An Overview of Approaches to Service Review and Evaluation
| Pages | 18-23 |
| Date | 01 September 1998 |
| DOI | https://doi.org/10.1108/13619322199700026 |
| Published date | 01 September 1998 |
| Author | Roy Curtis |
| Subject Matter | Health & social care |
18 The Mental Health Review 2:3 © Pavilion Publishing (Brighton) 1997
Roy H. Curtis, Associate Consultant
CMHSD
T
here are many audit/evaluation/monitoring
tools in mental health services. This paper
describes a number of specific examples,
ranging from those at macro level within the
organisation to micro-level tools. In general and
acute medicine, approaches to quality assurance
have generally focused on improving organisational
quality (for example, the King’s Fund Organisational
Audit) and/or clinical effectiveness. The emphasis
has been on the structures and processes by which
care is supported and delivered. In mental health
services, however, the context is different:
‘The concept of quality is central to human services.
It stands in the same relation to services for people
with severe disabilities as does the concept of cure to
medical services’.1
In the field of mental health, the goal of improving
quality of care has been replaced, or at least
complemented, by one of enhancing quality of life.
Service-wide (macro level)
An example of a macro-level (that is, whole-service)
audit is the approach developed within the study
commissioned by the Clinical Standards Advisory
Group to examine the standards of clinical care for
people suffering from schizophrenia.
Here, a protocol of standards is used by an
external, multidisciplinary team to evaluate the
standards of purchasing and providing care for
people with severe mental illness. The results of
the evaluation are presented in both quantitative
and qualitative ways. These results are not compared
against a set of national norms or ‘gold standard’,
but are used as a baseline against which future
improvements can be measured, following the basic
audit-cycle paradigm. A similar approach is used in
accreditation programmes. Such programmes are
in their infancy in the UK, but are well established
in other countries, especially the USA, Canada and
Australia.
In general, the agenda and methodology for
‘macro-level’ reviews or audits are likely to be set
by a body which is external to the organisation being
audited. In addition, the information required within
the review/audit process will include much that is
not collected routinely.
Topic, theme or locality-based
audit or evaluation
Examples here might include evaluation of part of
a service, such as in-patient provision, day care and
psychological treatments. The evaluation could be
conducted internally or by an external visiting team.
Other examples include audit (that is, not simply
reporting) of routinely-collected information; for
example: untoward incidents, non-attendance;
use of the Mental Health Act; CPA. This could also
include inspection by statutory authorities such as
An Overview of Approaches to
Service Review and Evaluation
FOCUS ON…
KEY POINTS
●Since 1990, national policy has been
developed within the framework of
individual rights, application of good
practice and increasing emphasis on
community and primary care.
●The concept of quality in health care has
been introduced quickly. In the absence
of national guidance, service responses
have been numerous and idiosyncratic.
●Quality in mental health services is firmly
rooted in philosophical and ideological
values.
To continue reading
Request your trial