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The last purpose highlights the fact that many clinicians accept clinical
audit also as an educational activity, led by the profession but reported in general
terms to managers.
1.1.2. Internal or external audits
Multidisciplinary clinical audit concerns not only the clinical practice
within individual professions but also demonstrates the contributions made by
each and the organizational links between them. Clinical audit thus reflects the
clinical directorate and health care team setting, as well as their relationship to the
overall management structure.
The general principle of audit imposes the requirement that the auditor has
to be independent of the service or process to be audited. Clinical audits are often
internal, i.e. carried out within a certain health care institution, when the principle
of independence is implemented by nominating auditors from subunits or
departments of the institution different from the subunit to be audited. Internal
audits should be routine activities within a good quality system.
Emphasis has recently been placed on external audits, in which the auditors
are external to the institution to be audited and thus totally independent of this
institution [3]. The value of external audits lies mainly in providing the audit with
more universal and broader perspectives, removing the possible inability of
internal auditors to recognize, in their own environment, the weaknesses and
limitations which may involve long-standing or routine practices. The external
auditors may be able to better judge the consistency of procedures from one
health care service to another and from one user to another. Recognition of
substantial variations of a medical procedure among health care services and
among clinicians can encourage a more systematic approach to this procedure
and lead to subsequent improvement of the agreed practices. The systematic
undertaking of clinical audits in a local or national health care area, and the
sharing of the knowledge of good practices with a wider audience, will also
contribute to further quality improvement of the practices, for the benefit of the
medical services, patients and staff.
By comparing the practice of the service against the standards of good
practice, clinical audits can inform the staff of the health care service, as well as
all other stakeholders, about the essential elements of quality and the weak points
of the overall clinical service. The audits will indicate areas for improvement and
provide reassurance on issues such as safety and efficacy, all of which are
essential to creating an environment of continuous development.
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