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The importance of a supportive environment in clinical audit: a pilot study of doctors’ engagement with the NHS National PET-CT audit programme

Ross, Petera; Hubert, Janec; Saunders, Miked; Wong, Wai Lupb

doi: 10.1097/MNM.0000000000000161
Original Articles

Purpose The NHS National PET-CT Audit Programme was launched in 2008 as part of a national NHS programme to widen patient access to PET-computed tomography (CT) imaging in England. However, to implement clinical audit effectively, healthcare professionals need to be fully engaged with the process. The purpose of the pilot study was to identify and explore the different factors that influence doctors’ engagement with the National NHS PET-CT Audit Programme.

Methods A single embedded case study was undertaken, which centred on the NHS National PET-CT Audit Programme. Seven theoretical propositions drawn from a review of the literature were tested and their influence evaluated. A purposeful sample of 13 semistructured interviews with consultant doctors was taken from different hospitals over a 6-month period. The data were analysed using directed thematic content analysis, with the themes compared against the study’s propositions.

Results Doctors’ perspectives of clinical audit changed in response to the way in which the audit was implemented. The main barriers to engagement were the lack of a common vision and poor communication, which contributed to poor interprofessional relationships and a perceived culture of blame. In contrast, factors that facilitated engagement centred on the adoption of a more supportive and collaborative approach, which in turn facilitated higher levels of trust between professionals. The dissemination of performance data was found to be a key influencing factor.

Conclusion The study makes use of a unique data set and to the best of our knowledge is one of the first studies to document how the dissemination of doctors’ performance data positively influences engagement with clinical audit in England. In addition, the study also shows how, contrary to some studies in the literature, clinical audit can reduce professional anxiety by providing a validation of professional competence. The study supports the premise that clinical audit will be fully embraced by doctors only if they are sufficiently involved in the process so as to be able to redefine and clarify its purpose and meaning. The preliminary findings of this pilot study provide the theoretical underpinning for a national survey into reporter perspectives of the National PET-CT Audit Programme.

aBirkbeck School of Management, University of London, London

bMount Vernon Hospital, Northwood

cNHS South West Commissioning Group

dNorth of England Specialised Commissioning Group, Humber Office, Yorkshire, UK

Correspondence to Wai Lup Wong, LLM, MBChB, MRCP, FRCR, Mount Vernon Hospital, Northwood, Middx. HA6 2RN, UK Tel: +44 1923 844 705; fax: +44 1923 844 600; e-mail:

Received March 9, 2014

Accepted June 2, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins