Introduction for speaker only

1. Introduction for speaker only Please see speaker notes below for details of the format of this presentation and suggestions on how it might be used

2. Clinical audit: Ten simple rules for NHS Boards based on ‘Clinical audit: A simple guide for NHS Boards and partners’ produced by HQIP and the Good Governance Institute, 2010.

3. The clinical audit cycle

4. Background Clinical audit is: • A key element of clinical governance • Crucial in assessing the quality of clinical care • Vital to achieving efficiency savings while improving the quality of service • A requirement for CQC registration and to meet NHSLA standards • A required element of Quality Accounts

5. Background But Trust Boards have been criticised: • Failure to use clinical audit in a systematic way to address risks • Little evidence of Board level discussion or challenge of data quality • Separating cost and quality • Detailed criticism in the Mid Staffordshire report

6. Clinical audit and commissioning Commissioners have a duty to monitor the conduct of clinical audit in providers: • They should participate in setting the local clinical audit agenda • Contracts should include clinical audit requirements • PECs should facilitate interface audit • Providers should report audit progress and outcomes • Commissioners require assurance about the implementation of action plans.

7. HQIP guidance The guide describes: • How the board can gain assurance about quality of service from clinical audit • What questions board members should ask • Acceptable answers • Where to go for further guidance and support • Ten simple rules for boards to follow

8. Rule 1 Use clinical audit as a tool in strategic management; ensure the clinical audit strategy is allied to broader interests and targets that the board needs to address. • Do we have a clinical audit strategy based on national and local priorities? • Do we engage with our providers to ensure their clinical audit strategies meet our requirements for quality assurance?

9. Rule 2 Develop a programme of work which gives direction and focus on how and which clinical audit activity will be supported in the local health economy. • Is our board assurance framework supported by clinical audit as assurance? • How can we be assured that the technical quality of clinical audit undertaken by our providers is high and that key issues that affect data quality are addressed?

10. Rule 3 Ensure all providers have appropriate processes for instigating clinical audit as a direct result of adverse clinical events, critical incidents and breaches in patient safety. • Is there a clear link between our processes for dealing with such events and our clinical audit strategy? • Who is responsible for ensuring this link works? • What assurance do we have that providers consider such events when developing their clinical audit programmes?

11. Rule 4 Check the clinical audit programme for relevance to board strategic interests and concerns. Ensure that results are turned into action plans, followed through and re-audit completed. • Has the board agreed what constitutes materially unacceptable variation in clinical audit results? • For all clinical audits that identify unacceptable variation is there an action plan? • Have we assurance that clinical audits have led to improved service delivery?

12. Rule 5 Ensure there is a lead clinician who manages clinical audit within every provider, with partners / suppliers outside, and who is clearly accountable at board level. • What proportion of approved clinical audits do our providers complete to time and budget? • Do our contracts with suppliers / providers require cooperation in clinical audits e.g. in CQUIN regime?

13. Rule 6 Ensure patient involvement is considered in all elements of clinical audit, including priority setting, means of engagement, sharing of results and plans for sustainable improvement. • Is there an explicit link between our clinical audit strategy and our patient and public engagement strategy? • Do we enable patients and carers to influence clinical audit and other quality improvement activities?

14. Rule 7 Build clinical audit into planning, performance management and reporting. • Do we have an explicit process for reviewing national clinical audit reports and quality accounts from providers? • Do we have an explicit process for using the outcomes of clinical audits to inform commissioning decisions? • What assurance do we have that our providers performance is accurately reflected in the assessments of the regulatory bodies?

15. Rule 8 Ensure with others that clinical audit crosses care boundaries and encompasses the whole patient pathway. • Do we have clear lines of communication with other local health and social care providers to facilitate cross boundary clinical audit? • Are any areas such as mental health or primary care neglected in local clinical audit programmes?

16. Rule 9 Agree the criteria of prioritisation of clinical audits, balancing national and local interests, and the need to address specific local risks, strategic interests and concerns. • Do we have a relevance test to approve commitment of resources? • Does our focus on national clinical audits mean we have no resource to advise on local priorities?

17. Rule 10 Check if clinical audit results evidence complaints and if so, develop a system whereby complaints act as a stimulus to review and improvement. • Is there a clear link between our processes for dealing with complaints and our clinical audit strategy? • Are complaints taken into account when approving local clinical audit programmes?

18. HQIP website

19. Contact us Healthcare Quality Improvement Partnership Email : lqit@hqip.org.uk Website:www.hqip.org.uk Promoting quality improvement for better healthcare