Clinical audit: Setting professional standards for counselling services

This paper describes the rationale behind the need to audit counselling services from both a purchasers' and a providers' perspective. It describes what audit is, why it is necessary, how to choose an audit topic, and how to implement audit methods. The process of Professional Standard Setting is documented and the differences and similarities between research and audit are explained. It is contended that all counsellors, whether working privately or for the National Health Service, should implement Quality Assurance and Audit Methods to ensure that clients receive the highest standards of counselling.     

A Review of: “Groups: Applying the Functional Group Model,edited by Sharan L. Schwartzberg,Margot C. Howe, & Mary Alicia Barnes, 2008”

This paper describes the process of developing and implementing a new information system, POTENT, as part of a quality assurance exercise to improve occupational therapy documentation in the hospital record. Results of a Retrospective criteria audit are presented and are supportive of a more rigorous examination of POTENT's impact on documentation practices.     

Searching for the facts in the clinical setting with couples

This paper describes a research proposal to examine whether or not the underlying analytic concepts behind the couple psychoanalytic psychotherapy model used at the Tavistock Marital Studies Institute in London are sufficiently coherent, both conceptually and clinically, to be used as the basis for a system of audit which respects the unique data produced in analytic psychotherapy. This 'psychoanalytic' system of audit is one which is characterized particularly by the use of the therapists' subjectivity, rather than attempts to be objective and gather data through such things as random controlled trials or generic outcome questionnaires. The paper describes the approach to the subject and the mix of qualitative and quantitative methods used. As the Tavistock Marital Studies Institute has a history of contact with Jungian analysts from the Society of Analytical Psychology, Jungian concepts are included in the model. The research is part of a professional doctorate in couple psychoanalytic psychotherapy at the Tavistock Marital Studies Institute in conjunction with the University of East London, entitled 'Conceptualizing audit in Couple Psychoanalytic Psychotherapy'.     

Audit of the Informed Consent Process as a Part of a Clinical Research Quality Assurance Program

Audits of the informed consent process are a key element of a clinical research quality assurance program. A systematic approach to such audits has not been described in the literature. In this paper we describe two components of the audit. The first is the audit of the informed consent document to verify adherence with federal regulations. The second component is comprised of the audit of the informed consent conference, with emphasis on a real time review of the appropriate communication of the key elements of the informed consent. Quality measures may include preparation of an informed consent history log, notes to accompany the informed consent, the use of an informed consent feedback tool, and the use of institutional surveys to assess comprehension of the informed consent process.     

Wild thoughts searching for a thinker. A clinical application of W.R. Bion's theories

This paper describes the results and implications of an 8-year audit cycle concerning premature termination of treatment in a population with severe personality disorder treated within a specialist residential setting. The results of the first audit showed (a) a high early dropout rate, (b) a significant difference in early dropout rates between the two clinical programmes (one-stage and step-down) offered by the unit, and (c) a higher attrition of non-borderline personality disorders compared to borderline type disorder. Qualitative analysis of interviews with early dropout patients helped to identify deficiencies in practice, which may have contributed to dropout. Discussion of results amongst the team led to corrective measures that allowed reduction of early dropout in the one-stage programme over the subsequent years. The implications of the results are discussed.     

Combating business crime in Sweden: A performance audit

This article describes an extensive audit of the work of government agencies against business crime in Sweden, as an example of a performance evaluation by an auditing institution. Business crime was shown to be a major and growing social problem. Manifold measures are required, and these must be directed and coordinated by the Government and the Riksdag. The cooperation of the commercial sector is also needed. The investigation was made by the Parliamentary Auditors of Sweden, which is the smaller of the two auditing institutions in the country. The method used in the investigation can be described as an “interactive” one. The intention was to create a thorough understanding of the issue and a shared approach to the problem. This aim seems to have been achieved to a great extent. Karin Rudberg is one of the audit directors at the Office of the Parliamentary Auditors of Sweden. She is an eonomist with experience in investigations of many different fields, such as restructuring government agencies, evaluation of energy research policies, and analyses of the Swedish industrial structure and labor market.     

