Opportunities to improve the impact of two national clinical audit programmes: a theory-guided analysis

Abstract

Background Audit and feedback is widely used in healthcare improvement, with evidence of modest yet potentially important effects upon professional practice. There are approximately 60 national clinical audit programmes in the UK. These programmes often develop and adapt new ways of delivering feedback to optimise impacts on clinical practice. Two such programmes, the National Diabetes Audit (NDA) and the Trauma Audit Research Network (TARN), recently introduced changes to their delivery of feedback. We assessed the extent to which the design of these audit programmes and their recent changes were consistent with best practice according to the Clinical Performance Feedback Intervention Theory (CP-FIT). This comprehensive framework specifies how variables related to the feedback itself, the recipient, and the context operate via explanatory mechanisms to influence feedback success. Methods We interviewed 19 individuals with interests in audit and feedback, including researchers, audit managers, healthcare staff, and patient and public representatives. This range of expert perspectives enabled a detailed exploration of feedback from the audit programmes. We structured interviews around the CP-FIT feedback cycle and its component processes (e.g. Data collection and analysis, Interaction). Our rapid analytic approach explored the extent to which both audits applied features consistent with CP-FIT. Results Changes introduced by the audit programmes were consistent with CP-FIT. Specifically, the NDA’s increased frequency of feedback augmented existing strengths, such as automated processes (CP-FIT component: Data collection and analysis) and being a credible source of feedback (Acceptance). TARN’s new analytic tool allowed greater interactivity, enabling recipients to interrogate their data (Verification; Acceptance). We also identified scope for improvement in feedback cycles, such as targeting of feedback recipients (Interaction) and feedback complexity (Perception) for the NDA and specifying recommendations (Intention) and demonstrating impact (Clinical performance improvement) for TARN. Conclusions The changes made by the two audit programmes appear consistent with suggested best practice, making clinical improvement more likely. However, observed weaknesses in the feedback cycle may limit the benefits of these changes. Applying CP-FIT via a rapid analysis approach helps identify strengths and remediable weaknesses in the design of audit programmes that can be shared with them in a timely manner.

Assessing infection prevention and control programs in residential aged care in Australia: A multi‐methods cross‐sectional study

“…The findings were reported back to RACFs using evidencebased principles to trigger change. 12,14 Although it is anticipated that evidence-informed feedback can facilitate practice change, future research should explore the impact of the action plans. Given that staff working in RACFs are time poor, our feedback reports aimed to be brief.…”

“…A summary of the study findings was presented to participating facilities in the form of a short report (see File S3) and online presentation with discussion, using audit-and-feedback principles. [12][13][14] Specifically, we delivered the feedback in verbal and written (multimodal) formats, co-presented with a content expert, included explicit targets and an action plan, and the patient/resident voice was incorporated. IPC leads and managers were invited to attend the online discussion that was hosted by a researcher and an IPC expert from the IMMERSE team.…”

Interventions to optimise the outputs of national clinical audits to improve the quality of health care: a multi-method study including RCT

“…Chapter 4 A theory-guided evaluation of two national clinical audit programmes (objective 2) P arts of this chapter are reproduced or adapted with permission from Willis et al 97 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/.…”

Harnessing the potential of data‐driven strategies to optimise transfusion practice

“…Analyses of national audit programmes in the UK found that they often did not fully utilise existing evidence on effective feedback methods, for example incorporating action plans. 47,48 Audit and feedback has a long history in transfusion medicine. However, limited progress with repeated national audits in the UK motivated the AFFINITIE programme (Audit and Feedback INterventions to Increase evidence-based Transfusion practice).…”

“…However, there is still a gap between what audit and feedback can achieve and what is actually delivered. Analyses of national audit programmes in the UK found that they often did not fully utilise existing evidence on effective feedback methods, for example incorporating action plans 47,48 …”