"Toward Clinical Excellence" is a series of publications developed to assist practitioners and managers as they work to improve clinical quality in the New Zealand public health system. This publication, the third in this series, provides a handbook for practitioners developing expertise in peer review and clinical audit as part of their service quality plan.
The systematic critical review of the quality of clinical practice by a multidisciplinary team is the key to improving outcomes for service users. Clinical audit, peer review and evidence based practice methodologies provide practitioners with knowledge to better understand the nature of their clinical practice.
At a policy level there is strong support for this development from the Minister of Health. The New Zealand Health Strategy (King 2000), along with the recently introduced Health and Disability Sector (Safety) Act 2001 and health professionals competency assurance legislation, provides clear direction toward quality improvement in health care. In addition, the new Clinical Services Directorate in the Ministry of Health has assembled key staff to provide more effective support and co-ordination for national quality improvement projects.
The most important factors driving the success of the move towards improved clinical quality, however, reside within District Health Boards themselves. Key success factors within their organisational culture include a focus on improving outcomes for service users, a commitment to learning organisation principles and a system of identifying and rewarding clinical quality improvement ‘champions’ to provide clinical leadership at both organisational and service levels.
The task of implementing activities for clinical quality improvement provides a number of challenges for health professionals, not least of which is prioritising the competing demands on available time and resources. Achieving a clinical environment in which all health professionals understand the concepts and tools required to be effective in their clinical audit activities, however, is well worth this investment. As a result, we can look forward to improved outcomes and satisfaction for service users and the maintenance of professional integrity at both practitioner and service levels.
Dr Colin Feek
Clinical Services Directorate