Improving healthcare through advancing the evolution of audit and feedback

Improving healthcare through advancing the evolution of audit and feedback

Health professionals do not always follow known best practice contributing to patients receiving less than perfect care. One strategy to improve healthcare delivery, known as Audit and Feedback (A&F), is to give health professionals data on how often they follow best practice and how often they do not. A&F is very popular worldwide and it is easy to see why; it is based on evidence, it can be provided at scale (i.e. to lots of health professionals within large organisations like the NHS) and it is a relatively inexpensive improvement strategy. A previous study, which combined the findings from over 140 experiments, showed that overall A&F works to improve healthcare delivery. However, it also showed that A&F is designed and delivered in lots of different ways and that sometimes A&F can make a big improvement on healthcare and sometimes only a small improvement. The science behind how, why and when it works best is very limited and in order for it to achieve the biggest improvements in healthcare this needs to be better understood. The main aim of this project was to contribute to understanding how to optimise A&F interventions for healthcare and increase the improvements that can be achieved in terms of quality, safety, efficiency and effectiveness.

The project:

  • co-designed prototypes for audit and feedback interventions for antibiotic prescribing and fissure sealant placement;
  • pivoted to better understand how the COVID pandemic impacted dentistry on prescribing and fissure sealant placement and how quality improvement initiatives were viewed going forward and the work highlighted just how hard dentistry had been hit by the pandemic;
  • COVID work led to exploring over which contexts and circumstances audit and feedback should not be started at all. A review of theories commonly used within audit and feedback work, a review of the existing empirical literature and key informant interviews were collated into a guidance paper of considerations for decision making about starting audit and feedback.

Funder: The Healthcare Improvement Studies (THIS) Institute

Project lead: Dr Eilidh Duncan, THIS Postdoctoral Research Fellow

Project mentor: Prof Craig Ramsay

Project advisory group: Prof Louise Locock, Prof Marion Campbell, Prof Jan Clarkson, Dr Jeremy Grimshaw