A co-designed intervention to enhance the national audit of dementia

Background:Patients with dementia do not always get best care [1]. Hospitals use audit and feedback to improve dementia care. Audit and feedback is variably effective at improving care [2]. There have been calls to test potential enhancements to national audit [3]. Both evidence and theory describe practices that might affect the effectiveness of audit and feedback [2,4]. We aimed to describe the content and delivery of the national audit of dementia, identify potential enhancements and develop a strategy to implement the enhancements.Method:We purposively sampled six hospitals, semi-structured interview participants (n=32), observations (n=36) and documentary analysis (n=39). We used framework analysis.Interim analysis was iteratively presented to stakeholders during codesign workshops (n=9; 18 hours) for challenge and to integrate findings, until a stable description was developed. The co-design group specified potential enhancements (3 workshops; 6 hours). Further co-design workshops (n=2; 4 hours) used the normalisation process theory toolkit [5] to identify mechanisms affecting implementation. This analysis informed a specified [6] implementation strategy. Results: Hospital actions were not informed by a robust analysis of performance, were selected from a narrow range of implementation strategies [7] and were not presented in a way to gain organisational commitment [8]. We co-designed a training intervention to hospital dementia leads and clinical governance leads that aims to improve the development and agreement of hospital-level actions. The intervention trains the leads to present information which supports governance committee sense-making in relation to implementation capability (by targeting low baseline, analysing barriers and linking barriers to actions) and change commitment (by addressing trust and credibility, linking to priorities, presenting comparators and considering existing work) [2,3,7,8].Conclusion:Training clinical leads to analyse performance, investigate barriers,select strategies and present specific information designed to gain organisational commitment may enhance the effectiveness of the national audit of dementia.