Since setting up the Clinical Audit Support Centre (CASC) in 2006, the one constant recurring theme we have heard in local, regional and national meetings has been variable feedback on the national audit programme. It is fair to say that views are mixed. Inevitably, some are better than others and some (step forward the registries) probably aren’t even clinical audit. It is fair to say that over the years we have been critics of a number of national audits, but that is because some of the outputs costing a lot of taxpayer’s money have been very poor indeed.
Having said that, we have also praised NCAs. And rightly so as some have had a real impact and are viewed as international leaders. As auditors we judge projects individually on their merits. Too often, those working at a local level have viewed NCA collectively as either ‘good and worthwhile’ or ‘bad and a waste of time’. It is not quite so simple and clear-cut.
The good news is, this blog is going to celebrate NCAs. As part of our annual survey we ask respondents ‘what is the single best attribute of national clinical audits’? Those who have taken part part have spoken and we are happy to share their feedback publicly. Of course, we could hide away valuable free-text comments and refuse to share these, but why would we do that and what purpose would it serve?
When you think of the best attribute of NCAs, what one-word springs to mind? Take a moment to ponder! Well according to our survey, that word is ‘BENCHMARKING’. Indeed, of the 90 comments in relation to our question, an astonishing 40 featured the word ‘benchmarking’. And that actually masks the true number as a further 16 comments used phraseology along the lines of ‘allows us to compare our care with others’. And this outcome is no surprise, as in 2018 our survey produced almost identical feedback. Think national audit, think benchmarking, which is exactly what we would expect!
But what else do our survey responders value when it comes to NCAs? Coming in at number 2, we have the ability to understand the national picture! Indeed, we had plenty of comments along the lines of ‘good picture of what is happening in the country as a whole’, ‘obtaining a national picture’, ‘gaining an overview and complete picture of national trends and outcomes’. And again, this is entirely what we would expect of national audits. To be useful, they must tell us what is happening collectively and allow participants to compare their performance with the national results and the results of others’.
When it comes to looking at what other attributes people like… the picture becomes much less clear, with comparatively few votes for other attributes. Some like the pre-determined tools and standards that save time and ensure uniform measurement. This can be seen via comments like ‘prioritises standards to review’, ‘measuring the right things’, ‘uniform data against NICE guidance’, ‘provide national standards’ and ‘pre-determined tools’.
From here onwards, analysis is almost impossible, with only singular comments coming through. However, that doesn’t mean the comments aren’t interesting…. ‘senior eyeballs watching results’, ‘the speed at which they are published’ and ‘highlights inequalities’.
So in term of feedback from our tenth annual audit survey, there is lots to be positive about when it comes to NCAs. The one disappointment is that we would have hoped to have seen the word ‘improvement’ cropping up. Sadly, there are only a few mentions….’can be used as a motivation to drive improvement’, ‘can be used as a driver for local improvement’ and ‘timely data to support local improvement’. From 90 comments, only 6 included the word ‘improvement’ within their reply.
And to finish on the subject of improvement… we at CASC realise that the question we have been asking each year may be doing a dis-service to national audit. Asking for the ‘single best attribute’ is restrictive. Next time we will ask ‘what are the best attributes of national clinical audits’? Hopefully that might broaden the range of positive responses and give us a an even better picture of what people value about national clinical audits.