Appreciative clinical audit—what reality is our audit data creating? A blog by Katy Fisher

Summary

In this blog, Katy Fisher, Senior Nurse Quality & Improvement at NHS Professionals, shares with the hub what appreciative clinical auditing could look like in health and care

Content

I recently hosted a 'learn at lunch' with the amazing Clinical Audit Support Centre to broach the subject of what appreciative clinical audit could look like in health and care. Although I had arrived with some preconceived ideas (as everyone does), I hadn’t foreseen the engagement that would happen in the room when we started to talk about the potential for clinical audit processes that are recognised and built to seek the good.

Clinical audit is described as "a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria" (Principles of Best Practice in Clinical Audit, 2011), but how often is that explicit criteria set to seek exemplary care? And what do we do with that information when it is witnessed and audited?

My clinical audit colleagues shared that they are often viewed negatively when approached. That people deem audit to be a punitive experience. But my experience of clinical audit has been anything but that.

One of the most meaningful pieces of work I had undertaken in the past few years was a clinical audit to review the care an Accident and Emergency department had delivered in a time of critical incident. Using the constructionist principle of appreciative inquiry that describes that there are multiple interpretations of what is real, I knew that "words create worlds" and if only the harm was sought, only the harm would be found.

By leaning towards my senior clinical audit colleagues, we were able to design a clinical audit with a mandatory field that asked "what went well?". The auditor could not bypass or work round it, they HAD to seek for the good, and it was found… often.

So, what could this look like in a day-to-day practice of clinical audit, and how could that affect senior leader decision making when receiving the data?

The learn at lunch was a great place to start to dream, and the participants (who would know much more than me regarding what an appreciative clinical audit process could look like) dreamed big. Existing positive processes were identified and acknowledged. Questions were asked of what a future could look like "when not practicing in anxiety of what could go wrong". Ideas grew when picturing where appreciative inquiry could sit within a clinical audit process and setting, and thoughts considered what it could be like "if we spend time looking at compliance as well as non-compliance".

But I want us to dream even bigger.  I want senior leaders to consider how the data you are receiving is scoped from the very beginning. Is it that the data you are reviewing is focussing solely on the substandard and prioritising the ‘red’ on your RAG charts? Alternatively, are clinical audit output reports focussing on best practice and exemplary care?

Could the future of clinical audit mean that the data your amazing audit teams are collecting and analysing could point towards your strategic vision and direction?

I think health and care could be evidenced to be a lot brighter through audit that seeks and documents the magic and dedication that happens every day.

Further blogs from Katy:

• Appreciative inquiry case study
• What could Appreciative Governance start to look like in the NHS? A blog by Katy Fisher

About the Author

Katy Fisher is currently co-host of Caring Corner podcast and website and Senior Nurse (Quality and Improvement) at NHS Professionals. After starting her career as an Adult Registered Nurse practicing in acute stroke, acute neurology, complex discharge planning and general medical nursing, she progressed to lead clinical governance, quality and risk management frameworks in acute hospitals in the Greater Manchester region. Her main interests are psychological safety as a system and creating learning and improvement processes within the healthcare setting.

Katie has led acute patient safety collaboratives, conducted complex multi-disciplinary After Action Reviews and has led numerous high level patient safety investigations focussing on both Safety II and Safety II in formal clinical governance structures.

She is passionate about making patient safety theory and methodology meaningful and appreciative in a frontline healthcare setting.