GUIDE TO MANAGING ETHICAL ISSUES IN QUALITY IMPROVEMENT OR CLINICAL AUDIT PROJECTS
The content in this guide was derived from an extensive search and review of published literature on ethics and QI and clinical audit carried out by HQQ. The guide describes:
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What’s involved in ethics and how ethics principles may apply
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Why healthcare organizations should provide for ethical oversight of QI and clinical audit projects
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The difficulty in distinguishing between a research and a QI or clinical audit project as the basis for ethical review
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The stages in QI and clinical audit projects when ethical oversight should be carried out
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How to screen projects for ethical issues
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The structure and systems needed in a healthcare organization for ethical oversight
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How to assess and improve current arrangements for ethical oversight.
The guide explains that many people think that QI and clinical audit projects do not require any ethical consideration. However, QI and clinical audit require ethical oversight because:
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Distinctions between the types of activities are blurred and can be ambiguous, unhelpful and arbitrary.
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A healthcare organization has an ethical duty to manage the conduct and act on the findings of QI and audit projects to benefit patients.
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Some QI projects are truly research on the QI process. These ‘hybrid’ projects, often referred to as ‘implementation science’, should be subject to research ethics oversight.
The guide includes practical checklists and guidelines to support ethical oversight of QI and clinical audit.
GUIDE TO INVOLVING JUNIOR DOCTORS IN CLINICAL AUDIT AND QUALITY IMPROVEMENT
Junior doctors are expected to carry out clinical audits or quality improvement projects (QIPs) to meet their training requirements. Training and support for junior doctors to help them benefit from their clinical audit or QI experiences may vary by healthcare organization.
This guide is intended to help people responsible for clinical audit and QI in a healthcare organization to provide appropriate support for doctors in training by explaining the following:
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What’s actually required and expected of junior doctors in relation to clinical audit and QI
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Why healthcare organizations should be actively helping junior doctors do clinical audits and QIPs
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The nature of the commitment needed by everyone involved to get valuable clinical audits and QIPs done by junior doctors
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The training junior doctors need on clinical audit and QI
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The individuals who should help junior doctors and how they should help
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The systems that have to be communicated to junior doctors and how the systems have to work to support them
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Ways to provide recognition for junior doctors’ clinical audits and QIPs
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Suggestions for subjects of clinical audits that junior doctors can or should do
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How to assess and improve current arrangements to support junior doctors’ involvement in clinical audit and QI.
Detailed content and learning objectives are provided to guide local training for junior doctors and practical guidance on subjects junior doctors can work on is given. There is also a checklist on support that should be available in a healthcare organization.
GUIDE FOR
CLINICAL AUDIT LEADS
This guide describes how clinical audit leads can manage the conduct of clinical audits in their clinical services so that the audits carried out provide benefits for patient care and are recognized as valuable by clinical colleagues and the organization. The guide includes the following:
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What is involved in being a clinical audit lead
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How to get started in the role
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Systems and support that should be available from a healthcare organization for clinical audit leads
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How to develop a plan for clinical audits to be carried out and implement the plan, including encouraging staff to involve patients or their representatives in relevant clinical audits
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How to monitor, manage and facilitate achievement of the intended outcomes of clinical audits carried out
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How to support colleagues in carrying out clinical audits
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How to communicate about the clinical audit programme and what it is achieving
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How to ensure that risks associated with clinical audits are recognized and handled properly
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Problems clinical audit leads can encounter and suggestions for handling the problems
A template role description for Clinical Audit Leads and a list of the knowledge and skills involved in the role are included in the guide.
GUIDE TO ENSURING DATA QUALITY IN CLINICAL AUDITS
Retrieving data from electronic or paper patient records for clinical audits is inherently more complex than clinicians may imagine. Factors such as imprecisely worded directions for making decisions about the quality of care, vague definitions of key terms, and poorly designed data collection tools can compromise data quality.
Clinical groups are expected to make changes in patient care, based on findings of clinical audits. However, they need to have confidence in clinical audit data in order to agree to change their practices.
This guide to ensuring data quality in clinical audits describes how to ensure the quality of data collected for clinical audits. It includes:
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What data quality means
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What’s involved in achieving quality data for clinical audits
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How to ensure that the purpose or objective of a clinical audit is so clear that it identifies the nature of data needed for the audit
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How to ensure that the cases selected to be included in or excluded from a clinical audit are the right cases and that cases selected won’t produce biased results
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How to test the validity of quality-of-care measures used in an audit
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How to check if data collection processes are producing reliable data
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How to select data collectors for a clinical audit and ensure they are doing the right job
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How to quality control data collection and data entry
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How to avoid pitfalls in data collection
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How to ensure that information governance requirements related to clinical audit data are being met.
GUIDE TO USING QUALITY
IMPROVEMENT TOOLS TO DRIVE CLINICAL AUDITS
The guide describes how QI approaches can be applied to clinical audit and specific QI tools that can contribute to the clinical audit process and when to use them. It includes:
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The traditional model of clinical audit
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How a QI process differs from the traditional model and the implications of the change in approach
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A summary of selected evidence on the importance of teamwork in QI
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When a QI tool could be used instead of or in addition to a clinical audit
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What clinical audit staff and clinical audit leads may need to do to be sure that clinical audit works as a true QI process.
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