title: The lack of integration of clinical audit and the maintenance of medical dominance within British hospital trusts.
abstract: Concerns have been expressed repeatedly about the effectiveness of clinical audit. Some have argued that this is limited by the lack of integration within day-to-day practice and with other NHS policy initiatives. We aimed to explore what mechanisms were being used to develop annual clinical audit programmes within NHS Trusts, and to describe the influence of other initiatives on this; to understand how such influences are exerted; and to understand the role of key players, in order to inform future programme development. Semi-structured face-to-face interviews were performed with Chairs of Clinical Audit Committees, Clinical Audit Managers and Co-ordinators (N = 15) in the former Yorkshire Region of the NHS in England. Concerns about the development, planning and integration of clinical audit focused upon an almost exclusive medical dominance and upon how audit leadership could be delivered within the context of hospital management structures. The lack of an overall plan for the development of clinical audit in most sites was seen as enabling the doctors' agenda to dominate. Purchasing authorities were recognized as being important, but often with limited influence. Other influences on the audit agenda, such as research and development (R&D) and clinical risk management, were rarely well co-ordinated. These findings concur with previous studies in identifying a wide range of constraints on the progress of audit. Several of these constraints operate within the internal environment, for example the doctors' agenda, and concerns about management involvement. Such constraints require resolution in order to facilitate the integration of audit with other initiatives and to achieve the goals of audit effectively. Clinical effectiveness and clinical governance may offer a means of facilitating this integration.
authors.affiliation: Dewsbury Health Care NHS Trust, UK.
authors.forename: T L
authors.initials: TL
authors.lastname: McErlain-Burns
authors.forename: R
authors.initials: R
authors.lastname: Thomson
mesh_terms: D006291:Health Policy; D006779:Hospitals, Public / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007400:Interprofessional Relations; D008485:Medical Audit / Q000379:methods* / Q000458:organization & administration; D011209:Power, Psychological; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom