Ensuring that health services are of high quality is one of the three domains of public health practice (see Chapter 1). A high-quality health service is mainly characterised by the criteria for healthcare evaluation – effectiveness, efficiency, equity, accessibility, quality and satisfaction (see Chapter 43). Services also need to be able to adapt and improve continuously to integrate health and social care systems, make judicious use of new medical technologies and preventative opportunities and adopt new ways of working, for example using new information and communications technology, rethinking the location of care (closer to home), staff skill mix and enhanced roles for patients and carers.
Methods for improving and maintaining service quality include regulation of health professionals (revalidation) and healthcare premises (inspection), education, setting standards and targets, investigation of variation in clinical practice and the implementation of clinical guidelines (see Chapter 14). Commissioning (see Chapter 41) can also support service improvement by requiring service providers to undertake audit and implement findings. In this section, we describe some specific tools for improving services.
Clinical audit is defined as the quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change (NHS – Principles for Best Practice in Clinical Audit, 2002).
Audit involves the collection of data in order to assess whether an organisation’s performance standards are being met. Standards may be internally set or adopted from external evidence-based sources. As audit is a tool for improving services, it is essential that audit topics are chosen in the context of overall service provision and performance and that their findings are acted on, resulting in change (Figure 42a).