When clinical audit was first introduced, it ruffled a few feathers among clinicians. But auditing the audit process itself can highlight the real benefits to clinical practice and quality of care, as well as identifying any weaknesses - and show that many clinicians are quite satisfied with audit staff and their work.

Clinical audit at Burnley Health Care trust began in 1991 with two co-ordinators. The clinical audit department now has 6.9 whole-time equivalent staff and a budget of£170,000. In the past 12 months it has completed 59 audits covering all departments. Each department is now compiling a list of topics for audit this year.

Changes to practice introduced as a result include refinement in the use of portable x-rays in accident and emergency , the introduction of orthoptic sessions at the hospital to supplement those held in the community and agreement on guidelines for the prescription of statins.

We decided to examine the departments effectiveness.

In particular we wanted to ensure that:

the auditors had the skills required for their job;

our reports were accurate, and their content and style acceptable to clinicians;

the audit projects were providing real benefits to clinicians;

the audit projects were facilitating improvements in the healthcare process;

preparations could be made for changing demands on the audit department with the development of clinical governance, the introduction of national service frameworks and the increased demand for participation in national audits.

The first part of the research aimed to identify clinicians perceptions of clinical audit. The second was to examine the competencies of audit staff.

An anonymised questionnaire was circulated to the trusts clinicians and managers during June and July 1999, asking about the usefulness of the department s work and its reports, strengths and weaknesses, and the department s success in initiating change.

What the clinicians and managers said A total of 35 questionnaires (35 per cent) were returned.

The results showed that most clinicians (57 per cent) found the services provided by the clinical audit staff to be satisfactory.

An even higher proportion (91 per cent) found audit staff to be friendly and helpful, providing adequate support (63 per cent) and satisfactory reports (71 per cent).

There were no negative comments about the skills of audit staff, but many respondents said they felt unqualified to comment on this. The overall results of the evaluation were positive. Weaknesses identified included the view that audit could not, on its own, effect change, long waits to get audits done and lack of detail in some reports.

Three exercises were undertaken to examine the competencies of audit staff. First, the form of audit reports was examined. As they lacked standardisation, a framework of what we considered essential in a model audit report was compiled. This draft framework was presented to the North West regional audit co-ordinators group so we could seek the views of a wider field of clinical audit experienced auditors.

Second, an annual appraisal system has been introduced for all audit staff. This includes a personal training and development plan so we can ensure that staff have the necessary skills to perform accurate audits. Such skills included communication and time management in addition to conducting clinical audits.

Finally, meetings have been organised with various key stakeholders to discuss how to evolve the trust's audit process to meet the demands of clinical governance. A presentation has also been made to the trusts clinical governance committee to discuss the integration of audit with governance.

The following further development is planned:

work on weaknesses identified in the evaluation;

repeat evaluation in a years time;

implementation of the model audit report framework;

an in-house audit of our reports against this framework;

planning of staff training, where needs are identified through auditing reports or the staffs annual performance and development reviews;

development of a methodology for costing audit projects so clinicians can compare the costs of audits against the level of change or benefits achieved as a result.

Conclusion The audit process is now well established at Burnley . But the audit department needs to continue self-audit to ensure we are working effectively.

Audit needs commitment, participation and acceptance at local level of the values that can occur.

This can only be achieved when accurate audit is performed, which in turn requires continual self-audit.