Why Audits Are Important.

One of the things I regularly find when undertaking mock inspections for providers is that while they get so much else right and provide a great service, they either skimp on their audits or just do not do any at all. The ‘reasons’ for this are invariably the same, “we have not got time”, “they do not improve what we do” and “we already know what we are doing”.

One of the recurring features of the reports for providers who skimp or skip audits is that they invariably need to improve what they do and, contrary to what they believe, have not got any insight into what their staff are doing.

While there are times when audits should take a back seat, for example during the height of the pandemic, audits in social care settings are invariably useful if they are used to improve care. Also invariably, they are one of the features which define services which get the best Care Quality Commission (CQC) reports and ratings.

In this short blog, we look at why audits are important and take a brief glimpse at how they fit into quality improvement processes. In a later blog we will consider how audits should be undertaken and how this can fit into the daily work of social care provision.

Why audit is important

As noted above, providers who undertake audits tend to get better CQC reports. This is not because they do the audits per se, but because audits feed into quality improvement and in so doing improve standards and meet many of the requirements of the five key questions.

Audits provide proof that providers are effective at what they do – providers that fail to audit cannot prove their effectiveness. They can be used to review the provision of care and the achievement of outcomes and to benchmark care against standards and quality statements. In this they show effectiveness both to the provider and to the inspector.

Audits show that providers are safe, because they measure what they do and make changes if they are not safe. Audits allow providers to monitor activities they do not observe first hand such as the administration of medication, and some infection control practices, and show that these practices are being undertaken in a way which promotes safety.

Well led care providers use audits to underpin accountability in the team, to manage risk and drive quality improvement in the team. It is a feature of well led providers that they make time for audit, because audit keeps them abreast of what is happening in their service and enables them to retain an on overview of care provision and quality.

How should audits work

One thing I have found with many providers over the years is that they undertake audits but do nothing with the results. Audit is in fact a process, not a one of event. Its purpose is to gather facts about an element of work and use these facts to compare what a provider is doing against what should be done – against the gold standard – or to provide a benchmark when no standard exists.

The process then involves making and embedding any changes which need to be made to achieve the standard. And then the whole process starts again auditing the changes to see if the changes have improved the provision of care. It really is that simple.

Perhaps some examples will help…

If the standard being checked in one of the audit questions is ‘did staff complete all of the planned care tasks for the person that day?’ then the record needs to be integrated to answer this. On an electronic care management system such as Nurse Buddy, it is easy, the system identifies when a care intervention is undertaken and when it is missed. On paper, it requires the auditor to look at the carers entries to see that they have recorded tasks or completed charts. If any intervention(s) are missed, then the answer is no, “staff did not complete all of the planned care tasks for the person that day”.

Within the audit cycle the question then becomes why did they not complete all of the care interventions for that day? If the service user was away at an appointment, then there is an answer, but if there is no reason found, the question should become “what can we do to improve this situation?”

In well led teams, issues such as this are addressed through training, supervision, handovers and team meetings. Individuals who do not complete interventions get extra support and training until they improve, or leave. The issue is then reaudited.

Finding imperfection is helpful

The purpose of audit is not to find perfection – although this is always worth celebrating where it exists. No-one can improve on perfection and, anyway, no one really believes that any service is 100% perfect – rather the opposite in fact. Providers who kid themselves that what they do and how they do it is perfect often get a big shock when the local authority or CQC inspect them because audit results which suggest perfection are almost certain to invite closer scrutiny.

Going round a service and removing all of the wedges from fire doors and then ticking that the service is compliant in that “all fire doors are functioning” does not help anyone. All it does is produce an audit outcome which is untrue, and which does not give the service the opportunity to address the issue of wedge use.

Similarly, enabling staff to correct medication data entry errors prior to an audit does not support the service in demonstrating a commitment to continuous improvement, nor does it send a clear signal to staff about getting things right first time, rather the opposite it promotes mediocrity.

The purpose of audit is to find issues and then to address them, not find issues and deny or hide them.

In their single assessment framework, the CQC point out in various places that they are looking for; “continuous improvement”, that “staff and leaders have a good understanding of how to make improvement happen” and that “managers can account for the actions, behaviours and performance of staff.”

What this means is that managers look at the reality of what they do and address any shortcomings and celebrate any areas of strength. Audit is one of the best ways of doing this.

This looking into the reality of the service then feeds into quality improvement where the service amends what it is doing to meet standards where it is not already and where it does more of the things it is getting right.

Summary

This blog has highlighted why audit is so important to the life of any social care provider. We have seen that audit is a cycle and is itself part of the bigger cycle which is quality improvement.

We have identified that one of the biggest dangers of audit is self-delusion, that is correcting issues during an audit or deliberately ignoring them in order to get a better audit outcome. We have seen that this is dangerous in that providers who fail to undertake audit properly are likely to get a shock when they are subject to external inspection.

Bettal Quality Consultancy has a comprehensive and regularly updated suite of policies, procedures and risk assessments tailored to all forms of social care provision, to support busy registered managers and their teams in the provision of CQC compliant care. We also have audit tools deigned to meet the demands of the single assessment framework and enable providers to prepare for their CQC inspection.

If you are still not sure whether your service would benefit from adopting our quality management systems and would like to know more, browse our website or get in touch with our friendly team of humans (no chat bots here):

Email: info@bettal.co.uk
Telephone: 01697741411

Peter Ellis MA MSc BSc(Hons) RN
Consultant
Bettal Quality Consultancy