Traditional methods of performing audit

Shaw in Frostick et al.’s Medical Audit: Rationale and Practicalities (1993) describes the traditional views of medical audit in terms of the ‘characteristics of effective audit’ and the ‘methods’.

The characteristics can be summarised as:

  explicit criteria for good clinical practice — guidelines for practice;

  objective measurement of patterns of current practice —looking at identified groups or activities;

       comparison of results amongst peers — acceptable published data;

  explicit identification of corrective action — agreed action and its implementation;

       documentation of procedure and results — a formal report of the proceedings and action required.

The methods that Shaw outlines are basically very simple and can be undertaken by a small group (i.e. a directorate) or on a larger scale. Examples of the usual types of audit that can and are performed include:

  workload and case mix;

  appropriateness of care;

  access to care;

  outcomes of care;

  quality of records;

  efficiency.

The advantages of a traditional approach to audit are as follows.

  It is simple and cheap.

  Data should be easy to acquire and their accuracy can be checked.

  The cycles and so the effectiveness of the audit can be repeated at short time intervals.

  There are simple educational outcomes which are derived from regular, small and well-run audit meetings.

The disadvantages of traditional audit are as follows.

  Meetings may occur but are not repeated so the audit cycle is not completed.

  Standards may not be easy to define in an objective way.

  The onus often falls on the most junior person on the firm to acquire and present the data.

  Morbidity and mortality meetings can be embarrassing and destructive.

  The education may be by guided ‘shaming’ not by guided learning.