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Knowing the difference between health service evaluation, audit and research can be tricky especially for the novice researcher. Put simply, nursing research involves finding the answers to questions about “what nurses should do to help patients,” audit examines “whether nurses are doing this, and if not, why not,”1 and service evaluation asks about “the effect of nursing care on patient experiences and outcomes.” In this paper, we aim to provide some tips to help guide you through the decision-making process as you begin to plan your evaluation, audit or research project. As a starting point box 1 provides key definitions for each type of project.
Box 1 Definitions of service evaluation, audit and research
▸ What is service evaluation?
Service evaluation seeks to assess how well a service is achieving its intended aims. It is undertaken to benefit the people using a particular healthcare service and is designed and conducted with the sole purpose of defining or judging the current service.2
The results of service evaluations are mostly used to generate information that can be used to inform local decision-making.
▸ What is (clinical) audit?
The English Department of Health3 states that:
Clinical audit involves systematically looking at the procedures used for diagnosis, care and treatment, examining how associated resources are used and investigating the effect care has on the outcome and quality of life for the patient.
Audit usually involves a quality improvement cycle that measures care against predetermined standards (benchmarking), takes specific actions to improve care and monitors ongoing sustained improvements to quality against agreed standards or benchmarks.4 ,5
▸ What is research?
Research involves the attempt to extend the available knowledge by means of a systematically defensible process of enquiry.6
How do I decide whether my project is service evaluation, audit or research?
Despite their differences there are clear similarities between service evaluation, audit and research. All start with important questions, require data to answer the questions, and each needs a systematic approach and sound design.1 Research methodologies are often used to evaluate practice or measure outcomes, so this can be confusing. The key differences in approach relates mostly to project scope and intent. Table 1 outlines key criteria to help guide your decision-making about what might be the right approach for different types of clinical projects.
So if, for example, we were to explore management of children's postoperative pain we could:
Undertake a service evaluation and ask parents and children to complete a questionnaire about how well they think postoperative pain was managed for them during their experience on the paediatric unit.
Complete an audit by comparing postoperative pain management practices in the paediatric unit to current best practice guidelines using a standardised data collection tool.
Undertake a research project to identify the most effective postoperative pain management practices for children.
The Health Research Authority in the UK has a useful online decision-making tool—see:
Applying ethical principles to service evaluation, audit and research
Ethical standards and patient privacy protection laws apply to all type of health research, service evaluation and audit processes. Research projects being carried out in healthcare will normally need approval from a research ethics committee or affiliated Institutional Review Board (IRB), as well as from the healthcare service site/s such as the hospital's Research and Development Department. If you are carrying out an audit you should register your project with the hospital's Audit Department or Quality and Safety Unit—this is mandatory in some organisations. If you are undertaking a service evaluation you should ensure the necessary permissions have been obtained at a local level or even regional level depending on the service.
A service evaluation or audit may not require specific approval from a research ethics committee or IRB but ethical principles must still be adhered to for the protection of patients. Ethical principles and Patient Protection laws that need to be followed:
Consent—It is important that potential participants are not coerced to take part in the project. They have the right to refuse to take part and to withdraw at any point.
Anonymity—Participants need to know whether their anonymity will be protected and if so how this will be carried out.
Data protection and privacy—You need to consider how you are going to ensure that your data is stored safely and that participant privacy is protected. In the UK you will adhere to the Data Protection Act (1998) and in the USA you will comply with the Health Insurance Privacy and Portability and Accountability Act (HIPPA; 1996) Privacy Rule.
The Healthcare Quality Improvement Partnership (HQIP) has a useful guide in relation to applying ethical principles to service evaluations and audits. This can be downloaded from:
The U.S. Department of Health and Community Services, Office of Research Integrity has some useful resources on the principles of ethical research practice for a variety of roles in research http://ori.hhs.gov/
While researchers seek to provide evidence to guide practice, it often takes time for evidence to make the journey from ‘bench to bedside’. When organisations need answers fast, service evaluation and/or audit may be used to capture ‘real-time’ data and quickly move findings to create tangible practice change. An audit is like ‘taking the pulse’ of an organisation—it can produce results fast. As we check the organisational pulse against an expected range of normal we need to be sure we use the best approach to get an accurate reading so that our response is based on good data. This means no matter what the project scope or purpose, your project design should produce high-quality information about patient care and comply with ethical standards that protect patients.
Competing interests None.