Describing and enhancing audit and feedback in dementia care: An intervention development study

Abstract

Background Approximately one in four people in general hospitals have dementia. Patients with dementia do not always receive best care. To improve care, health services assess (‘audit’) current care and provide staff with ‘feedback’ about how well they are doing. Audit and feedback is a variably effective complex intervention. Both evidence and theory identify components associated with the effectiveness of audit and feedback. This thesis asks the research questions, how is the national audit of dementia currently undertaken, are there potential enhancements that could improve the effectiveness of the national audit, and if so, how should these enhancements be implemented? Method There were two phases to the work, each supported by stakeholder involvement (coproduction group n=9; advisory group n=9). In phase 1, I undertook a multi-method qualitative exploration at six hospitals, involving semi-structured interviews (n= 32), documentary analysis (n=39) and observations (44 hours). I analysed the data using inductive framework analysis and iteratively presented the findings to stakeholders for challenge and synthesis. In phase 2, the stakeholders used evidence from phase 1, literature and theory to: determine how to enhance the process; specify the enhancements; and develop a theory-informed strategy to implement the enhancements. Results I found common stages to the audit, although the content and delivery of each stage differed between sites. The stakeholders identified potential enhancements to data collection, feedback and action planning. The stakeholders specified enhancements to organisational action planning and co-developed a strategy to implement the enhancements. I called the strategy Logical Improvement Planning. Discussion This thesis extends previous knowledge by describing the intervention content across stages of the national audit, including a detailed exploration of the current sense-making work of committees. The national audit of dementia has an organisational-level affect that is 4 influenced by the sense-making work of quality assurance committees. I describe twentyfour evidence- and theory-informed potential enhancements to the national audit. Logical Improvement Planning is an intervention to enhance committee sense-making. The findings have informed the commissioning of future audits. The next step is to assess the feasibility and impact of these enhancements.