Clinical Audit and Reform of the UK Research Ethics Review System

There is an international consensus that medical research involving humans should only be undertaken in accordance with ethical principles. Paradoxically though, there is no consensus over the kinds of activities that constitute research and should be subject to review. In the UK and elsewhere, research requiring review is distinguished from clinical audit. Unfortunately the two activities are not always easy to differentiate from one another. Moreover, as the volume of audit increases and becomes more formal in response to the demand for evidence-based practice in medicine, the overlap between research and audit grows more acute. Arguably, similar ethical standards and systems for ensuring that those standards are met should be applied regardless of whether or not a project is classified as research or audit. At a time when the research ethics review system in the UK is undergoing significant reform it is important that the opportunity is not missed to address the longstanding research-audit problem. We discuss suggestions for further reform that addresses this issue.     

Audit responses: responses maintained by access to existing self or coactor scores during non-social, parallel work, and cooperation procedures

Human subjects, mostly between 11 and 16 yr old, matched to sample for points that were exchangeable for money. An audit response was defined as a response maintained by allowing a subject access to an existing score on his own (self audit) or a coactor's (coactor audit) performance. In Experiment I, changes from non-social procedures (no coactor) to social procedures (coactor present) increased self and coactor audits. Since both types of audits occurred at about the same rates during cooperation and parallel work procedures, the increases did not depend on the subjects' response interactions. Although Experiment I did not demonstrate that subjects were comparing scores, the frequent occurrence of each kind of audit within a brief time period (interpersonal audit) did indicate that it was reinforcing to have both scores at the same time. These interpersonal audits suggested that the coactor's score increased self audits during social procedures. Experiment II supported this notion: relative to a non-social procedure, self audits increased more during a parallel work procedure when the coactor's score was accessible than when it was not accessible. Thus, increases in other behaviors that occur in the presence of a coactor, i.e., social facilitation, may also result from or be increased by providing a coactor's score.     

Improving partnerships with families and carers in in‐patient mental health services for older people: a staff training programme and family liaison service

In spite of policies advocating the involvement of families in the care of mental health service users in the UK, there are few examples of initiatives to develop staff confidence and skills in partnership working. This article describes a whole team training initiative and family liaison service to promote family inclusive working on in‐patient wards for older people in Somerset, UK. A three‐day staff‐training programme is described and training outcomes are reported. Staff report a substantial increase in confidence and family meetings held. A pre‐and post‐ training case note audit shows increased consideration of the needs of families. To further increase face to face meetings with families a family liaison service has been established, whereby a staff member with systemic family therapy training joins ward staff to hold family meetings as part of the assessment/admission process. Evaluation of this service has shown it to be effective with positive feedback from families and staff.     

Innovative method to evaluate quality management system audit results’ using single value neutrosophic number

Using Quality Management System (QMS) enables the organization to fulfil its purpose and mission to meet customers and regulatory requirements and improve its effectiveness and efficiency on a continuous basis, Quality Audit is very critical tool to ensure that the standards, policies and/or procedures are applied in the organization as planned in QMS, in real world applications, the results of the Quality Audit process depend on the auditors’ human judgments that characterized with doubts sometimes, estimating values another times, and using general impressions in his judgment, which motivate to introduce for the first time the Neutrosophic Quality Audit (NQA) model which can be extended to manage and audit in the future. NQA will be used to enhance the way of evaluating the quality audit results while many uncertainty aspects and indeterminacy do exist, the proposed model using Single Value Neutrosophic Numbers (SVNN) which is an instance of neutrosophic set, to overcome the weakness of using a crisp value to present the result of the audit findings, in addition, using Simplified Neutrosophic Weighted Geometric Average Operator (SNWGAO), and cosine similarity degree, an illustrative example is provided to validate the proposed model.     

