Action on Audit: Injecting a few PDSAs to deliver service improvement

For decades the medical profession has worshipped at the altar of audit: embracing the method in everything from large national confidential enquiries, increasingly complex extensions to NICE guidance and a key competency for all doctors in training. In the last decade even our NHS Masters have got in on the act – mandating nurses to complete weekly and monthly audits (e.g. Safety Cross) in an attempt to meet and maintain standards in everything from infection control to waiting times.

So, national confidential enquiries aside, what is it about this industrious investment of staff time that makes me feel the urge to challenge such wisdom?’s the INSANITY of all the WORK EFFORT expended in the face of such little evidence of impact! The shedloads of FY1 audits submitted with recommendations to implement ‘some thing’! So many audits repeated with no change in outcome; so many before and after graphs confidently showing something has changed – with just two data points!

Do something less insane!

So why not inject a few PDSAs, do something LESS INSANE and make a difference that you can count!

Contained within the Model for Improvement, the Plan-Do-Study-Act (PDSA) test cycle is a well established way of learning and improving through small, rapid incremental steps. Each series of PDSAs are designed to test the hypothesis that a particular idea or intervention will improve a process or outcome. Each test cycle contains a prediction which, using simple measures (quantitative and/or qualitative), indicate whether the idea tested should be abandoned, adapted or adopted and spread further.

Follow the advice of Damian Roland, Sarah Haden, Kate Pryde, and Peter Lachman way back in 2011 [1]: Learn to use PDSA to implement changes and load the dice in favour of improving the services you deliver.

qic action on audit


Image © QIC Ltd 2017

Audit has its place, but in a resource strapped health service, much of it looks and feels like a sorry waste of physical and emotional capital worthy of Einstein’s description of insanity.

If you feel the same, get curious about the Model of Improvement and PDSA, learn how to do it well [2] and inject a little know how into your improvement efforts!

See also ref to Audit and Quality Improvement at

[1] Roland D et al. 2011 Paediatric trainees and the quality improvement agenda: don’t just do another audit


[2] The foundations of quality improvement science Reed JE, Davey N and Woodcock T