Book review: M. Kogan and S. Redfern et al.. Making use of clinical audit. A guide to practice in the health professions, Buckingham: Open University Press, 1995. Price (UK) £14.99.
✍ Scribed by Ann Pursey
- Publisher
- John Wiley and Sons
- Year
- 1997
- Tongue
- English
- Weight
- 62 KB
- Volume
- 12
- Category
- Article
- ISSN
- 0749-6753
No coin nor oath required. For personal study only.
✦ Synopsis
When I was asked to review this book I thought ``Oh no, not another dreary book on clinical audit''. However, I was quickly reassured by the excellent second chapter of this book which places the development of clinical audit within a policy and organizational context. In particular, the concise description and analysis of some of the fundamental policy changes of the last decade will enable the overseas reader to understand more clearly the issues shaping health care in the UK. The description of the historical development and emergence of audit within the UK provides a vital backdrop to discussions later in the book. Also useful is the discussion of links between clinical audit, the quality assurance movement in general and the generation of knowledge, again placing audit within a broader context. More important, perhaps, is the connection between clinical audit and wider organizational frameworks within the NHS which is not comprehensively explored within this chapter, though it retains a signi®cant presence throughout the remainder of the book.
The core of this book focuses on a discussion of the ®ndings of a large Department of Health-funded study undertaken around 1993. The overall aims of the study were to analyse examples of audit practice and to ``produce guidelines on models of good practice upon which professions might base their audit activities in the future'' (Appendix 2, p. 148). The four clinical professions studied were: clinical psychology, physiotherapy, occupational therapy and speech and language therapy; and, the research team also examined the impact of health service managers, both professional and general, on audit practice. Fieldwork was conducted in six main case study sites with a further three sites involved in testing the clinical audit models developed as a consequence of the research. Whilst the focus is naturally on issues concerning the four therapy professions, the book has much to say about clinical audit generally and should be useful to anyone working within the health care setting. Developments described within the book tended to be initiated within provider units as there were little or no purchaser-stimulated audit projects within the study sample.
Another chapter I found interesting was one which described managerial concerns with audit. The authors reiterate the point that managerial support for developments is a signi®cant factor in determining their success. It also highlighted the diering interest in the use of audit by dierent stakeholders. For example, audit projects initiated by general managers were more likely to be structure and process oriented, whereas the therapy-initiated projects were more likely to be process and outcome oriented. It was clear that members of health care organizations viewed the utilization of audit in dierent ways, depending upon the emphasis of their job role. The chapter very clearly identi®ed managerial approaches and priorities for audit; an area which has not been very well explored/articulated to date.
As a researcher, I was equally as interested in the research approach used by the team. The research approach hinged, ®rstly, around analysis of policy aimed at introducing clinical audit at the provider level, with a second stage concerned with creative modelling and the production of guidelines for future audit activity. At a time when service-and cost-modelling are enjoying increasing popularity within the health care arena, the book would provide some useful insights into the application of modelling techniques.
Although the book is based on a signi®cant piece of academic research, the style of writing should appeal to clinical sta, middle management and researchers/quality