Termination of information evaluation in auditing

A screening decision is about whether a candidate fails to meet a decision maker's criteria and must be rejected, or whether it meets the criteria and can be accepted. Image theory contends that screening decisions are based on a simple, noncompensatory process that focuses solely upon the candidate's negative attributes. This contention has received empirical support in a job screening context in which students role-played a hypothetical person seeking a job. But how robust is image theory's prediction? The present work was done in the context of professional auditors screening prospective clients. The client screening context is a particularly interesting setting to test the implications of image theory. If auditors reject clients with negative attributes, as predicted by image theory, this will indicate that some clients are being denied access to a socially useful service. Further, auditors can accept prospective clients with negative attributes and simply adjust the audit plan and fees to compensate for the client's riskiness. Thus, it is not clear that the preliminary findings obtained in a job screening context will generalize to the audit context. On the other hand, results consistent with the image theory prediction would suggest a robust theory. Even in the client screening context, where auditors used their own criteria to screen prospective clients, we found overwhelming support for image theory's view of screening. The results indicate the potential payoffs of image theory as a robust framework to address audit and other substantive problems. Implications of a noncompensatory, negative oriented, client screening strategy are discussed.     

Establishing family inclusive acute inpatient mental health services: a staff training programme in Somerset

In spite of policies advocating the involvement of families in the care of mental health service users in the UK there are few examples of training initiatives to bring this about. This article describes the delivery of a whole-team training initiative to promote family inclusive working in all acute inpatient units in Somerset. The three-day staff-training programme is described and training outcomes are reported. Staff reported a significant increase in confidence in their skills for working with families, and a pre- and post-training case note audit showed an increased consideration of the needs of families. This was accompanied by a modest increase in the average number of family meetings. Obstacles to family inclusive ways of working on inpatient units are described, and strategies to overcome these are discussed.     

Effects of the difference between self and coactor scores upon the audit responses that allow access to these scores

An audit response allows access to an existing score from a subject's own performance (self audit) or from his coactor's performance (coactor audit). A previous study found that social stimuli (coactor present) increased audits relative to a non-social (no coactor) condition. The increase, designated a social-stimulus effect, was found to be due more to the coactor's score than to his mere presence. This finding suggested that the difference between self and coactor scores might affect the size of the social-stimulus effect. In the present study, six pairs of human subjects matched-to-sample for points that were exchangeable for money. During a session, matching-to-sample problems were distributed so that a subject's score was ahead, behind, or about even with his coactor's score. The even condition produced the largest social-stimulus effects, i.e., the most audits that could not be attributed to non-social variables such as time or number of problems. The even condition may have produced the largest social-stimulus effects because it was the only condition where the major social reinforcer (being ahead) could be both present or absent and, consequently, the even condition was the only one where audits had a discriminative function with respect to the presence of the major social reinforcer.     

Effects of competitive reward distribution on auditing and competitive responding

This study allowed subjects to audit each other's responding during a series of competitive contests. Six pairs of female college students competed in 3-min contests in which the competitive response was a knob pull. A sum of money was divided using a proportional distribution or a 100%/0% reward distribution. In the proportional distribution, a subject's proportion of the sum was her proportion of the total number of responses. Also, in every contest either subject could make a response that would end the contest prematurely and give both subjects the same amount: a sum equal to 33% of the competitive total. Each subject could press either or both of two audit buttons that displayed her own and the other's response total for 10 s. Results replicated earlier findings in showing the superiority of the proportional distribution in total number of competitive responses made. No subject audited continuously, and only 1 audited most of the time. Most audits were interpersonal, including both own and other's scores. Auditing typically was more frequent in 100%/0% contests in which subjects were more likely to stop the contest when they were far behind. Winners were more likely to audit than were losers. Competitive response rates increased when the differences revealed by audits were small and decreased when they were large. Overall audit patterns were consistent with the view that feedback as "news" is more often sought when it can lead to improved outcomes.     

Audit in psychoanalytic psychotherapy with children and adolescents

The importance of multidisciplinary audit in child and adolescent psychiatry, including the work of child psychotherapists, is discussed. Research is highlighted which shows that certain groups of children in particular benefit from psychoanalytic psychotherapy. The problems related to auditing psychoanalytic psychotherapy are discussed, and a possible method of audit based on peer review of notes, which takes into account both inner and outer change, is presented.

