Demystifying Audit - how to get the best from the audit process (Part 1)

Published: 16 November, 2016
Demystifying Audit - how to get the best from the audit process (Part 1)

Audit is one of those words that have an unnerving ability to strike fear into people, just by mentioning it.  You say audit and visions of hordes upon hordes of auditors lined up with clipboards and disconcerting looks across their faces are conjured. These humourless souls are just waiting to find faults and they’ll stop at nothing until they find them.

Except that’s not really what audit is about, far from it.  Yes, audits are about identifying areas for improvement but they’re also about identifying areas of good practice.  In this blog I’ll explain why we undertake audits and hopefully demystify them along with a bit of jargon busting.

Why do we audit?

Straight to the crux of the matter then, why do we audit?  Quite simply it’s a highly effective way method of quality improvements.  A good audit will identify areas that are not working but also identify those that are working and give them a platform to be shared and implemented elsewhere.

Simply put, it’s about what’s identifying what’s working, what’s not working and how we can make things better.

So when do we audit?

There’s no real answer to this, an audit can and does occur at any time that’s deemed appropriate and/or necessary.  Some audits are commissioned because of a complaint or a Serious Incident, for example.  It could be that the subsequent investigation has uncovered something amiss.  An audit will identify if this was an isolated occurrence or accepted practice within a team/unit/organisation.   Other audits could come about because of anecdotal observations, for example a Nurse may raise concerns to their line-manager around some clinical practice.  An audit will allow further detailed analysis of this concern and even identify where any problems are stemming from.   

There are also national audits that organisations like Care Plus Group contribute towards.  These usually come from national guidance and the role of provider organisations is to provide evidence that they meet these standards. 

What’s a Standard?

A standard is arguably the most important element of an audit, without it the audit will fall down under the weight of irrelevant data.  The standard is the expectation, the requirement and ultimately what you will audit against.  So for example ‘All staff should have an ID badge on their person at all times’ is a basic standard.  All standards will be occupied by a Target which is what the bare minimum expected return should be.  For the example given, this would be 100.00%.    Adding this together we expect to see that all (100.00%) staff have an ID badge at the time of auditing.    Standards and targets can also be accompanied by exceptions.  An exception is a reason why a standard wouldn’t be met, these are not excuses for non-compliance.  Using our example, a justified exception may be for staff that have only joined the organisation on the day of the audit.  An excuse would be staff who have forgot to wear their ID badge.  Standards often come from existing criteria such as guidance or policies.  Within an audit you can have as many as standards as you like.

Be SMART

The key with all standards is that they have to be SMART.

Specific - covers one topic only
Measurable - can be measured in a practical way
Achievable - is something that is reasonable for staff to achieve
Relevant - is an issue that is important to patients and staff
Timescale - can be measured within a reasonable period of time

Scoping

So we’ve identified what Standards are and that they have to be SMART, but what else do we need to do before we audit?  First of all we need to design and scope the audit itself.   This will allow us to identify the following:

  • What data are we collecting?
  • Where is the data held?
  • Who will collect it?
  • How will it be collected?
  • How much data should be collected?
  • How long will it take?
  • What resources (time, people etc.) are needed?

Questions

Before undertaking any audit, it’s always a good idea to have the standards set out as questions in a template for you to use whilst collecting the data.  I always find Excel is good a tool as any for this.  It allows you to keep all the data together, which makes life much easier when you come to looking at the results.   The picture below gives an idea of the type of collection tool that I use on a regular basis.

Once the scoping and questions are settled, it’s a good idea to conduct a very small dummy run of the audit (2 or 3 cases/records) just to see if your audit scope works, if not redesign to suit.

Once you’re happy with this you’re ready to audit, all that needs doing is determining your sample size.  This will greatly vary from audit to audit and could be done as a fixed number or a percentage of eligible records/participants, there is no definitive rule on this one.

to be continued........

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Written by: Paul Holmes

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