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Is it Possible to Measure What Truly Matters? The Paradox of Clinical Audit in Developing Continence Service Standards for Older People

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Abstract

Background: Standards, benchmarking, and audits are integral to quality monitoring in health and social service provision. Recent policy in the UK National Health Service dictating the need for increased consumer involvement necessitates that service users have significant input into the composition of standards for quality of care.

Objective: To report the authors’ recent involvement in research towards developing a set of agreed, measureable statements regarding quality in the provision of continence services using the views of older service users.

Methods: This article focuses on the third of a three-stage project to involve, identify, and incorporate the views of older continence service users in the development of standards of care in continence services. Whereas stage 1 developed a questionnaire with the assistance of service users, and stage 2 piloted this as a postal survey in two contrasting areas, stage 3 applied the tool in the context of face-to-face interviews with more vulnerable older people. The approach also included open-ended questions to elicit qualitative data around experiences of continence service provision.

Results: Earlier stages of the project involved the relatively unproblematic construction of standards based on views given by experts and focus groups of older people. However, more in-depth, semi-structured interviews with service users brought to light the holistic, complex, and subjective way in which the sample viewed their experiences.

Conclusions: This study raises a number of questions over the efficacy of simple statements in capturing what is important to service users. If such standards are to empower patients usefully and assist professionals informatively in their provision of high-quality care, greater effort and sophistication is needed to truly reflect the needs and interests of service users. Alongside these concerns, however, there are potential ways of bridging the gap between standard setting and the lived patient experience.

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Acknowledgments

Grants for the conduct of this study were received from the British Geriatrics Society and the Charitable Trustees of the Royal College of Physicians. These funders had no role in the design, management, analysis, interpretation, or presentation of the findings. Two of the authors (Dr Wagg and Dr Potter) are affiliated with the Royal College of Physicians.

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Authors and Affiliations

  1. Centre for Health Services Studies, University of Kent, Giles Lane, Canterbury, Kent, CT2 7NF, UK

    Patrick Brown Lecturer & Jenny Billings

  2. General Internal and Geriatric Medicine, University College Hospital, London, UK

    Adrian Wagg

  3. Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK

    Jonathan Potter

Authors
  1. Patrick Brown Lecturer
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  2. Jenny Billings
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  3. Adrian Wagg
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  4. Jonathan Potter
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Correspondence to Patrick Brown Lecturer.

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Brown, P., Billings, J., Wagg, A. et al. Is it Possible to Measure What Truly Matters? The Paradox of Clinical Audit in Developing Continence Service Standards for Older People. Patient-Patient-Centered-Outcome-Res 3, 11–23 (2010). https://doi.org/10.2165/11318800-000000000-00000

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