Audit and Quality Improvement Committee (Clinical Radiology)

Overall purpose

The Clinical Radiology Audit and Quality Improvement Committee (CRAQIC) carries out an annual programme of planned audit and quality improvement (QI) work and advises and represents the RCR and Faculty on matters related to audit and QI. It is responsible to the Clinical Radiology Professional Support and Standards Board (CR PSSB).

Terms of Reference

1. In alignment to the Faculty-wide annual plan and objectives, to produce an annual programme of planned audit and QI projects and activities for consideration and approval by the CR PSSB at its first meeting of each Council year. This may include multi-centre audits and joint audit or QI project work with other Royal Colleges, Faculties and other groups as appropriate.

2. The Committee will be accountable to CR PSSB and will report regularly to CR PSSB on the implementation and progress on its annual programme of audit and QI projects and activities.

3. To produce an annual plan of audit and QI professional learning and development activities for Fellows and members of the RCR, including contributions to the CR Scientific Meetings Programme and running an annual audit and QI event.

4. To maintain, develop and promote AuditLive.

5. To collaborate with Guideline Review Working Parties and contribute to the guideline consultation process, including but not limited to production of audit templates for all guidelines.

6. To promote the benefits of audit and QI activities to the faculty, as a means to encourage involvement of departmental Audit Leads, and members and Fellows more widely, to audit and QI projects and activities undertaken by the RCR.

7. To identify through the annual programme of work exemplar audit and QI initiatives for promotion to members and Fellows, and more widely, by the RCR.

8. To advise and represent the RCR and Faculty on matters related to audit and QI.

Membership

9. All members are appointed by the Medical Director, Professional Practice, CR in consultation where necessary with the Chair of the committee and/or others as appropriate. Letters confirming appointments will be signed by the Medical Director, Professional Practice, CR.

10. All clinical members of the committee shall be in active clinical practice at the time of their appointment, and throughout their term of service. If during their term a member retires, their term of office would cease at the end of that RCR year.

11. There shall be no more than six members, one of whom should be a representative of the Junior Radiologists’ Forum (JRF).

12. Members usually serve for a term of three years, renewable for one further term of up to three years. However, if at the end of two three-year terms the member is leading an ongoing project, membership can be extended until the completion of the project or for one further year, whichever is shorter.

13. The membership of the committee should reflect the diversity of the profession as far as possible and where appropriate to the work being done. It should also reflect the geographical spread of members and the sub-specialisation and specialist interests of clinical radiologists.

14. Co-opted members can be identified to fill areas of practice or geographical representation or other specific, relevant needs among the membership of the committee. Where a specific audit or survey may benefit from lay input, the committee should seek the advice of the Lay Member Network.

15. All co-opted members are appointed by the Medical Director, Professional Practice, CR in consultation where necessary with the Chair of the Committee and/or others as appropriate.Letters confirming appointments will be signed by the Medical Director, Professional Practice, CR.

16. The term of appointment of any co-opted member will usually be for the amount of time that their assistance is required for an audit/QI project, and will be reviewed annually.

17. Subject to availability and necessity the Committee may appoint a Clinical Fellow as a member or a co-opted member of the Committee.

18. The following shall serve ex officio: President; Vice-President, CR; Medical Director, Professional Practice, CR; and Medical Director, Education and Training, CR.

19. If a member of the committee does not attend for two consecutive meetings, enquiries shall be made as to whether the member wishes to resign and any recommendation that the period of office should be terminated as a result shall be made to the Medical Director, Professional Practice, CR.

Chair

20. The Chair will usually serve for a term of three years renewable for a further term of up to three years and no more. A committee member who is subsequently appointed as Chair of the committee will not have counted against his or her term of office as Chair any period of service as member of that committee.

21. The Chair will serve ex officio on the CR PSSB.

22. The duties of the Chair include –

• Working with the Audit & QI Officer and Medical Director, Professional Practice, CR jointly to review the current and planned work of the committee in June each year, to ensure cohesion with the wider College strategy and annual planning. Seek the wider views of the committee at its spring meeting.
• Chairing all meetings.
• Ensuring that the purpose and terms of reference are observed.
• Engaging all members of the committee in the work being done.
• Attending and ensuring regular reports are made to the CR PSSB; and attending CR Faculty Board (CR FB) meetings when invited to do so by the Vice-President, CR.
• Ensuring that relevant matters are drawn to the attention of the Medical Director, Professional Practice, CR.
• Reporting to the Medical Director, Professional Practice, CR where a member fails to be active or fails to attend meetings so that the Medical Director, Professional Practice, CR can form a view as to whether a member should be invited to vacate his or her place.
• Ensuring that links and liaison are established and developed with relevant external bodies.

Operation

23. The committee will meet not more than three times per year on dates to be agreed unless exceptionally required to transact urgent business.

24. Meetings may be held by virtual means/remote attendance.

25. Committee members may be called upon to consider or determine matters electronically between meetings and are expected to contribute to such considerations or decisions as part of their duties as committee members.

26. Committee members will not speak on or behalf of the College unless authorised to do so.

27. Committee members will abide by any stated or implied confidentiality that attaches to the work of the committee during and after any period of membership. (See Appendix A, The Audit Data Policy.)

28. Committee members will comply with the provisions of the Data Protection Act 1998 as regards processing (as defined in the Act) of any personal data where it is made available to them as part of their work.

29. The quorum shall be not less than three appointed members.

Approved by CRAQIC and CR PSSB: September 2018