Journal Club Reference: Ferguson, C., Vaismoradi, M., and Glarcher, M. (2025). What’s the Point of Quality and Safety Auditing in Healthcare if Nurses Don’t Use Data to Drive Improvement? Journal of Advanced Nursing.

Summary

This editorial critically examines the current state of clinical auditing in healthcare. It focuses particularly within nursing, highlighting a significant disconnect between data collection and its effective use in driving clinical improvement. Clinical audits are acknowledged as vital tools for enhancing quality and safety. However, their utility is often hampered by poor feedback mechanisms. Redundancy and workforce disengagement also contribute to these issues, leading to “audit fatigue” and a perception of “safety clutter.” The central argument is that audits frequently fail to lead to tangible practice changes. This is due to systemic issues. There is also a lack of effective behavior change strategies and a need for a more strategic approach to auditing. It should focus on data utilisation and improved feedback loops. The third focus should be the application of evidence-based behaviour change theories to bridge the “evidence-practice gap.”

“Are we auditing for improvement, or auditing for auditing’s sake?”

Nurses frequently report “audit fatigue and frustration when the same data are reviewed repeatedly without visible change.”

Barriers to Effective Data Utilisation:

• Feedback Failure: A significant barrier occurs when health services fail at the “feedback” stage. This is a part of the audit and feedback cycle. Clinical audits are criticised for being “research for research’s sake” with data that “no-one ever does anything with.”
• Importance of Feedback Loop:Transparent, high-quality, and timely data feedback enables clinicians to benchmark performance and identify gaps.
• Routine Exercises: Audits that “fail to drive tangible change risk becoming routine exercises with little practical value.”
• Overuse and Burden: The overuse of audits, particularly in nursing, is increasingly described as safety clutter. These activities consume time and resources. They do not deliver clear benefits to patient safety or clinical outcomes.
• Complexity of Behaviour Change: Quality Improvement (QI) aims to address care gaps by changing clinician behaviour. However, changing behaviour is complex.
• Inadequate Intervention Strategies: Leaders often default to “education will fix it,” using “ad-hoc remedial training or an in-service education approach.” This “stick approach” can be harmful to organisational culture and detrimental to the achievement of meaningful practice change.
• COM-B Framework: The COM-B (Capability, Opportunity, Motivation, Behaviour) framework is recommended for understanding and influencing behaviour. This is because of its simplicity and wide use in healthcare.

Future Directions

• A need for “greater strategic thought on clinical auditing, as a nursing practice to enhance quality and safety in healthcare.”
• Focus on Action and Engagement: It is “crucial that as a profession we do not busy ourselves with over-auditing.” We must engage and act on data.
• Innovation in Audit Conduct: “Scope for innovation in how audits are conducted,” potentially leveraging AI as technology advances.
• Dashboard Design and Data Burden: While dashboards are popular, “data burden and alert fatigue are problematic.” Nursing must contribute to dashboard design for “best integration into nursing workflow.”

Clinical auditing is a fundamental component of patient safety, but its current execution often falls short of its potential. The prevailing issues of audit fatigue, data disuse, and a lack of effective feedback mechanisms undermine its value. To move beyond auditing for auditing’s sake, we need a strategic shift. We must leverage audit data through robust feedback loops. It is crucial to integrate evidence-based behaviour change strategies. Adopting iterative learning health system models is also necessary. This will ensure that precious nursing time and resources contribute meaningfully to genuine quality and safety improvements in healthcare.

Additional Resources

Ivers, N., S. Yogasingam, M. Lacroix, et al. 2025. Audit and Feedback: Effects on Professional Practice. Cochrane Database of Systematic Reviews.

Antonacci, G., Whitney, J., Harris, M., & Reed, J. E. (2023). How do healthcare providers use national audit data for improvement?. BMC Health Services Research, 23(1), 393.

Hut-Mossel, L., Ahaus, K., Welker, G., & Gans, R. (2021). Understanding how and why audits work in improving the quality of hospital care: a systematic realist review. PloS one, 16(3), e0248677.

Bowie, P., Bradley, N. A., & Rushmer, R. (2012). Clinical audit and quality improvement–time for a rethink?. Journal of evaluation in clinical practice, 18(1), 42-48.