The Staff-Designed Medical Audit

Abstract

The presentation describes a cyclic process of patient-care evaluation especially suited for use in ambulatory care settings. The cycle is discussed in detail, beginning with topic selection and moving through all steps to the final activity, reevaluation. Rather than assessment of a single individual's competence, the development of a composite profile of performance for the group is made possible through examination of the four perspectives of prevention, investigation, management, and outcome. The standards, or criteria, are developed by those whose performance is to be evaluated, thus assuring a high degree of commitment to the process.

In the 2 1/2 years' experience with the use of such staff-designed audit at one health service, 10 of 11 re-audits, performed after intervals of 6 to 12 months, have demonstrated improvement in performance when measured against the same criteria. Each of 13 new topics considered during this period has provided subject matter for staff meetings, either through general discussions, review of pertinent literature, or presentations by invited speakers. Such data provide supporting evidence for the concept that a nonpersonalized, internally-developed assessment process can elicit significant commitment to improved patient care and to ongoing education.