Organising an audit or quality improvement project: tips for beginners

Organising a clinical audit is not only a requirement for the foundation programme, but also an essential skill that interviewers look for during specialty applications. From experience, junior doctors who are new to the hospital setting often find it challenging to initiate an audit or quality improvement project.

Here, we offer seven pieces of advice to anyone new to working in the hospital environment, and has a passion to improve patient care:

1. Be inquisitive: One of the first steps to organising an audit is to understand how the department and the wider hospital work. As soon as you start your new job, you should get to know the multidisciplinary team and form an idea of how patients flow through the hospital. This will not only give you ideas for an audit, but will also help you to understand how your audit would fit into the larger picture of the hospital organisation.
2. Go to audit meetings: Most departments have regular audit meetings. It will be useful to know what audits have been carried out in the department, in order to get an idea of what types of project are feasible. These meetings are also an excellent place to meet seniors who are actively engaged in the audit process, as well as consultants whom you can approach to support audit projects.
3. Look up guidelines: By definition, audits are carried out to improve services to meet an established standard. Read up on national and local guidelines to find recognised standards that are available pertaining to the department that you are working in. For national guidelines, the National Institute for Health and Care Excellence is an excellent platform to start.
4. Have your own ideas: Every proposal for an audit or quality improvement project would need to be discussed with a consultant, and their approval sought. Most consultants who have worked in the department for many years would have some idea of what a feasible quality improvement project could be, so I recommend approaching them with your ideas. Even if your idea is not feasible, consultants are more likely to guide you or provide suggestions when they see that you are taking the initiative and are passionate about improving patient care.
5. Start small: The holy grail of an audit or quality improvement project is to effect a change, not to generate an enormous amount of data to demonstrate a problem for which you have no solution. It is advisable to begin with a small sample of patients and to demonstrate an issue for which you could easily provide an intervention. Examples include the display of reminder posters or a teaching session to improve prescriber adherence to guidelines.
6. Planning ahead: Most foundation doctors work in 4-month rotations. It is important to plan ahead so that you have adequate time to conduct the initial audit, implement change and re-audit within this time period. If unable to do this, you could either liaise with one of your incoming colleagues to complete the audit, or make the extra effort to return to the department after work during your next rotation to complete the audit cycle.
7. Dissemination of your audit experience: Presenting your audit at a regional or national conference not only benefits you by building your portfolio, but also allows others to learn from your experience in providing better care. You might also come across an opportunity to collaborate with others to expand your audit into a regional project. Another way of dissemination is through publication in quality improvement journals such as BMJ Open Quality or RCP’s Future Healthcare Journal.