Improving care or professional advantage? What makes clinicians do audit and how well do they fare?

OBJECTIVE: To find out why clinicians undertake audit, the extent to which they complete the process of audit and their perception of the benefits of taking part. DESIGN: Semi-structured interviews. SETTING: Twelve trusts in three Scottish Health Boards. SUBJECTS: One hundred and forty five respondents of different status from a wide range of clinical specialities. RESULTS: Sixty six per cent of respondents defined clinical audit as a means of making changes with a view to improving care, but 62% reported the purpose of audit as the examination of the usefulness of treatment or the observation of practice. Personal reasons for taking part included justifying practice (32%) and as a means of professional development (15%). Twenty one percent held formal minuted meetings, the majority were informal. Sixty six percent of clinicians completed a project plan but pilot studies (49%) and re-audits (26%) were less common. Twenty four percent changed practice as a result of the audit. The extent to which the audit process had been completed predicted clinicians' ability to make changes. CONCLUSION: Clinicians' understanding of the concept of audit was not translated into practical projects. The main reasons for this are the organisational difficulties clinicians are faced with when carrying out audit and a lack of attention to all parts of the audit process. Despite this failure to achieve change, many clinicians felt they had benefited from their experience of audit. Management should appeal to these motivations of employees and provide a culture which enforces their importance over and above changing practice.