DOES CLINICAL AUDIT PROMOTE PROFESSIONAL REFLEXIVITY? THE EXPERIENCE OF CASABLANCA PUBLIC HOSPITALS IN MOROCCO WITH QUALITY OF CARE IMPROVEMENT Blaise P (1), Gruénais ME (2), Nani S (3), Sahel A (3), De Brouwere V.(1) (1) Institute of Tropical Medicine (ITM), Antwerp, Belgium. (2) Institut de Recherche pour le Développement (IRD), Marseille,France. (3) Ministry Of Health, Rabat, Morocco (Correspondence : pblaise@itg.be ) ABSTRACT Clinical audit was introduced in 2005 in 4 public hospitals of Casablanca to improve the quality of clinical care. We report on a qualitative analysis of subsequent in-depth group interviews that aimed at documenting longitudinally the process pertaining to professionals and organisational change dynamics. The level of appropriation remains limited with wide variability. The implementation faces a web of technical constraints related to the poor quality of clinical records and the limited capacity to analyse data. Improvements remain limited by the capacity to implement changes revealing the high interdependency of medical activities across and beyond hospital departments, calling for the integration of audit in a global quality improvement strategy. Professionals attribute the gap between actual practice and standards to resources shortage, to patients’ behaviour and to other departments’ dysfunction. However, they only marginally question possible competence or professional deficiencies, justifying them by the need to ...