Quality assurance

Abstract

The Department of Health in the UK in 1989 described audit as “The systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient."9 In reality, the medical profession has always undertaken a process of self-evaluation and group analysis of medical care, it is just that it was not called audit until about 15 years ago. What the rediscovery of the whole process in the late 1980s did, however, was to increase the profile of the process and make it more systematic and structured in application. The process up to that time had existed, but had been undertaken in a more haphazard way. The underlying aim of audit was to improve, maintain, and protect the quality of medical care. The reasoning behind the system went along the lines that the best way to do this would be to regularly and comprehensively review practice. Clearly, however, reviewing practice is only a part of the whole process. There is little point in reviewing current practice and simply filing the results. The findings must be compared with a known (previously defined or newly created) standard to calibrate the practice against that measure. The question must then be asked “Are we achieving the standard, could we do better?” The next obvious step is to introduce appropriate changes which it is anticipated will improve the quality of the care to either achieve or exceed the standard. But one cannot be certain whether or not the change has been successful unless we re-examine the whole process after an interval of time and again compare the situation with respect to the original, or revised, standard. Hence, the whole process of audit is one in which the care process is examined, compared with the standard, changed appropriately and then re-examined. This has been termed the “audit cycle."10.