Do we control for improvement or control for an audit? – Nursing education network

Ferguson, C., Vaismoradi, M., I Glarcher, M. (2025). What is the meaning of quality and safety control in healthcare if nurses don’t use data to extend improvement? Journal of Advanced Nursing.

This editorial critically analyzes the present state of clinical control in healthcare. It focuses especially in nursing, emphasizing the numerous disconnection between data collection and its effective application in conducting clinical improvement. Clinical audits are considered vital tools to extend quality and safety. However, their usability often hinders bad feedback mechanisms. Redundance and disconnection of the labor force also contribute to those problems, which results in “tiredness of the audit” and the perception of “mess”. The predominant argument is that audits often don’t result in tangible changes in practice. This is as a consequence of system problems. There can also be an absence of effective strategies for changing the behavior and the necessity for a more strategic approach to regulate. He should deal with using data and improved feedback loops. The third focus ought to be using the speculation of change of behavior based on evidence to fill “gap in evidence practice”.

“Do we control for improvements or audit audit?”

Nurses often report “fatigue and frustration of the audit when the same data is checked many times without visible change.”

• A big barrier occurs when health services fail on the “feedback” stage. This is a component of the audit and feedback cycle. Clinical audits are criticized for “research for research” with data, with whom “no one ever does anything”.
• Transparent, high -quality and timely feedback from data allow clinicians to check performance and discover gaps.
• Audits that “do not drive tangible risk, becoming routine exercises of low practical value.”
• The abuse of audits, especially in nursing, is increasingly described as a security mess. These activities eat time and resources. Do not provide clear advantages of patients’ safety or clinical results.
• Quality improvement (QI) is geared toward solving problems related to care gaps by changing the behavior of clinicians. However, changing behavior is complex.
• Leaders often “education will fix it” by default, using “ad hoc repair training or approach to education”. This “stick approach” will be harmful to organizational culture and harmful to achieving a big change in practice.
• Com-B frames (ability, possibility, motivation, behavior) are really useful to grasp and affect behavior. This is as a consequence of its simplicity and wide use in healthcare.

• The need for “greater strategic thought on clinical control as a nursing practice to increase quality and safety in healthcare.”
• “It is crucial that we do not deal with excessive assessment as a profession.” We must engage and act in the info.
• “The scope of innovation in the field of conducting audits”, potentially using artificial intelligence as technology progresses.
• While navigation desktops are popular, “data load and warning fatigue are problematic.” Nursing must contribute to the design of the dashboard to get “the best integration with the flow of nursing work”.

Clinical audit is a basic element of patient safety, but its current implementation is usually not capable of potentially. The dominant issues related to the fatigue of the audit, lack of information and the dearth of effective feedback mechanisms undermine its value. To transcend the audit due to audit, we want a strategic change. We must use the audit data with solid feedback loops. It is essential to integrate the behavior changes based on evidence. It can also be vital to take iterative models of healthcare systems. This will be certain that the priceless time of nursing and resources will significantly contribute to the true improvement of quality and safety in healthcare.

Ivers, N., S. Yougasam, M. Lacrox et al. 2025. Audit and feedback: impact on skilled practice. Cochrane systematic reviews database.

Antonacci, G., Whitney, J., Harris, M., I Reed, IS (2023). How do healthcare providers use national audit data to enhance?. BMC Health Services ResearchIN 23(1), 393.

Hut-Mossel, L., Ahaus, K., Welker, G., I Gans, R. (2021). Understanding how and why audits work in improving the standard of hospital care: a scientific review of a realist. Plos OneIN 16(3), E0248677.

Bowie, P., Bradley, na, I Rushmer, R. (2012). Clinical audit and quality improvement – time to take into consideration?. Journal of Evaluation in Clinical PracticeIN 18(1), 42-48.