title: Practitioner based quality improvement: a review of the Royal College of Nursing's dynamic standard setting system.
abstract: OBJECTIVE
  To explore and describe the implementation of the Royal College of Nursing's approach to audit--the dynamic standard setting system--within the current context of health care, in particular to focus on how the system has developed since its inception in the 1980s as a method for uniprofessional and multiprofessional audit.
  
  
  METHODS
  Qualitative design with semistructure interviews and field visits.
  
  
  METHODS
  28 sites throughout the United Kingdom that use the dynamic standard setting system.
  
  
  METHODS
  Quality and audit coordinators with a responsibility for implementing the system; clinical staff who practice the system.
  
  
  METHODS
  Experiences of the dynamic standard setting system, including reasons for selection, methods of implementation, and observed outcomes.
  
  
  RESULTS
  Issues relating to four themes emerged from the data: practical experiences of the system as a method for improving patient care; issues of facilitation and training; strategic issues of implementation; and the use of the system as a method for multiprofessional audit. The development of clinical practice was described as a major benefit of the system and evidence of improved patient care was apparent. However, difficulties were experienced in motivating staff and finding time for audit, which in part related to the current format of the system and the level of training and support available for clinical staff. Diverse experiences were reported in the extent to which the system had been integrated at a strategic level of quality improvement and its successful application to multiprofessional clinical audit.
  
  
  CONCLUSIONS
  The Royal College of Nursing's dynamic standard setting system can successfully be used as a method for clinical audit at both a uniprofessional and multiprofessional level. However, to capitalise on the strengths of the system, several issues need to be considered further. These include modifications to the system itself, as well as a more strategic focus on resources and support for audit, better integration of quality initiatives in health care, and a continuing focus on ways to achieve true multiprofessional collaboration and involvement of patients in clinical audit.
authors.affiliation: Radcliffe Infirmary, Oxford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Morrell
authors.forename: G
authors.initials: G
authors.lastname: Harvey
authors.forename: A
authors.initials: A
authors.lastname: Kitson
mesh_terms: D005069:Evaluation Studies as Topic; D007318:Inservice Training; D015401:Nursing Administration Research; D009731:Nursing Audit / Q000458:organization & administration / Q000592:standards*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards; D012956:Societies, Nursing; D013222:State Medicine / Q000592:standards; D017749:Total Quality Management / Q000379:methods*; D006113:United Kingdom