HomeSponsoredWhy audits form the cornerstone of a quality improvement culture
Why audits form the cornerstone of a quality improvement culture
How do GP practices ensure that they are always providing safe and effective care? How do practices know that the services they provide are well-led and responsive? The best way of ensuring a high standard of clinical care is to champion an environment with quality improvement at its core. To really improve the quality of patient care, however, requires regular auditing and embedding policies, procedures and process – deep within the cultural fabric of a practice.
In this exclusive Q&A, Tracy Green, QCS’s Head of Primary Care, reveals why audits are important, how they should be implemented and finally she provides best practice tips for as to how GP practices can carry out outstanding audits.
Q) Why are audits necessary?
“As the majority of GPs reading this will already know, audits are a compulsory requirement of the Care Quality Commission (CQC). The CQC expects patients’ care records – which include clinical data – to be kept safe. They also will want to check that medicines are being administered in the correct way. Finally, the CQC will expect GPs and their staff to monitor patients closely and to advise them on when they may need more help.
In addition to meeting CQC guidelines, providers must also ensure that standards of clinical care also conform to the requirements of The Health and Social Care Act 2008 (Regulations 12, 15 and 17), the Health and Safety at Work Act 1974, the Medical Act 1983 and the Data Protection Act 2018.
It is also a General Medical Council (GMC) recommendation for GPs to demonstrate involvement in quality improvement at least once a year, particularly when training.”
Q) Many experts say that for audits to make a profound difference to a GP surgery, providers need to have also instilled a culture of quality improvement within the practice? To what extent is this true?
“In my opinion, having a culture of quality improvement is extremely important. Using imagery, if we were to imagine the entire quality improvement process as an iceberg. The audit process is the tip of the ice floe, while the largest section of the glacier, which is hidden by the water, is the culture of quality improvement that has been firmly embedded within a practice.
So, how do you do instil a culture of quality assurance and quality improvement within all of the practice team? At QCS, the leading provider of content, guidance and policies for the healthcare sector, where I am Head of Primary Care, we firmly believe that the cornerstone of clinical and non-clinical auditing culture lies in utilising Quality Improvement models. The CQC’s ‘GP mythbuster 4: Quality Improvement Activity’ document lists eight different Quality Improvement tools, but I think the PDSA cycle, is by far the most effective, not to mention very easy to deploy.”
Q) What is the PDSA cycle and how does it help practices to deliver a culture of all-round excellence?
“If you’ve never used the PDSA model, it’s a continuous cycle which stands for ‘Plan’, ‘Do’, ‘Study’, ‘Act’. Using this methodology in an audit, as part of the ‘Plan’ stage, Practice management teams can easily set the objectives and standards they wish to achieve. They then must decide which members of the practice needs to be involved, what needs to be measured, when and where? In the ‘Do’ stage, whoever is managing the audit, must measure current activity and practice. Having gathered the results, the third stage, which is the ‘Study’ phase, calls for the auditor to compare the results to CQC and GMC standards, before reflecting on them. Reflection is viewed as a significant part of the process and outstanding providers will leave nothing to chance. If there are gaps in standards, they are ironed out in the ‘Act’ phase. Practice management teams will work with individuals, arrange group sessions and also facilitate meetings with Patient Participation Groups, as the new updated CQC strategy advises. This helps to ensure that holistic improvements are made. Finally, if the first audit wasn’t successful, the Practice management team will commission another one to check that improvements have been made. The secret of PDSA is the cycle, which is constantly repeated to ensure quality advancements continue.”
Q) How can QCS’s content and guidance help to underpin the quality improvement process?
“A number of QCS tools can be utilised to support improvement. In addition to creating hundreds of different policies and procedures, QCS has also developed a myriad of auditing tools and checklists. The tools enable assessors to audit and outline quality improvement in a number of different areas. The audit list includes ‘Missed diagnosis’, ‘Care plans completed’, the Electronic Frailty Index, tools to monitor improvement routine referrals, medicine usage and safety alerts. QCS has also created a specialist Coronavirus Hub, which includes the Hand Hygiene Audit, the Infection Prevention Control Audit and the Coronavirus Infection toolkit. For ease of use, these tools are available on the QCS App.”
Q) What best practice tips would you give to providers who wish to deliver outstanding audits?
As a CQC specialist advisor, many people ask how many audits they need to carry out every year to be considered outstanding. Unfortunately, questions like this completely miss the point, I would advise that Practice Managers stage as many mock audits as they need to, to drive improvement. QCS has developed a number of checklists to make the process faster and more efficient.
Surgeries that have successfully inculcated a PDSA model into their practices have an advantage however in this respect. Why? Because such a model provides practice management teams with greater visibility to see whether clinical and patient experience standards are being met. This, in turn, will go some way in helping them to determine how frequently quality improvement work needs to take place to maintain the required standards.
Secondly, audits and quality improvement activity is not something that staff should be scared of. While audits are designed to illuminate gaps, they’re also designed to recognise excellence. Most crucially, however, staff must not think of the auditing process in terms of success or failure. Instead, they should regard it as a process which leads to measureable improvement.
Thirdly, outstanding practices will carefully analyse audit results in order to reflect, learn and to build upon team members’ knowledge, skillset and experience. A huge part of a culture of quality improvement is the willingness to share data. Team members and patients need to know what is working, what is not, and how to strive for and attain the expected standards.
Finally, following a systematic process, which meets CQC and GMC standards, is absolutely essential, as is developing a robust system that logs, evidences, records and allows for regular re-audit. Without such a system, historical benchmarking cannot take place. This could potentially leave future improvement stunted and lead to worse patient outcomes.”
Tracy Green is QCS’s Head of Primary Care.
Quality Compliance Systems (QCS) is a leading provider of content, guidance and standards for the healthcare sector. If you wish to find out more about QCS, why not contact QCS’s compliance advisors on 0333-405-3333 or email firstname.lastname@example.org?