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Two simple ways to improve national clinical audit


Last week’s blog focused on feedback we received via our annual survey at the end of 2019. Do take a look if you get a moment. The blog examined the best attributes of NCAs with respondents highlighting the importance of benchmarking, the opportunity to understand the national picture (i.e. aggregated results) and the value of pre-determined audit tools and standards. All very useful stuff.


This week’s blog looks at the slightly more controversial subject of… how can NCAs improve? Again, this blog focuses on feedback from our annual survey with information shared here obtained in response to our question… ‘what one change would you make to improve national audits'?


Those you that read last week’s blog will be aware that the ‘runaway’ winner in terms of what people like about NCAs is the fact that they allow benchmarking across participants. When looking at suggestions for how NCAs could be improved, there isn’t one runaway winner, but there are two clear messages that stand out above everything else.


First of all, the perceived need for more rapid reporting of results, as conveyed by a small selection of comments such as: ‘quicker reporting of results’, ‘quicker report turnaround – in many cases we do not receive the final report until 12 months after data collection’, ‘quick turn round from the data collection to the publication of the final results’, speed up – some organisations need to report quicker’, ‘I would like to see a reduction in the time between data submission and the production of reports’, ‘speedier reports’, ‘quicker reporting’, ‘a quicker turnaround on the reports… by the time some come out, as a service, we have moved on’, ‘results available earlier’… and it goes on. We all know that high quality clinical audit relies on timely reporting. Old data is meaningless. Feedback from our survey suggests not all NCA suppliers are cutting the mustard!


Second, there is a clear view that NCAs are too burdensome and time consuming and our respondents told us as much in many different ways: ‘less data burden’, ‘make them less burdensome please, we are drowning in data’, ‘in general the national audits are very time consuming’, ‘more focused questions – rather than trying to collect everything’, ‘less burden to collate the data’, ‘collect only data that is needed’, ‘reduce their time burden’, ‘make them bi-annual’, etc. We all know that the best audits should have a laser-like focus and only collect the data that is essential. Many replies to our survey highlighted burden caused by excessive data collection and one respondent stated ‘ensure that the focus of these projects is on improving quality of care for patients and not simply collecting data for somebody’s research paper’… ouch! HQIP advocate that for the NCAs they procure and fund they aim for ‘minimal data burden’. Are they holding their NCA suppliers to this in 2020?


What is interesting here is that when we look at feedback from our December 2018 survey… the exact two same themes topped the list! Good for consistency and endorsing our survey work, but not so good for proving that the likes of HQIP and their friends at the Academy of Royal Medical Colleges (who run most of the NCAPOP projects) are listening to those at the coalface who do most of the work. And the same can be said for all those bodies that run the non-NCAPOP audits. As audit staff we should be good at making changes, adopting LEAN methodology and reducing waste and burden. Is this happening across all the NCAs?


Footnote: next week we will continue to look at our survey feedback on national audits. This year more than perhaps ever before we have had some really radical feedback from our survey respondents. And we will be sharing some of these suggestions in next week’s blog.

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