National Clinical Audit Fishbone

Updated: Oct 2, 2019


You will remember that our last blog focused on how the fishbone diagram that is often employed in an attempt to identify possible problems with the aim of implementing changes that improve patient safety.


This blog uses the fishbone diagram to look at the eternal question of how we can improve national clinical audits. You will see that we have populated the diagram with perceived and actual ‘problems’ that relate to some NCAs. This information has been taken from our annual survey plus every-day conversations CASC have had with those involved in national audit.


A couple of points to make… 1) we know publishing this will be seen as controversial by some, 2) we want to make it clear that CASC support high quality national audits that have a proven track record of improving care and 3) we are not saying all the points raised here relate to all national audits. Indeed, we offer this as a ‘starter for 10’ for all those passionate about NCAs. This is not a definitive list of issues, so feel free to tell us what needs to be added. Equally, what is unfair and needs to be removed from the fishbone? We have never seen NCA problems laid out like this, so let’s collectively map out where the true root causes are and work together to implement change urgently! That's what auditors are good at...


From our viewpoint...the amount of money and time spent on NCAs must be vast. Put simply, all NCAs should be meaningful and meet the HQIP’s high quality audit parameters as a minimum benchmark. We have presentations from 10 years ago from various stakeholders telling us key plans to improve NCAs… and yet every year via the CASC annual survey -available here - we encounter quantitative and qualitative data that tells us there is still vast room for improvement.


What else is there to say? Can we use this fishbone to eliminate some of these ongoing issues? Over to you…


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