Service evaluation and development: experience of a paediatric disability team

Classical audit frameworks encourage the use of audit cycles, with performa nce being evaluated against predefined quality targets and modified accordi ngly. This approach has obvious validity in clinical settings where treatme nts have very clear endpoints and outcome measures can be prioritized with ease. The situation becomes more complex in disability service settings, wh ere the impact of clinical intervention is often qualitative rather than qu antitative, and where management strategies are dependent on working in par tnership with families, purchasers and other professional colleagues. There is thus a danger of neglecting aspects of service delivery which are of ma jor importance to one sector of this extensive network. To ensure that service goals and standards comprehensively reflect the spec ific concerns of all parties, it is proposed that measures of service quali ty should be defined within the context of a dynamic multi-user framework. Development of such a framework is dependent on collating information on sp ecific needs from parents, referrers, purchasers and other involved profess ionals, and determining areas of overlap, as well as areas of potential con flict. Audit techniques for key issues can then be devised, alongside a tim etable to revisit these issues at appropriate intervals. Application of this approach is illustrated by reference to our own paediat ric disability service.