Teaching about Audit

and making it fun!

Are you sitting comfortably?

Does it matter? Why?

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”.

How can you achieve this?

Comfortable setting Uninterrupted/bleep-free environment Relaxed, non-threatening approach Interaction Enjoyable session Make it fun.

Some more theory…

Approaches to Learning (Gibbs G, 1992) Surface approach Deep approach.

Surface Approach

Teacher selects content presents material tests whether it has 'stuck'

Learner tries to remember list of unconnected facts.

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.

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.

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

Avoid overloading with…

Long teaching sessions Excessive course material

So – Less is More!

Aim for

Motivation enthusiasm

Learner activity with time for reflection and “processing”

Interaction with others easier to discuss meaning of concepts playing with ideas.

The traditional approach to lecturing

Tell them what you’re going to tell them Tell them Tell them what you’ve told them.

Boring!

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.

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

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.

Check everyone has understood

No point going further unless they understand the “audit cycle” concept.

Get them to discuss the concept

Challenge them“Does audit really matter?”

Get them to discuss the concept

“Why is it a cycle?”“What’s the most difficult part

of the cycle?”

Get them to show off

“Have any of you been involved in audits already?”

“What did you do?”

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.

Choosing a subject

Ask them to come up with ways to identify what needs auditing.

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.”

Give tips on choice

“Don’t audit something that is already being done well”“You’ll find plenty of areas

that do need improvement!”

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?”

KISS

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.”

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.”

Ways to collect data

Get them to think about methods of gathering data.

Comparing results with standards

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

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 detailwhat needs to be donewho’s going to do itwhen and how.”

"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.”

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.”

Instant audit

Ask for examples of the fun audits reinforce the good points.

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.

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…”

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.

A little more theory…

Preferred learning styles

We have different ways that we prefer to learn activists reflectors theorists pragmatists

Which are you?

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.

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.

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.

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.

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.

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.

Pragmatists

like making practical decisions and solving problems

wish to get on with things

are impatient with open-ended discussions.

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.

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.

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.

Ending the session

Give out audit guide & simple pro-forma Feedback sheet.

Ending the session

On-line audit study guide www.mharris.eurobell.co.uk/contents.htm

Ending the session

“Tell me one thing that you’ve learnt from the session”

This is a form of reflection reinforcement of what has been learnt a suggestion of what should have been learnt involving everyone “telling them what you’ve told them”.

End on a high…