Published: 07/06/2002, Volume II2, No. 5808 Page 28 29

Principles for Best Practice in Clinical Audit By The National Institute for Clinical Excellence

Publisher: Radcliffe Medical Press. ISBN: 1857759761.

206 pages.£29.95 (paperback).

As the foreword to this book says, too often local and national audits have failed to bring about change.

As far as clinical audit is concerned, the lesson of the Bristol baby deaths tragedy is that simply observing data is not enough.There has to be commitment from individuals and organisations to review their work, learn from it and implement changes to make the future better than the past.

This book is an excellent source of background material on audit. It is well written and easy to follow.

Two-thirds of the book consists of appendices giving details of projects, contacts and sources of information.

The main text is divided into the five stages of audit: preparing for audit, selecting criteria, measuring levels of performance, making and sustaining improvements.

It is well referenced, without being off-puttingly academic.For the technophiles among you, a useful CD contains the (searchable) text of the book, and bibliographic details of the evidence on which the key points are based.

However, what the book will not do - and, to be fair, it does not claim to - is provide the impetus for the NHS to take clinical audit to its heart and put it to work.

In that sense, while the book succeeds well in its own terms, I could not help feeling that we are in danger of continuing to miss the point: the problem with clinical audit is that it is talked about and not done.

So, for example, the 'statement' from NICE on clinical audit which prefaces the main text is written by policymakers, not those who struggle with frontline care.There is nothing to quarrel with, but it left me feeling 'yes, but...' Another problem - dealt with as well as any book could - is that 'clinical audit'covers diverse activities, including monitoring the outcomes of care and measuring processes.

Its context may be that of learning, or management, or inspection.These environmental issues cannot be ignored: context-free clinical audit is no audit at all.And yet, the book necessarily has a restricted scope, exploring what works on the basis of the available evidence - back to saying that the content is good, but will not of itself change anything.

The most significant technical omission is the failure to relate clinical audit to the large, and growing, literature on quality control and quality improvement in both health services and other sectors.

This reflects the rather theoretical (as opposed to academic) approach - but then a book is not the place to learn to practice what is preached.

If the publication of this book heralds the resumption of official interest in audit, it is particularly welcome.

Understandably, when it started, the National Institute for Clinical Excellence focused on technology appraisals.

But the debate over new technologies, particularly pharmaceuticals, has distracted attention from the potential power of clinical audit to influence the quality and cost of everyday services, as well as typical patient experience.This is, by definition, where most of the action is.

So, two hearty cheers for this book.For anyone who has responsibilities in clinical governance and clinical audit, it will be useful to dip into. It will provide useful leads.But it will not change organisations, and it will not inspire.Let us hope that the various reforms, of which NICE is a part, will actually deliver what is promised.