Clinical audit as a framework for the consultation on the future of Libyan Health Services

I read with interest the special article entitled ‘Consultation on the Libyan Health Systems: towards patient centred services’ (1). In my opinion, the consultation would be better conducted as a clinical audit, which has been shown to be an effective method to improve the quality of health services (2, 3). Making recommendations for good practice before a thorough review of current services has been performed may lead to standards being set too high initially. Staff may consider such high standards unobtainable and would not be engaged. Instead, achievable standards should be set within an appropriate timeframe, which is the essence of a clinical audit. The involvement of local staff in the clinical audit of current services will help engage them with the concept of the need for change and thereby motivate them. It will also provide an insight into the available resources and perceived barriers to change, allowing the setting of meaningful, realistic, measurable, and achievable goals, both short and long term. There is a good evidence that staff engagement correlates with improvement in the performance and innovation of the organisation (4). Once staff appreciate the need for change and adopt the concept as their own, it gives them a sense of direction and vision for the future. Clinical audit is ‘a quality improvement process that seeks to improve patient care and health outcomes through the systematic review of care, and the implementation of change’ (5). The process involves five stages (6):