Audit: The good, the bad and the ugly

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I started my journey with Xyla Diagnostics in September 2020 as Quality Lead, during a challenging year due to COVID-19. It has been quite a ride.

The audit process is very important for the company; this allows us to measure how our echocardiographers are performing and to have a feel of our relationship with our customers. Ultimately, we want to deliver the best care possible to the patients.

For us, it was very challenging to keep track of our work when you had to limit your travel, and you constantly had to do the LFT's and look after your wellbeing. It was difficult to liaise with the departments as it was required to limit the number of people working in the same workplace and the number of outside visits. Geographically our work was (still is) very widespread. Instead of sitting in your office and looking at a couple of echoes, you have to book the visits, drive or hop on a train, book hotels and find where to eat, communicate with your colleagues, customers and echocardiographers and find some time to do your own clinics and find time for yourself. It is challenging, but it is very exciting too. You meet new people, new places. There is a lot of diversity, and you learn.

Our protocols are robust but obviously have their flaws. We base ourselves on the BSE EQF protocol. We have a spreadsheet where we mark the studies reviewed, and we look at typically more than 5% of the work provided. We ask our echocardiographers to log studies with new severe pathology and new congenital/cardiomyopathy findings, and we review all these studies providing a safety net. The results are then reviewed, and a report and feedback are given to all the parts involved.

The main flaw is timeline and access. You try to organize your agenda and keep track of everything, but most of the time, you look at the studies that were done 2/3 months before. It isn't easy to pass the message over the wire or at the end of an email. There are a lot of variables that can impact the work, and those are normally not accounted when you just look at the scans. Everyone has got their own way of doing an echo. Every department has its own protocols, and we noticed that after the new guidelines were published, it took quite some time for everyone to adapt to them. You can't expect a Formula 1 driver to be as fast around the track in a road car.

There is pressure to deliver care, the pressure of keeping ourselves safe, of delivering all the numbers; it is putting a lot of pressure on people. Budgets depend on numbers; however, there is a patient at the end of the probe, and we are all accountable.

The audit process is essential, but we need to focus ourselves not on a number, not on colour (whatever system you use), but we need to take time and understand what is wrong and what needs to be changed, so you don't feel: "Argh, here we go again!"

At the same time, I really love my job, and every challenge is always welcome, and that overcomes whatever feeling you get.

Francisco Martins
Quality Lead for Echocardiography, Xyla Diagnostics

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