Why doesn't audit work?

When representatives from 10 British hospital trusts met last September to tackle the issue of why clinical audit has failed to bring about change, the NHS white paper and the term “clinical governance” had not been born. It is now clear, however, that the Action on Clinical Audit project, which brought these trusts together, was conceived in the same camp—and with the same aim, to improve clinical services. Action on Clinical Audit is a two year project, funded by the NHS Executive, that is devised to unravel the complex relationships that seem to render audit unworkable.* On paper, clinical audit takes the form of a neat cycle of events, leading to harmonious improvement in the activity under scrutiny.1 In the gritty world of doctors, patients, and managers, the cycle can all too easily lose its shape, stop short, or simply vanish. The promised improvement never materialises. The founders of …