• Lynn McVey, Natasha Alvarado, Justin Keen, Joanne Greenhalgh, Mamas Mamas, Chris Gale, Patrick Doherty, Richard Feltbower, Mai Elshehaly, Dawn Dowding, and Rebecca Randell.
• School of Healthcare, University of Leeds, Leeds, UK.
• J Eval Clin Pract. 2021 Feb 1; 27 (1): 143-150.

Rationale, Aims, And ObjectivesHealthcare systems worldwide devote significant resources towards collecting data to support care quality assurance and improvement. In the United Kingdom, National Clinical Audits are intended to contribute to these objectives by providing public reports of data on healthcare treatment and outcomes, but their potential for quality improvement in particular is not realized fully among healthcare providers. Here, we aim to explore this outcome from the perspective of hospital boards and their quality committees: an under-studied area, given the emphasis in previous research on the audits' use by clinical teams.MethodsWe carried out semi-structured, qualitative interviews with 54 staff in different clinical and management settings in five English National Health Service hospitals about their use of NCA data, and the circumstances that supported or constrained such use. We used Framework Analysis to identify themes within their responses.ResultsWe found that members and officers of hospitals' governing bodies perceived an imbalance between the benefits to their institutions from National Clinical Audits and the substantial resources consumed by participating in them. This led some to question the audits' legitimacy, which could limit scope for improvements based on audit data, proposed by clinical teams.ConclusionsMeasures to enhance the audits' perceived legitimacy could help address these limitations. These include audit suppliers moving from an emphasis on cumulative, retrospective reports to real-time reporting, clearly presenting the "headline" outcomes important to institutional bodies and staff. Measures may also include further negotiation between hospitals, suppliers and their commissioners about the nature and volume of data the latter are expected to collect; wider use by hospitals of routine clinical data to populate audit data fields; and further development of interactive digital technologies to help staff explore and report audit data in meaningful ways.© 2020 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.

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