8 Standards and audits
It seems a bit of a paradox to talk about standardising work when, up to this point, we have been discussing how to continuously change and improve. There is a balance between standardising work and never changing it so that it stagnates, and improving work without have a standard to compare it to – which would be chaotic. How would we know which approach is working well and which isn’t, which reflects best practice and the current evidence? How can we be sure that the new approach is having the results it is supposed to if we can’t be sure people are actually using the new approach?
Standardised work has been defined as the current best way to safely complete an activity with the proper outcomes and the highest quality.
In services that operate across the 24 hours there is plenty of opportunity for people to do the same work in many different ways – despite there being policies and procedures.
In order to cope in an environment that delivers care 24 hour, 7 days a week, we need a formal system to manage and improve the way work is done, and how these methods are communicated.
Many root causes of problems are linked to a lack of standardization. For example, pressure ulcers can be prevented by repositioning patients every 2 hours. That’s simple, so why do they occur at all? It could be that people are not following that standard practice because they too busy. Even if they are, unless they are documenting or recording it against the standard and monitoring the results, it is impossible to say why pressure ulcers persist.
Even having instituted a standard there is no guarantee that it will be followed. To check that it is consistently being followed, you may need to do random (or routine) observational or record audits. An audit tool should reflect the standard – simple!
There is no lack of audits in the world of National Standards. So how do you ensure that your audit is simply not adding unnecessary work and distracting people from actually getting the work done?
You might do random audits such as the Nursing and Midwifery Board of Australia (NMBA) do for CPD. The NMBA audit approximately 1% of registered nurses per year to check the evidence that they have complied with the requirement to undertake 20 hours of CPD per year.
You might also undertake a period of auditing as part of a investigation into an incident.
You could also add a period of audits for any new standards introduced until it is clear the new practice has been embedded.
Audits are another source of performance data that show areas for improvement. Make sure that the results are reported as part of your continuous improvement cycle and shared governance reporting process.
What standards dictate how you work currently?
Are there any practices that do not have a standard but would benefit from one (i.e. a routine practice that is done in a variety of ways)?
What audits do you currently perform routinely?