RESUMO
BACKGROUND: Recently, the frequency of audit inspections of health services for people with intellectual disability (ID) in the UK has increased, from occasional inquiries to a systematic audit of all services. From 2008, a process of continuous audit 'surveillance' of specialist health services is to be introduced. Similar regimes of inspection are in place for social care services. AIM: To explore the conceptual positions which inform audit, through detailed examination of the investigation into the learning disability service at Sutton and Merton. FINDINGS: Audit is distinct from evaluation because it neither provides opportunities for service staff to give an account of their work nor represents a search for knowledge. Audit investigates adherence to government policy. In ID, audits measure aspirations derived from normalisation, despite research showing that some of these aspirations have not been achieved by any service. As audit consumes significant public resource, it is questionable whether the dominant finding of the Healthcare Commission's investigation into Sutton and Merton, that the ID service was chronically under-funded, represents value for money. DISCUSSION AND CONCLUSIONS: While basic checks on minimum standards will always be necessary, service excellence requires not audit but research-driven evaluation. Audits inhibit rather than open-up debate about improving support to people with ID. They impose an ideology, squander resource, and demoralise carers and staff. Evaluations challenge the implicit management-versus-professional binary enacted by audit, and can inform new care systems which make effective use of all those engaged with people with ID.
Assuntos
Deficiência Intelectual/reabilitação , Programas de Assistência Gerenciada/ética , Auditoria Administrativa/ética , Serviço Social/ética , Medicina Estatal/ética , Atividades Cotidianas , Atenção à Saúde/ética , Ética Profissional , Recursos em Saúde/ética , Humanos , Comunicação Interdisciplinar , Avaliação das Necessidades/ética , Objetivos Organizacionais , Garantia da Qualidade dos Cuidados de Saúde/ética , Reino UnidoAssuntos
Conflito de Interesses , Auditoria Administrativa/organização & administração , Qualidade da Assistência à Saúde , Códigos de Ética , Conflito de Interesses/legislação & jurisprudência , Serviços Contratados/ética , Serviços Contratados/organização & administração , Guias como Assunto , Humanos , Auditoria Administrativa/ética , Nova Zelândia , Ética Baseada em Princípios , Qualidade da Assistência à Saúde/normasAssuntos
Criação de Animais Domésticos/ética , Bem-Estar do Animal , Medicina Veterinária/ética , Direitos dos Animais , Bem-Estar do Animal/ética , Bem-Estar do Animal/normas , Animais , Animais Domésticos , Ética Profissional , Auditoria Administrativa/ética , Auditoria Administrativa/métodos , Auditoria Administrativa/normasRESUMO
PURPOSE: Quality has an established history in health care. Audit, as a means of quality assessment, is well understood and the existing literature has identified links between audit and research processes. This paper reviews the relationships between audit and research processes, highlighting how audit can be improved through the principles and practice of social research. DESIGN/METHODOLOGY/APPROACH: The review begins by defining the audit process. It goes on to explore salient relationships between clinical audit and research, grouped into the following broad themes: ethical considerations, highlighting responsibilities towards others and the need for ethical review for audit; asking questions and using appropriate methods, emphasising transparency in audit methods; conceptual issues, including identifying problematic concepts, such as "satisfaction", and the importance of reflexivity within audit; emphasising research in context, highlighting the benefits of vignettes and action research; complementary methods, demonstrating improvements for the quality of findings; and training and multidisciplinary working, suggesting the need for closer relationships between researchers and clinical practitioners. FINDINGS: Audit processes cannot be considered research. Both audit and research processes serve distinct purposes. ORIGINALITY/VALUE: Attention to the principles of research when conducting audit are necessary to improve the quality of audit and, in turn, the quality of health care.
Assuntos
Auditoria Administrativa/métodos , Garantia da Qualidade dos Cuidados de Saúde , Pesquisa , Serviços de Saúde , Auditoria Administrativa/ética , Reino UnidoRESUMO
Managed care organizations employ nurses as medical utilization reviewers; however, little is known about the ethical climate of these organizations. This study describes different ethical climates in which utilization review nurses work and the implications of these differences for nurse administrators. The nurse participants, although demographically similar across three managed care organizations, perceived distinct ethical climates across the organizations. Nurses were employed to make complex decisions regarding medical care utilization; however, none of the organizations had an ethics committee to help nurse reviewers in this decision-making process. The need for such committees, as well as clarification of a consistent and deliberate ethical climate by nurse administrators, is discussed.