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The Sentinel Stroke National Audit P...

Russell, Lal Elizabeth,

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The Sentinel Stroke National Audit Programme: An Improvement Tool for Community Stroke Care? /

Record Type:	Electronic resources : Monograph/item
Title/Author:	The Sentinel Stroke National Audit Programme: An Improvement Tool for Community Stroke Care? // Lal Elizabeth Russell.
Author:	Russell, Lal Elizabeth,
Description:	1 electronic resource (332 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 86-12, Section: B.
Contained By:	Dissertations Abstracts International86-12B.
Subject:	Success. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=32092241
ISBN:	9798283477619

The Sentinel Stroke National Audit Programme: An Improvement Tool for Community Stroke Care? /
Russell, Lal Elizabeth,

The Sentinel Stroke National Audit Programme: An Improvement Tool for Community Stroke Care? /Lal Elizabeth Russell. - 1 electronic resource (332 pages)

Source: Dissertations Abstracts International, Volume: 86-12, Section: B.

BackgroundThe Sentinel Stroke National Audit Programme (SSNAP) is an established quality improvement tool for hospital-based stroke care. It is the only national stroke audit that collects data detailing stroke care beyond hospital discharge. However, its role in driving quality improvement in the community setting was unexplored.AimTo understand the role of national clinical audit in driving quality improvement in community stroke care.MethodsThis thesis consists of four phases of study, each informing the next. Phases used distinct research methods as part of the overall realist evaluation.i. A scoping review of the literature exploring the contextual features that influence the contribution of externally initiated, multidisciplinary clinical audits to quality improvement.ii. A mixed-methods online survey investigating stakeholder experiences of SSNAP in the community setting.iii. Realist interviews exploring what influences the ability of SSNAP to contribute to quality improvement in the community setting.iv. National clinical audit data was used to explore the use, and interpretation of a patient reported outcome measure (EQ5D-5L) as part of quality improvement in community stroke care.ResultsThe scoping review identified important features pertinent to audits that are multidisciplinary and externally initiated. The findings suggest individual engagement to be influenced not only by a perception of the audit and its purpose, but also by perceptions regarding credibility and organisational culture. Findings were used to develop an online mixed methods survey.The survey captured the perspectives of a broad range of stakeholders in different roles from across England, including administrative, clinical, management and commissioning (n=206). Participants reported being engaged in the audit and using feedback to inform a variety of quality improvements. Teams were described as committing significant resources to audit participation, despite facing a number of barriers. Challenges to audit participation were highlighted such as the administrative support available, the inflexibility of the online audit platform and the ability of the audit to reflect the services delivered in this setting. Findings were used as a framework for subsequent realist interviews.Interviews were undertaken with a broad variety of stakeholders in different roles from across England (n=20). The findings generated greater understanding of the contextual features in community stroke care and the mechanisms by which these influence the ability of the audit to drive quality improvement in this setting. Four theories have been proposed that seek to explain the mechanisms by which SSNAP contributes to quality improvement in community stroke rehabilitation.Firstly, organisational support such as leadership interest, the fostering of champions and dedicated administrative support legitimizes audit activity. This provides opportunities for skill sharing which motivates team engagement with the audit. Secondly, an accessible audit feedback report enables leaders to be confident in using the information to inform strategic conversations such as commissioning. Thirdly, channels of communication across the stroke pathway provide opportunities for collaboration around shared goals such as the curation of complete datasets. Finally, audit feedback is more likely to be used for quality improvement if stakeholders perceive it as reflecting the services they deliver and capturing the impact of these services for stroke survivors.

English

ISBN: 9798283477619Subjects--Topical Terms:

518195
Success.

The Sentinel Stroke National Audit Programme: An Improvement Tool for Community Stroke Care? /
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245 1 0 $a The Sentinel Stroke National Audit Programme: An Improvement Tool for Community Stroke Care? / $c Lal Elizabeth Russell.
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520 $a BackgroundThe Sentinel Stroke National Audit Programme (SSNAP) is an established quality improvement tool for hospital-based stroke care. It is the only national stroke audit that collects data detailing stroke care beyond hospital discharge. However, its role in driving quality improvement in the community setting was unexplored.AimTo understand the role of national clinical audit in driving quality improvement in community stroke care.MethodsThis thesis consists of four phases of study, each informing the next. Phases used distinct research methods as part of the overall realist evaluation.i. A scoping review of the literature exploring the contextual features that influence the contribution of externally initiated, multidisciplinary clinical audits to quality improvement.ii. A mixed-methods online survey investigating stakeholder experiences of SSNAP in the community setting.iii. Realist interviews exploring what influences the ability of SSNAP to contribute to quality improvement in the community setting.iv. National clinical audit data was used to explore the use, and interpretation of a patient reported outcome measure (EQ5D-5L) as part of quality improvement in community stroke care.ResultsThe scoping review identified important features pertinent to audits that are multidisciplinary and externally initiated. The findings suggest individual engagement to be influenced not only by a perception of the audit and its purpose, but also by perceptions regarding credibility and organisational culture. Findings were used to develop an online mixed methods survey.The survey captured the perspectives of a broad range of stakeholders in different roles from across England, including administrative, clinical, management and commissioning (n=206). Participants reported being engaged in the audit and using feedback to inform a variety of quality improvements. Teams were described as committing significant resources to audit participation, despite facing a number of barriers. Challenges to audit participation were highlighted such as the administrative support available, the inflexibility of the online audit platform and the ability of the audit to reflect the services delivered in this setting. Findings were used as a framework for subsequent realist interviews.Interviews were undertaken with a broad variety of stakeholders in different roles from across England (n=20). The findings generated greater understanding of the contextual features in community stroke care and the mechanisms by which these influence the ability of the audit to drive quality improvement in this setting. Four theories have been proposed that seek to explain the mechanisms by which SSNAP contributes to quality improvement in community stroke rehabilitation.Firstly, organisational support such as leadership interest, the fostering of champions and dedicated administrative support legitimizes audit activity. This provides opportunities for skill sharing which motivates team engagement with the audit. Secondly, an accessible audit feedback report enables leaders to be confident in using the information to inform strategic conversations such as commissioning. Thirdly, channels of communication across the stroke pathway provide opportunities for collaboration around shared goals such as the curation of complete datasets. Finally, audit feedback is more likely to be used for quality improvement if stakeholders perceive it as reflecting the services they deliver and capturing the impact of these services for stroke survivors.
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