Audit in Podiatry Medicine
Auditing plays a very crucial role in organizations and not just in podiatry medicine. It is usually divided into two, where we have both internal and external audit. The role of internal audit is to “provide independent assurance that an organization’s risk management, governance and internal control processes are operating effectively” (Institute of Internal Auditors, 2010). Internal auditors deal with issues that are pivotal to the survival and success of the organization. They look at such things as the organizations standing in society, the way the organization treats its employees, growth and development, and the organization’s impact on the environment. External auditors however, look at such issues like financial risks and statements of the organization (Institute of Internal Auditors, 2010).
National Institute for Clinical Excellence (2008) describes Clinical audit as a “process of improving quality that tries to find a way to improve patient care and outcomes through systematic review of care against overt criteria and the implementation of change”. To do this, aspects of the structure, processes and outcomes of care given are selected and systematically evaluated against a clear-cut criteria. Where indicated, changes are implemented at an individual, team or service level.
When conducting a clinical audit, some key notes need to be observed. These are:
Firstly, clinical audit projects are best conducted within a structured program. They should have effective leadership and emphasis on team work and support and participation by all staff. Organizations should also know the fact that this kind of exercise requires enough funding. Another thing that organizations need to recognize is that improvements in care resulting in clinical audits can increase costs. The barrier that is cited as the most common in clinical audits is the failure by the organizations to provide enough protected time for the healthcare teams.
Organizations should make sure that their healthcare staffs learn the skills of clinical audit, and that those involved in organizing audit programs must consider various methods of making sure that health service staff provide their full participation. Nice says that another key note is that clinical audit is used to improve aspects of care and is used to confirm that the current medical practice being offered meets the expected level of performance. Participation of staff is important especially in selecting topics because this enables concerns about care to be reported and addressed. This is not always necessary, but it may play a big role in reducing resistance to change. Lastly, since what is important to the patients that are receiving care are significantly different from those of clinicians, service users should therefore be involved in the clinical audit process (2008).
According to the Board of Podiatric Medicine (2010), one of the roles that audit plays in podiatry medicine is the role of ensuring that doctors of podiatric medicine (DPMs) show continued capability in their work. According to section 2496 of the State Medical Practice Act, requirements for continued competence are specified and it authorizes the Board of Podiatric Medicine to adopt regulations to ensure the “continuing skill of persons licensed to practice podiatric medicine”. Every time a renewal is done, a DPM must officially state that he agrees with one of the following under punishment of false swearing, subject to audit: that the DPM, is required to have passed an exam administered by the board within the past ten years.
He is to have passed an exam administered by an approved specialty board within the past ten years, to have completed an approved residency within the past ten years. He is also required to have current, suitable or competent status with an approved specialty board. He is to have passed Part 111 exam administered by the National Boards within the past ten years, be recertified by an approved specialty board, and have completed an extended course of study approved by the board within the past five years. He should have granting/renewing healthcare facility privileges within the past five years.
Audit is also important in podiatry medicine, because it helps keep doctors accountable to their patients. Though this is not common practice as such, there is one surgeon, Ernest Amory Codman MD (1869-1940) who employed this rule in his profession. Despite the fact that he was one of the best doctors of his time, even he made mistakes. The only difference between him and his counterparts was that instead of hiding his mistakes, he publicized them and chose instead to learn from them. It is said that he “recorded diagnostic and treatment errors and linked these errors to outcome in order to make improvements” (Neuhauser, 2002). He resigned from Massachusetts General Hospital where he was a staff and started his own private clinic called the “End Result Hospital”.
The difference between Codman’s hospital and the average healthcare organization is that he admitted his errors in Print and in public. He published this report so that patients would be the ones to decide whether they would be able to receive quality care from him, and the outcome of the care provided. He sent copies of these reports to major hospitals throughout the country, challenging them also to follow his prints, but this did not happen. They would say that they were not allowed to do so by their lawyers.
Another role that audit plays in this field of podiatry medicine is to improve the practice of the doctors. The General Medical Council advises that it is mandatory for all doctors to take part in regular and systematic medical and clinical audit. They are advised also that when doing this, they should record their data honestly, so that they are able to get the proper results and be able to improve their practice, by for example, taking part in further training. The UK Central Council for Nursing, Midwifery and Health Visiting, says that every registered practitioner is responsible for assisting the coordination of quality improvement initiatives such as clinical audits.
Clinical audit is indeed an important exercise to carry out in one’s organization. According to the Royal Society of Psychiatrists (2009), the main reason that audits are done is to improve the service offered to users. They say that without some form of clinical audit, it is not easy for one to know whether they are doing the right thing or even practicing effectively. If you are not sure about this yourself, then it also becomes a difficult task to demonstrate to others that you are practicing effectively. Some of the benefits of clinical audit are audit helps to ensure that working relationships, communication and liaison between staff, staff and service users (the people who receive service from medical practitioners), and between agencies are improved. It identifies and promotes good practice, and it may result to the improvement of service delivery and outcomes for users. Another benefit of doing clinical audits is that when performed, one is able to provide information to show your users that your service is effective and pocket friendly,
thus, ensure its development. Audits provide opportunities for education and training. They help increase efficiency by ensuring that there is better use of the resources that are available. They also help in improving working relationships, communication among staff members, staff and service users and between agencies.
Audit is an avenue that medical professionals can use to retain the trust and respect of their patients especially in an era where the patients are becoming increasingly critical. This is one of the ways that they can establish and maintain confidence in the quality of clinical care that is being accorded to them. It is a quality improvement tool, and through it, one may be able to tell whether efforts are being made by medical professionals to give their patients high quality professional care. It is increasingly becoming an essential component of professional practice (Nice, 2008).
When done in the right way, audit has provided a way in which the quality of care that is given to patients by medical professionals can be assessed and reviewed objectively, within an approach that is supportive and developmental. All areas of professional practice have been subjected to questions and challenges due to changes in society. Clinical audit therefore provides medical practitioners with a way of responding that compares the care given to the best practice while keeping the central role of the clinical team in agreeing and implementing plans for change. Clinical governance provides a new challenge – “to take audit at its best and incorporate it within organization’s wide approaches to quality”.
Institute of Internal Auditors. (2010). What is an internal audit? Website, (online)
NICE. (2008). Principles for Best Practice in Clinical Audit. Report (online).
Royal Society of Psychiatrists. (2009). Clinical audit: what it is and what it isn’t. What is a Clinical Audit? Report (online).Site: http://www.rcpsych.ac.uk/pdf/clinauditChap1.pdf
Surrey and Sussex NHS Trust. (2006). Audit Committee, Terms of Reference: Report (online)
Neuhauser, D. (2002). Heroes and martyrs of quality and safety: Ernest Amory Codman. Quality Safety Health Care, 11, 104-105 (online).
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