Table 1 Tool for reflecting on the implementation and maintenance of an audit programme
STAGE | QUESTIONS TO CONSIDER |
|---|---|
Stage 1: Create awareness • of problem (e.g. high PNMR) • that something must be done • of audit programmes that could be used | • What is the level of awareness of staff about the problem? • How can we create or improve a general awareness of the importance of audit among staff? • Do we have review meetings (e.g. perinatal review meetings) on a regular basis? ○ If no, how could we organise and institute these meetings? ○ If yes, how could we use the existing meetings to create better awareness of the importance of audit? • Should a specific person at our facility be designated to find out about the programme (e.g. PPIP)? • Could a representative of an institution using the audit programme or the owners of the programme (e.g. PPIP) be invited to come and tell staff about it? • Are other facilities in our area/district using audit programmes? ○ If no, what role can our facility play in reaching out to create awareness of the problem and the importance of audit? |
Stage 2: Commit to implement audit • More people commit to implement programme | • Can existing review meetings be used to facilitate commitment from more people? ○ How could we use this? ○ What needs to be done? • Can existing communication channels be used to facilitate commitment from more people? ○ How could we use this? ○ What needs to be done? • Are there specific persons whose commitment is required who need to be approached? ○ People at management level? Who? How? ○ IT officials? Who? How? ○ Clinicians? Who? How? ○ Government officials? Who? How? ○ Other? Who? How? • What steps are needed to get the use of the programme approved in principle? • What kinds of commitment are needed? (E.g. Who? What? Where? When? How?) ○ Written? ○ Verbal? |
Stage 3: Prepare to implement • Practical aspects to get the programme up and running | • What do we expect of the driver(s) of the process? • How will we identify the driver(s)? Who should be considered? • What are the financial outlays for getting the programmes and necessary equipment? ○ Must the audit programme be purchased or is it free? ○ What will orientation and training in the use of the programme cost? ○ Do we have a dedicated computer for capturing audit data? - Should more computers be made available? • How do we get budget approval for the purchase of the programme and other equipment (if applicable)? • What kind of support do we have from senior management on the practical aspects of the audit implementation process? ○ In what areas do we need additional support? ○ What else should we do to secure the necessary support? • Has the software for the audit programme been installed? • Who will be responsible for data entry? ○ Has this duty been negotiated with the assigned data capturer(s)? - How well have they bought into the idea? ○ What kind of computer training do they need? ○ What kind of training do they need in the use of the software? - How will that be organised? ○ What kind of support or incentives should be provided to the data capturers to make them aware of the value of their work? • What kind of quality control will be exercised on the captured data? • Who has been trained in interpreting the data and generating reports? ○ If no one, what should be done about it? • Are all the responsible clinicians trained in the use of the computer hardware? • Are all the responsible clinicians trained in the use of the software? • How are facility information officers or IT officials involved in the establishment of the system? ○ How informed are they? ○ What kind of support will they be able to provide? • What kind of support do we need from our outreach clinicians and other health department officials in our preparation for implementation? ○ How could these person(s) assist us in keeping the process on track or speeding it up? |
Stage 4: Implement audit • Collection of the first data • Analysis of the results • Dissemination of results | • Have we started collecting data? • How do we keep back-ups of data files? ○ Who is responsible for making back-ups? ○ How often are back-ups made? ○ How do we check that this is done regularly? • Are all persons sharing the computer(s) aware of the programme? (To avoid unintentional deleting of files or programmes) • How can accuracy and regular data entry be improved? ○ Are data always entered immediately? ○ Should refresher sessions on the use of the software be provided? • How is/are the driver(s) of the implementation process coping with the tasks? ○ What kind of additional support do they need? • How is feedback of results given at the review meetings? ○ How can we improve on this feedback? • How good is the attendance of review meetings? ○ How can it be improved? ○ Are attendance registers kept for review meetings? - If yes, how does it help us in what we are doing? - How do we use the information to ensure that all relevant role-players are invited regularly and/or have the opportunity to attend? • Is the usefulness of the audit programme (e.g. PPIP) evident at meetings? ○ If yes, how? ○ How can this be improved? • Are minutes taken at review meetings? ○ If no, how will we get this process going? ○ If yes, how can we improve on what we are doing? - How are the minutes used? - How are recommendations noted in the minutes? - Are timelines and the allocation of specific persons included in the recommendations? • How are the recommendations incorporated into in-service training? • How does the use of the results contribute to accountable behaviour of all relevant role-players? • What kind of support do we need from our outreach clinicians and other health department officials in the implementation process? ○ How could these person(s) assist us in keeping the process on track or speeding it up? • How can communication at different levels be improved? ○ Between providers at the coal face? ○ Between providers and their immediate managers? ○ Between managers and senior management? ○ Between the facility and the other levels of the health system? ○ Other? |
Stage 5: Integrate audit into routine practice • Data collection • Analysis of the results • Dissemination of results • Use of findings ↓ Routine practice | • Are audit duties written into the job descriptions of relevant staff members? • Is feedback on audit results regularly provided to all relevant service providers in the institution? ○ How can we improve on this? • Is feedback on audit results regularly provided to senior management in the institution? ○ How can we improve on this? • Is feedback on audit results regularly provided to higher levels in the health system (e.g. district, regional or provincial managers)? ○ How can we improve on this? • How are the audit data interpreted? ○ How can we improve on this? • What kinds of recommendations and improvements are suggested following the interpretation of data? ○ How can we improve this? • How are we faring with the execution of the recommendations? ○ What are we doing well? ○ How can we improve on the things we are not doing so well? • Does our facility need (more) visits from an outreach person or team to assist us with the institutionalisation of the audit programme? |
Stage 6: Sustain audit • Data collection • Analysis of the results • Dissemination of results • Use of findings ↓ Sustained over a longer period of time | • How can the regular review meetings be improved and used more effectively? • How often and to whom is feedback given? ○ Monthly? To whom? ○ Quarterly? To whom? ○ Six-monthly? To whom? ○ Annually? To whom? • What are the gaps in our feedback procedures? • How can the feedback to service providers and senior management in the facility be improved? ○ How can engagement in the audit process, the use of the findings and the application of recommendations be improved? • How can the feedback to the higher levels of reporting be improved (e.g. district or provincial levels)? ○ How can involvement from these levels be improved? • Who is responsible for keeping the audit system together? ○ One person? ○ A team? • Who is leading the audit? ○ Who takes responsibility when the leader(s) is/are not there? ○ What kind of succession plan do we have? • How do staffing issues such as rotations and turnovers influence the audit activities? ○ How can staff stability be improved? • What is our facility's responsibility in reaching out to another facility or facilities to introduce and establish an audit programme (e.g. PPIP)? |