Enhancing national audit through addressing the quality improvement capabilities of feedback recipients: a multi-phase intervention development study

Sykes, Michael, O’Halloran, Elaine, Mahon, Lucy, McSharry, Jenny, Allan, Louise, Thomson, Richard, Finch, Tracy and Kolehmainen, Niina (2022) Enhancing national audit through addressing the quality improvement capabilities of feedback recipients: a multi-phase intervention development study. Pilot and Feasibility Studies, 8 (1). p. 143. ISSN 2055-5784

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Background: National audits are a common, but variably effective, intervention to improve services. This study aimed to design an intervention to increase the effectiveness of national audit.
Methods: We used interviews, documentary analysis, observations, co-design and stakeholder engagement methods. The intervention was described in an intervention manual and illustrated using a logic model. Phase 1 described the current hospital response to a national audit. Phase 2 identified potential enhancements. Phase 3 developed a strategy to implement the enhancements. Phase 4 explored the feasibility of the intervention alongside the National Audit of Dementia and refined the intervention. Phase 5 adapted the intervention to a second national audit (National Diabetes Audit). Phase 6 explored the feasibility and fidelity of the intervention alongside the National Diabetes Audit and used the findings to further refine the intervention.
Results: The developed intervention is a quality improvement collaborative (QIC), containing educational workshop, outreach for local team leads and facilitation of a learning collaborative delivered after feedback has been received. The QIC aims to support national audit recipients to undertake improvement actions tailored to their local context. The target audience is clinical and clinical governance leaders. We found that actions from national audit were constrained by what the clinical lead perceived they deliver personally, these actions were not aligned to identified influences upon performance. We found that the hospital response could be enhanced by targeting low baseline performance, identifying and addressing influences upon to performance, developing trust and credibility, addressing recipient priorities, presenting meaningful comparisons, developing a conceptual model, involving stakeholders and considering the opportunity cost. Phase 3 found that an educational workshop and outreach strategy could support implementation of the enhancements through developing coherence and cognitive participation. We found feasibility could be increased by revising the content, re-naming the intervention, amending activities to address time commitment, incorporating a more structured analysis of influences, supporting collaboration and developing local feedback mechanisms. Phase 5 found adaptation to a second national audit involved reflecting differences in the clinical topic, context and contractual requirements. We found that the behaviour change techniques identified in the manual were delivered by facilitators. Participants reported positive attitudes towards the intervention and that the intervention was appropriate.
Conclusions: The QIC supports local teams to tailor their actions to local context and develop change commitment. Future work will evaluate the effectiveness of the intervention as an adjunct to the National Diabetes Audit.

Item Type: Article
Additional Information: Funding information: This report is independent research arising from a Doctoral Research Fellowship (DRF-2016-09-028) supported by the National Institute for Health Research. The views expressed in this presentation are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.
Uncontrolled Keywords: Audit and feedback, Quality improvement, Intervention development, Implementation
Subjects: B700 Nursing
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Elena Carlaw
Date Deposited: 18 Jul 2022 12:11
Last Modified: 18 Jul 2022 12:15
URI: http://nrl.northumbria.ac.uk/id/eprint/49562

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