A patient is discussed whose notes have been audited using the audit form. It is suggested that this form of audit has good educational potential as well as ensuring a high standard of patient care.     

An analysis of complaints to the British Association for Counselling and Psychotherapy, 1996–2006

In autumn 2006 the British Association for Counselling and Psychotherapy approved a proposal to conduct an independent audit of complaints submitted. This article represents the first stage of that audit. Case information from the professional conduct files was accessed and a total of 84 cases, considered by a pre‐hearing assessment panel to require a full hearing, were identified for this audit. The cases cover the period from October 1996 to January 2006. The information obtained was entered into a database for numerical analysis. Key findings suggest that accredited members are disproportionately complained against, as are male members of the association. The majority of complaints are made by people who are themselves involved in counselling.     

Evaluating New York City’s Smoke-Free Parks and Beaches Law: A Critical Multiplist Approach to Assessing Behavioral Impact

This article describes the evaluation of the law banning smoking in New York City’s parks and beaches that went into effect in 2011. We discuss the practical and methodological challenges that emerged in evaluating this law, and describe how we applied the principles of critical multiplism to address these issues. The evaluation uses data from three complementary studies, each with a unique set of strengths and weaknesses that can provide converging evidence for the effectiveness of the law. Results from a litter audit and an observational study suggest the ban reduced smoking in parks and beaches. The purpose, methodology and baseline results from an ongoing survey that measures how frequently adults in NYC and across New York State notice people smoking in parks and on beaches are presented and discussed. Limitations are considered and suggestions are offered for future evaluations of similar policies.     

DIMENSIONS AND CORRELATES OF THE PERSONNEL AUDIT AS AN ORGANIZATIONAL ASSESSMENT TOOL

This study analyzes the measurement properties of the personnel audit as an organizational assessment tool and the extent to which audit results relate to important organizational criteria. The findings reported here indicate that nine dimensions can effectively summarize 37 audit measures. The composite factor scores for these dimensions predict executive perceptions of "overall organizational performance" and "overall contribution of Personnel Function," employee "overall satisfaction with personnel services," and to a lesser extent, "profitability per capita." The personnel budget allotted per capita is in turn related to executive perceptions of Personnel's contributions.     

Quality of life - three competing views

The aim of the present paper is to describe three different attempts, which have been made by philosophers, to define what quality of life is; and to spell out some of the difficulties that faces each definition. One, Perfectionism, focuses on the capacities that human beings possess: capacities for friendship, knowledge and creative activity, for instance. It says that the good life consists in the development and use of these capacities. Another account, the Preference Theory, urges that satisfying one's preferences, or desires, is what improves one's quality of life. And a third account, Hedonism, sees life-quality as consisting in the enjoyment of pleasure and the avoidance of pain. The paper describes and evaluates objections to each of these views, thereby displaying their weaknesses and strengths. Since no view comes out as the right one there is a choice to be made. At the end of the paper it is being discussed how well each of the views cohere with different methodologies used in quality of life research. Also it is suggested that considerations about what the research is to be used for are relevant.     

THE ICA COMMUNICATION AUDIT AND PERCEIVED COMMUNICATION EFFECTIVENESS CHANGES IN 16 AUDITED ORGANIZATIONS

This study brings to light evidence on the benefits of a methodology for evaluation of organizational communication processes and outcomes—the ICA Communication Audit. The audit procedure was developed and tested by ICA (International Communication Association) Division IV, between 1974–1974. Sixteen field tests of the audit have been conducted from 1974–1977. This study undertook an “after” survey of the 16 audited organizations to determine the degree to which the audit was perceived to improve organizational communication effectiveness as well as overall organizational effectiveness. The findings confirmed the ICA Communication Audit as a valid diagnostic methodology and organization development intervention technique which improved both communication awareness and processes in a majority of audited organizations.