Widening digital and clinical participation through clinical audit
The journey of a thousand miles begins with one single step — Lao Tzu
Clinial audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.
Florence Nightingale and Ernest Codman are recognised as early advocates of clinical audit during the late 19th and early 20th century with their work on sanitation and surgical outcomes; but it was not until after the publication of the Working for Patients white paper in 1989 that it was formally introduced into the NHS as part of professional health care.
It was perhaps inclusion in NHS policy documents such as the NHS plan in 2000 with the mandatory participation by all doctors in clinical audit, developments to support the involvement of other NHS staff, and the role of professional regulatory bodies such as the General Medical Council (GMC) and Nursing and Midwifery Council (NMC) that has further driven clinical participation.
More recently, the focus of NHS services has been on improving the quality of healthcare through quality improvement.
What is quality?
The Institute of Medicine has identified the dimensions of healthcare quality as: Safe, Effective, Patient-centred, Timely, Efficient and Equitable.
Quality improvement is then best described as a systematic approach that uses specific techniques to improve quality.
However, it is commonly observed that clinical audits are being performed independently in an uncoordinated way across an organisation with resulting negative impact on clinical effectiveness and the resources invested.
Between 30–58% of all attempted audits were completed by foundation doctors in a study reported in 2009 and does not seem to have improved in a more recent study of surgical audits completion.
This is further compounded by multiple independent silos of captured data in mixed paper and digital formats that prevents access and sharing of information to enable truly transformative care; and presents the inherent risks to information governance.
It does not matter how slowly you go as long as you do not stop — Confucius
The role of technology in the NHS has long been recognised with the vision in the 2000’s of the NHS National Programme for IT (NPfIT) which has brought mixed success.
The role of digital in increasing care, quality and efficiency have been identified in recent reports in 2016 by Robert Wachter and Lord Carter which cite the role of information technology in enablement, strategy and change.
In February 2019, Eric Topol provided an independent report on preparing the healthcare workforce to deliver the digital future that made recommendations to support the NHS long-term plan, the workforce implementation plan and to ensure a sustainable NHS.
To support deployment of digital healthcare technologies, three principles were proposed: Patients as partners, evolving the healthcare workforce and providing the gift of time.
How can a digital clinical audit platform meet these visions?
A number of benefits can be gained through digitalisation of clinical audits that include centralisation of data and audit registration, improvements in information governance and increasing the ability to monitor progress of quality improvement projects.
The Healthcare Quality Improvement Partnership (HQIP) currently lists over twenty five active national clinical audits and this serves to demonstrate the value of digitalisation.
At a more local level, digitalisation can be faced with resistance to change from clinicians, governance teams and intriguingly even IT.
Breaking down this resistance involves identification of key stakeholders to then enable exploration of current processes and technologies; and to critically examine the opportunities for digital disruption.
These disruptions would include: transformative improvement to information governance, align with strategies for paperless working, centralisation to improve governance and monitoring, support the ability to perform analytics; and explore technological and economic impacts.
The role of widening digital participation through a digital clinical audit platform will help to evolve the digital skills of the healthcare workforce by improving their digital literacy skills, their understanding and safe utilisation of clinical data; to empower them to use these skills and technology to positively improve the health outcomes for patients; and to release time through greater efficiency.
This is in alignment with the NHS long term plan of: Empowering people, supporting health and care professionals, supporting clinical care, improving population health and improving clinical efficiency and safety.
Be content with what you have; rejoice in the way things are. When you realise there is nothing lacking, the whole world belongs to you — Lao Tzu
On 30th January 2020, the World Health Organisation declared the coronavirus disease 2019 a public health emergency of international concern then declaring it a pandemic on 11th March 2020.
The challenge of delivering NHS services has resulted in very significant progress in the use of digital technology; presenting new opportunities and innovations that would be difficult to move away from.
There is as they are saying no going back.
