Reflecting on QIA
Audit has become a central activity for many, if not most, medical organisations and it carries with it a recognition that in human systems there is invariably room for improvement. Recent high profile cases of failure to provide adequate care have heightened public awareness of this and the need to strive for improved quality of care3. Quality can be achieved by various means and this is recognised by the GMC1 who provide several examples of this. However, clinical audit is the most familiar of these and is used as an example here.
A doctor decides to conduct an audit examining the care provided to patients with Parkinson’s disease. She arrives at this decision following reflections on recent cases seen in her caseload whose care seemed to have been less than adiquate. She has read the latest NICE guidelines, discussed local services with a colleague and approached the local specialist nurse who identifies the patients they have in common. She identifies the key criteria that one would expect for good care, considers acceptable standards and embarks on a data collection. It is notable that the appropriate audit activity often arises out of discussion with others. To add greater impact to the exercise a similar sharing of the data and discussion with colleagues to identify appropriate actions to bring about change is often required.
The doctor identifies levels of care that are less than optimal in this data collection but is optimistic that change for the better will arise from greater awareness in the multi-disciplinary team, a strategy to recall patients for further assessment and the use of a template to structure areas for discussion with the patient.
Reflection Tools: To read, enquire, discuss, debate and consider (reflection is not necessarily a lonely pursuit).