Driving Clinical Improvement in the NHS through Audit Management.

Improvement, Innovation and Effectiveness Lead Tracey Brailsford at Derbyshire Community Health Services NHS Foundation Trust explains how a cloud-based system is helping senior leadership and frontline staff learn from performance and continually improve services for patients. 

When Tracey Brailsford joined Derbyshire Community Health Services NHS Foundation Trust in 2015, the organisation’s clinical audit activity was based around paper forms and spreadsheets.

“Audits were administrative,” says Brailsford. “They were sometimes not completed and often didn’t lead to improvement.”

The Trust wanted to change how it managed the clinical audit programme.

“We did a lot of work to develop from being an audit team to become the Improvement, Innovation and Effectiveness team,” says Brailsford. “We began to change the culture of the organisation to help people to see clinical audit as a quality improvement methodology.”

An organisational view

The Derbyshire Trust provides services across the county, including community hospitals, GPs, occupational therapy and mental health services. With such a range, the Trust wanted to gain a better picture of its effectiveness.

“We needed a view, organisationally, of what was happening around quality improvement, clinical effectiveness and clinical audit,” says Brailsford. “We needed to be able to shine a light on where brilliant activity is happening locally, and where it is not.”

She found that Audit Management and Tracking (AMaT), a cloud-based system developed with NHS clinical audit teams, could provide the control over audit activity she needed, through real-time insight and reporting to clinicians, wards, audit departments and healthcare trusts. With support from the organisation’s chief nurse, her managers, and the medical director, Brailsford oversaw the deployment of AMaT in 2020.

“I built a business case for AMaT with the argument that it would give visibility to where teams are doing really well and where we might need to have some concern,” she says. “It would reduce repetitiveness, improve access and visibility, and save clinicians time when using the system, who would have easy visibility about audits they needed to complete.”

An immediate response to Covid challenges

From its inception, AMaT helped the Trust gain a better understanding of, and improve, frontline services during the pandemic.

“The chief nurse rang me with a requirement to do an organisation-wide hand hygiene audit,” says Brailsford. With her team largely redeployed, and working from home, the Trust was able to rapidly launch the audit in AMaT for the county and its 4,500 staff.

It highlighted a compliance ‘red area’ with hand gel. “People knew they should wash from hand to elbow with soap and water,” she says, “but not everyone knew to do that with hand gel – so we launched comms on best practice. Without AMaT, we wouldn’t have known we needed to address that at an organisational level.”

It also helped the Trust assess the effectiveness of new service-delivery methods during the pandemic.

“Our community physiotherapists, for example, were doing consultations via video and were keen to evaluate that. We were able to send surveys to patients and staff using AMaT.”

While there might be anecdotal fear and myth about doing a video conference with an 80-year-old with a broken hip, surveying that patient – and finding that they loved it – is really powerful evidence that it can work.

Engaging staff, improving care

Within a year, AMaT had raised the profile of using audit in the Trust to improve quality.

“We want people to be engaged and excited to improve care for patients, rather than seeing audit as a chore,” says Brailsford, “and there has been an increase in people coming to us to ask what they can do to improve.

One example of this is the Trust’s four urgent-treatment centres, which previously carried out their audits independently.

“They approached us to use AMaT to place audits in a system where commissioners can look at them,” says Brailsford. “All of their audits are now on the system and visible across the trust. If there were any points of concern, they would become visible very quickly. The tick-box bit is that they are providing the evidence needed for commissioners – but the quality piece is that the senior leadership team and the staff themselves have really engaged in it.”

Standardising and saving time

Part of this development is about standardising how services are measured.

Enabling the trust to feed back to commissioners when variation in commissioning requirements impacts on service provision helps this process greatly. “The system offers possibilities for improving care in areas such as fall prevention,” says Brailsford. “Here, you can look at performance across the organisation – whether you are the falls prevention lead, the chief nurse, or the Care Quality Commission (CQC).”

This ‘helicopter view’ across the county means we can reduce variation in care. If we decide to do an audit around lower-limb wound management, for example, we will have a county-wide picture of compliance with the evidence base. If there is any variance, we will be able to pick that up quickly.”

AMaT has also helped avoid wasted time, too. Where NHS doctors had often carried out audits in isolation, these are now recorded and can be picked up by the next clinician for re-audit, creating a legacy, and ensuring a robust, scientific methodology is used.

“When improvement actions are identified, the system can be used to track whether these have been carried out,” Brailsford says. “It avoids merely ticking boxes, and enables doctors to be collaborative workers on a project.”

With staff across Derbyshire now using the system to learn from each other’s performance, Brailsford sees the potential for AMaT to be used nationally. “It’s not just about benchmarking results,” she says. “It’s about driving a culture of improvement. There is a lot of power in sharing and collaborative working across systems.

“There is something to be said for it being a nationwide, cross-trust system. We can all learn from each other’s best practice.”

Five Benefits Of AMaT
Usability:  it is an easy-to-use system with intuitive dashboards.
Accessibility: the cloud-based platform can be accessed from anywhere, at any time.
Visibility: teams can see what is being audited and any improvements needed, and manage who is responsible for actions and by what deadline.
Guidance: AMaT allows Trusts to monitor the guidance against which something is being audited, compliance, risks, barriers, and actions for implementation and improvement.
Time-saving: AMaT allows instant audit compliance and results, with activity centralised in one location and accessible to all teams for reporting.

Attribute to original publisher/ publishing organization: Improvement, Innovation and Effectiveness Lead Tracey Brailsford at Derbyshire Community Health Services NHS Foundation Trust, https://www.quality.org/knowledge/driving-clinical-improvement-nhs-through-audit-management

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