The components of audit
Audit is traditionally viewed as a loop, the
components of which are structure—process—output. The term structure refers
to the physical environment in which healthcare is provided; process refers to
the activity of providing care; and output to the outcome of that care both for
the individual and for the community as a whole. The loop is completed by the
output feeding back on potentially both structure and process. Table 71.1
summarises what is needed to provide a quality service — structure, process,
outcome data and feedback.
Both
a quality service and an audit cycle need the feedback loop to be effective. The
loop must be viewed as an unending sequence. Moreover, it is implicit in the
definitions that a single clinician cannot perform audit alone; teamwork with
finance managers and other clinical staff, etc., is obligatory.
All
aspects of clinical audit must be compared with some form of standard and then
retested against the standard on the next loop of the cycle. It is generally
accepted that as far as specific surgical techniques are concerned the
comparison must be against properly constructed prospective randomised clinical
trials. Other independent and objective standards must be established for other
comparisons.