Teaching about Audit

1. Teaching about Audit and making it fun!

2. Are you sitting comfortably? • Does it matter? • Why?

3. A bit of educational theory… • Remember Pavlov’s dogs? • if you teach in conditions that produce pleasure • that subject will produce feelings of pleasure • “conditioning”.

4. How can you achieve this? • Comfortable setting • Uninterrupted/bleep-free environment • Relaxed, non-threatening approach • Interaction • Enjoyable session • Make it fun.

5. Some more theory… • Approaches to Learning (Gibbs G, 1992) • Surface approach • Deep approach.

6. Surface Approach • Teacher • selects content • presents material • tests whether it has 'stuck' • Learner tries to remember list of unconnected facts.

7. Deep Approach • Learner functions independently • with the facilitation of the teacher • Learner attempts to make sense of what is to be learnt • thinks about ideas and concepts • seeks integration between components • 'plays' with ideas.

8. Does their approach matter? • Surface approach leads to rapid forgetting • even on tests of factual recall • a week later, surface approach students score far lower • Knowledge which involves understanding • little forgotten even 11 years later.

9. So, how can we promote a deep approach to learning about audit?

10. Avoid overloading with… • Long teaching sessions • Excessive course material • So – Less is More!

11. Aim for • Motivation • enthusiasm • Learner activity • with time for reflection and “processing” • Interaction with others • easier to discuss meaning of concepts • playing with ideas.

12. The traditional approach to lecturing • Tell them what you’re going to tell them • Tell them • Tell them what you’ve told them.

13. Boring!

14. Instead – start by asking what they’d like to cover • Gives you a check-list • helps you gauge their needs • you may get some surprises • Effectively, it tells them what you’re going to tell them.

15. And at the end - get them to tell you what they’ve learnt

16. Don’t assume any knowledge • Ask if they know what the audit cycle is • someone will nod • ask that person to draw it on a flip-chart • get the others to modify it if needed.

17. Check everyone has understood • No point going further unless they understand the “audit cycle” concept.

18. Get them to discuss the concept • Challenge them • “Does audit really matter?”

19. Get them to discuss the concept • “Why is it a cycle?” • “What’s the most difficult part of the cycle?”

20. Get them to show off • “Have any of you been involved in audits already?” • “What did you do?”

21. Ask them to define “criteria” and “standards” • Give a pro-forma for criterion and standard statements • “All patients with xxx should have had yyy in the last zz months” • “This should have happened in xx% if cases” • Get them to give examples • Check everyone is happy.

22. Choosing a subject • Ask them to come up with ways to identify what needs auditing.

23. Give tips on choice • “Choose something that interests you“ • “Talk to others that will be involved with making changes” • “Do they agree with your proposal?” • “You won’t get changes made if people aren’t with you from the start.”

24. Give tips on choice • “Don’t audit something that is already being done well” • “You’ll find plenty of areas that do need improvement!”

25. Help them prioritise • “To help yourself prioritise possible audits, ask yourself:” • “Is the problem common?” • “Does it have serious consequences?” • “Can I do something about it?”

26. KISS

27. Give advice on keeping it simple • “Make sure there is evidence for your criterion – check the literature” • “Ensure that the criterion is measurable – • ‘all asthmatics should have had yearly peak flows’ is difficult to measure (how many years will you go back?); • ‘all asthmatics should have had a PF recorded in the past year’ is more practical.”

28. More advice on keeping it simple • “If possible, make sure that what you are doing is fairly easy to measure” • “Think about how reliably all the points in your criteria are coded or recorded” • “Delegate!” • “Important - don’t try to audit too many criteria at once – one or two will keep you busy enough.”

29. Ways to collect data • Get them to think about methods of gathering data.

30. Comparing results with standards • Start them thinking broadly about why standards may not be met, e.g. • Patient reasons • Nurse/Doctor reasons • Organisational reasons.

31. Implementing change • Suggest common errors in trying to implement change • “Simply saying ‘We’ve got to do better’ won’t result in change.” • Give practical advice • “You need to think through in detail • what needs to be done • who’s going to do it • when and how.”

32. "Closing the loop" • “Audit is a continuous cycle” • “If you didn’t meet the standard and you’ve planned changes… • …repeat the audit to see whether the changes have happened.”

33. Instant audit • Give them a fun audit exercise • “Think of an activity that you aim to do a few times each week, but suspect you don't do as often as you should. It can be as silly (or lewd) as you like” • “(Examples of activities: the amount of exercise you've had in the last week; the number of glasses of wine)” • “Now audit it and plan changes.”

34. Instant audit • Ask for examples of the fun audits • reinforce the good points.

35. Have they grasped the concepts? • Ask everyone to come up with one real-life criterion that they might audit • give time to think about it, e.g. over coffee.

36. Have they grasped the concepts? • Go round group one by one • ask rest of group to comment • Ensure • good points reinforced • poor ideas are addressed and discussed positively • “You could make it even better by…” • “Have you thought about…”

37. Commitment to doing an audit • Try to get them to commit to doing an audit • suggest setting a deadline • offer to meet with them to hear the results.

38. A little more theory…

39. Preferred learning styles • We have different ways that we prefer to learn • activists • reflectors • theorists • pragmatists • Which are you?

40. Activists • involve themselves fully in new experiences • are enthusiastic about anything new • thrive on the challenge of new experiences • are bored with implementation • as soon as the excitement from one activity is over, look for the next.

41. Activists also… • like to learn something new • prefer a wide variety of different activities • wish to let their hair down and have fun • like tough problems and challenges.

42. Reflectors • like to stand back to ponder experiences and observe them from many different perspectives • prefer to think about data thoroughly before coming to any conclusion • philosophy is to be cautious.

43. Reflectors also… • prefer adequate time to consider, assimilate and prepare • want opportunities to assemble relevant information • like opportunities to listen to other people's points of view.

44. Theorists • think problems through in a vertical, logical way • won't relax until things fit neatly into a rational scheme • feel uncomfortable with subjective judgments, lateral thinking and flippancy.

45. Theorists also… • prefer lots of opportunities to question • like the programme to indicate a clear structure and purpose • want to encounter complex ideas and concepts that are likely to stretch them • expect the approaches to be 'respectable' - sound and valid.

46. Pragmatists • like making practical decisions and solving problems • wish to get on with things • are impatient with open-ended discussions.

47. Pragmatists also… • prefer opportunities to practice • like lots of practical tips and techniques • wish to address real problems • expect the session to result in action plans to tackle their current problems • want experts who can do it themselves.

48. How can we satisfy these different learning styles? • We tend to teach in the way we’d like to learn • Try to include something for each learning style.

49. How can we satisfy these different learning styles? • Activists: • fun audit; opportunity to “take the pen” • Reflectors: • breaks for discussion; time to think; opportunity to review at later date • Theorists: • “audit cycle” model; structured approach • Pragmatists: • lots of practical tips; planning an actual audit.

50. Ending the session • Give out audit guide & simple pro-forma • Feedback sheet.