The DOI matches its Crossref record; 80 of the 81 references it cites were found in a registry or an index.
Reviewing audit: barriers and facilitating factors for effective clinical audit
Open accessAbstract
OBJECTIVE: To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process. DESIGN: A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audit of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers. RESULTS: Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers. CONCLUSIONS: Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.
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“A hierarchical structure, defined as the degree to which the organisation prescribed roles or responsibilities and/or promoted autonomy was mainly presented as a barrier [44, 54, 67].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [67]
In the citing paper
“Conversely, lack of effective leadership to advocate change, set priorities or manage the implementation process; and changes in leadership were presented as barriers [55, 67–69].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [67]
In the citing paper
“the amount of technical assistance and support required at all stages of the project, e.g. some resources available to support the project at the beginning but insufficient for its completion [67].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [67]
In the citing paper
“support to perform additional data entry or deal with paperwork [31, 67, 71, 72] were reported as barriers.”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [67]
In the citing paper
“Resistance to change caused by disagreement with the evidence, negative beliefs about the usefulness or added value of the intervention or belief that the intervention was not part of their role were commonly described as a barrier to implementation [3, 14, 35, 41, 67–70, 76, 77, 80].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [67]
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Metadata
- Authors
- Johnston, G., Crombie, I. K., Alder, E. M., Davies, H. T. O., & Millard, A.
- Affiliations
- Queen's University Belfast (GB)
- University of Dundee (GB)
- Corresponding author
- Johnston, G
- Venue
- Quality in Health Care
- Publisher
- BMJ
- Published
- 2000-03
- Volume
- 9
- Issue
- 1
- Pages
- 23-36
- ISSN
- 1475-3898 (ISSN-L)
- 0963-8172
- 1475-3901
- PMC
- PMC1743496
- OpenAlex
- W2128747629
- Cited by
- 317
- References
- 81
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 14 · 2023: 13 · 2022: 13 · 2021: 15 · 2020: 16 · 2019: 12 · 2018: 15 · 2017: 12 · 2016: 10 · 2015: 7 · 2014: 15 · 2013: 14 · 2012: 18
- FWCI
- 34.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- clinical audit, enabling factors, quality of care, professional attitudes, litigation risk, primary-secondary care interface
- MeSH terms
- Attitude of Health Personnel, Evaluation Studies as Topic, Family Practice, United Kingdom, Hospitals, General, Interprofessional Relations, Job Satisfaction, Leadership, Medical Audit, Medical Records, Medical Staff, Hospital, Nursing Audit, Partnership Practice, Physician-Patient Relations, Physician's Role, Primary Health Care, Quality of Health Care, Retrospective Studies, Databases, Bibliographic, MEDLINE, Patient Satisfaction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
