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Clinical Audit In Hospital- STAGE 4


									 STAGE :FOUR

making improvements
  Changing behaviors

• Theories of how behavior changes help to
  explain the influence of the situation in which the
  change occurs.
• Encountered in many different fields,
• Education and learning,
• Management,
• Economics,
• Sociology,
• Psychology.
 NCCSDO (National Co-ordinating Centre
for NHS Service Delivery and Organisation)

 summarised the change management
 literature and described the context of the
 modern NHS (Iles and Sutherland, 2001)

• different socialisation processes of the

• different needs and expectations of
  different client groups
• the different histories of different

• local priorities, resource allocation, and
  performance management.
Organisational change

• Organisations can be thought of as
  existing in a state of quasi-equilibrium, in
  which driving forces are opposed by
  restraining forces, with the net effect that
  changes in the organisation are
Driving forces                 • Restraining forces
• Patient pressure             Individuals
• National policy              • Fear of increased
• Demands from referring          workload
  general                      • Concern about staffing
• practitioners for improved      and mix
  access                       • Loss of control over work
                               • Resistant culture
                               • Lack of resources
                               • Rigid structure
Group change

• A group exerts pressure on its members to
  conform, and this pressure can be so
  powerful that individuals not only comply,
  but come to believe that the group view is
  valid and adopt it as their own
Individual change

• The trans-theoretical model, which was
  developed for management of people with
  addictive behaviours, such as smoking
  (Robertson, 1999), explains individual
  behaviour change as a transition through a
  series of five stages:
• precontemplation – the individual has no
  intention of changing.
• contemplation – change is regarded as a
  possibility in the near future.
• preparation – explicit plans are made.
• action – the change occurs.
• maintenance – the changed behaviour is
Identifying barriers to change

• If the barriers to change are identified
  beforehand, implementation methods can
  be tailored to overcome them.
• Obstacles to change can be identified in
  several ways (Table 13), but generally the
  simplest and most practical method should
  be used.
Some methods of identifying barriers to change.

•   Interviews of key staff and/or users.
•   Discussion at a team meeting.
•   Observation of patterns of work.
•   Identification of the care pathway.
•   Facilitated team meetings with the use of brainstorming.
Implementing change:

• A recent review of tools, models and
  approaches to changing management in
  the NHS. (Iles and Sutherland, 2001)
  provides a helpful overview of how change
  can be.implemented, addressing issues
  affecting the management of health
  services rather than just clinical care,
  which tends to be the focus of clinical
Promoting successful audit

• Most health professionals have taken part
  in audit before, and their experiences
  support the more formal reviews of
  implementing change – it is possible to
  change practice, but it is not a simple
• Factors that promote the success of clinical audit

• lack of resources
• lack of expertise in project design and analysis
• lack of an overall plan for audit
• poor relationships between professional groups or
  agencies and within teams
• organisational problems, such as lack of a supportive
  relationship between clinicians
• and managers (Johnston et al., 2000).
Establishing the right environment

 • Nature of environment is more
   important for the implementation
   than for other aspects of audit.
Individual environments

• Individuals need time to implementing
• Giving opportunities to think, discuss
  practical issues with others make a
  change less of challenge.
• Time alone is not sufficient, systems and
  support also available to help in improving
  existing skills or develop new ones of
Team environments

• teams must be able to meet together, to
  discuss their objectives and share ideas
  about making changes in their work.

• Once meetings are established,leadership
  skills are needed to establish effective
  communication and ensure that everyone
  is able to contribute
Organisational Environments

• chief executives are accountable on behalf
  of trust boards for assuring the quality of
• seeks to improve it should regard the
  experience of service users as the starting
  Point for change.
• Must not fear external review by the health
  service or the public,

• Must be able to show openness and
Users and the public

Communication with the local public must be
  good, and depends on effective
  communication systems.
• All trusts are to ask users for their views
  on the services they have received.
• Every local NHS organisation is to publish
  a patient prospectus setting out the range
  of services available and the ratings users
  have given them.
• Financial rewards to trusts are to be linked to the
  results of the annual National Patient Survey.
• User versions of guidelines and other forms of
  information for users about the care of particular
  conditions are to be routinely available.
• annual prospectuses, published by all trusts and
  Local Health Groups, that set out the services
  available (ministry of health and social

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