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.