Why do clinicians do audits? Why do you want to improve care?

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<p>Malawi May 2012</p> <p>Why do clinicians do audits?Why do you want to improve care?What are values?</p> <p>Values are principles and beliefs that guide our actionsWhat are the values of your patients?In clinical practice whose values do we need to be aware of?Respect for the diversity of valuesIntroduction to clinical systems improvementWhat is the perfect healthcare system?No needless deathsNo needless suffering No delaysNo wasteNo inequalities No feelings of helplessnessImportant questionsYou are providing a service so who is the customer?Is there variability, waste, poor morale, poor value for money and defects in your system?Does your system have the capacity to cause harm?How much of your system adds value from the patients perspective?Has your system been designed?Why use clinical systems improvement methodologies?They are good at discovering waste in a systemCan tackle the problems in your service Can reduce waiting timesCan revolutionise your service (given commitment)Require a team of key stakeholders who can analyse a problem from different perspectives (including that of the patient)Who are the stakeholders in a better Malawian healthcare system?Which methodologies are useful to use when considering your audits?Root cause analysis and the use of 5 whys to truly discover the problemAsk the question why? 5 times to get to the bottom of the problem</p> <p>5 whys exampleThe patient was late in theatre, it caused a delay. Why? There was a long wait for a trolley. Why? A replacement trolley had to be found. Why? One of the trolley's wheels was worn and had broken. Why? It had not been regularly checked for wear. Why?</p> <p>The root cause - there is no equipment maintenance schedule.Setting up a proper maintenance schedule helps ensure that patients should never again be late due to faulty equipment. This reduces delays and improves flow. If you simply repair the trolley or do a one-off safety rail check, the problem may happen again sometime in the future.</p> <p>5 Whys group exerciseIn small groups, think of a problem that you have all experiencedAs the question why? 5 times to identify the root causeHow will you plan to improve the root cause?Was that easy?Some things are considered undiscussible but may be the underlying cause of organisational problemsThink about an example in your own workDivide a page into two columnsIn the right column: write down an actual or imagined conversation about an unsolved organisational problem on the rightIn the left column: write your unspoken thoughts &amp; feelings relating to the conversationNow you are more aware of any undiscussable problems, think about how you might discuss them Define a patient journeyIn two groups, discuss the patient journey for a 22 year old woman presenting with obstructed labourWhat are all the steps that she experiences from arriving at the hospital?All the members of staff she meetsAll the procedures she undergoesMap these steps out as a flow chart on paper</p> <p>Is our patient journey wasteful?Does every step add value to our patient?Waste that does not add value Unnecessary movement of patientsUnnecessary motion (equipment and consumables not to hand)WaitingUnnecessary tests and investigationsOver processing (repeated history taking, examinations etc)ErrorsOverdurden of staff</p> <p>Can you improve yourpatients journey?</p>