Healthcare Audit Checklist

What are healthcare audits?

Maintaining compliance with regulations and upholding standards is essential in healthcare. A healthcare audit plays a critical role in this process by comprehensively reviewing operations, procedures, and practices. Its primary objective is to identify potential risks and implement effective corrective action plans for a healthcare organization.

With a heightened emphasis on clinical outcomes and patient satisfaction, health authorities and organizations are prioritizing audits as one of the key quality improvement initiatives (Hut-Mossel et al., 2021). This approach involves systematically assessing the care provided, identifying opportunities for enhancement, and implementing changes to drive better patient outcomes (Spencer & Walshe, 2009).

What is a Healthcare Audit Checklist?

The checklist is a guide to be used during the audit process. It helps the healthcare organization conduct thorough evaluations and identify areas for improvement. This process ensures that healthcare organizations comply with high standards of care, mitigate risks, and enhance healthcare services' overall quality improvement process and effectiveness.

The seven elements of a successful compliance program that this healthcare audit is based on are structured around the U.S. Department of Health and Human Services Office of Inspector General's General Compliance Program Guidance (2023):

1. Written policies and procedures

This provides a roadmap for healthcare organizations outlining the duties, workflow management, and documentation requirements. These mitigate compliance risks specific to the entity and demonstrate how the entity complies with regulations, applicable laws, and requirements. There are two elements:

• Code of conduct: This communicates the entity's goals, mission, and ethical requirements relevant to its operations and how these align with laws and regulations.
• Compliance policies and procedures: This encompasses the implementation and operation of the entity's compliance program and describes the processes used to reduce risks of non-compliance by laws.

2. Compliance leadership and oversight

Compliance leadership is necessary for an effective entity that saves costs, reduces and mitigates risk, and provides patients with safe, high-quality care. Several necessary members of leadership must understand the value and be committed to the entity's success. These are a compliance officer and a compliance committee. It is also necessary for board compliance oversight to occur to ensure that the compliance officer and committee are adhering to protocol.

3. Training and education

An annual training plan that covers the entity's compliance program and potential compliance risks needs to be developed and administered to relevant staff. Training material must be accessible to healthcare professionals and other designated users, ensuring that cultural competency is adhered to.

4. Effective lines of communication with the compliance office and disclosure program

It is important to have open communication between compliance officers and entity personnel; this should be made available to all necessary individuals.

5. Enforcing standards: consequences and incentives

The entity needs to ensure that they have established clear and appropriate consequences and incentives for compliance and non-compliance.

6. Risk assessment, auditing, and monitoring

These are crucial for quantifying and identifying compliance risks. Risk assessment refers to analyzing, identifying, and responding to risk. Auditing and monitoring refer to the schedule of audits to be conducted based on the identified risks in the annual risk assessment.

7. Responding to detected offenses and developing corrective action initiatives

It is important to ensure that there are methods and guidelines for when a concern is raised or a necessary investigation into the organization. Investigations of violations, reporting to the government, and implementing corrective action initiatives are all necessary procedures that need to be available for use when necessary.

How does our Healthcare Audit Checklist template work?

To use our template, follow these steps:

Step 1: Download template

Access the Healthcare Audit Checklist template by clicking "Use template," allowing you to edit the resource via the Carepatron app. For a PDF copy, choose "Download."

Step 2: Familiarize yourself with template

Our Healthcare Audit Checklist has seven sections that cover the necessary requirements based on the U.S. Department of Health and Human Services Office of Inspector General's General Compliance Program Guidance (2023). Healthcare organizations can use the checklist to determine whether their policies and procedures ensure healthcare compliance and that staff members are adequately trained on relevant regulations.

Step 3: Complete the audit checklist

Take the time to answer the questions. The simple yes or no questions will give auditors a clear picture of any gaps in the healthcare organization. This will guide any implementation or procedures that need to be put in place.

Step 4: Give a copy to required recipients

Share the Healthcare Audit Checklist template with the necessary individuals. This will reinforce the information in the checklist and allow them to review the details at their own pace.

What are the benefits of having a Healthcare Audit checklist ready?

Having a Healthcare Audit Checklist readily available offers numerous benefits for healthcare organizations:

Staying on top of regulations and laws

Healthcare facilities must prioritize regulatory compliance with laws and regulations to avoid fines, penalties, or a loss of patient trust. Effective compliance programs are essential, encompassing clear policies and staff training in billing practices, patient privacy, and data security. Regular audits help identify and address risks proactively, minimizing potential consequences. Additionally, staying informed about regulatory changes ensures organizations remain compliant and maintain credibility with patients and regulatory bodies.

Maintaining compliance through communication

Clear communication and proper documentation are foundational to healthcare compliance. A well-documented compliance manual ensures staff understand their responsibilities and remain updated on evolving standards. Centralized databases streamline processes, foster teamwork, and simplify the tracking of compliance deadlines. These tools also enable organizations to identify areas needing improvement, reducing the likelihood of violations and improving patient care. By promoting a culture of open communication, healthcare providers can address compliance challenges efficiently and maintain patient trust.

Reducing risks and promoting patient safety

Minimizing healthcare-acquired infections (HAIs) and improving safety are key to compliance. Effective infection control measures—like using protective equipment, maintaining hand hygiene and employing checklists—significantly reduce risks. Data-driven strategies and robust communication systems enhance safety by addressing potential issues early. Encouraging incident reporting also fosters transparency, allowing facilities to implement policy changes that enhance safety and trust among patients, staff, and regulatory bodies. A strong compliance culture benefits everyone involved.

References

Hut-Mossel, L., Ahaus, K., Welker, G., & Gans, R. (2021). Understanding how and why audits work in improving the quality of hospital care: A systematic realist review. PloS one, 16(3), e0248677. https://doi.org/10.1371/journal.pone.0248677

Spencer, E., & Walshe, K. (2009). National quality improvement policies and strategies in European healthcare systems. BMJ Quality & Safety, 18(Suppl 1), i22-i27.

U.S. Department of Health and Human Services Office of Inspector General. (2023). General Compliance Program Guidance. https://oig.hhs.gov/documents/compliance-guidance/1135/HHS-OIG-GCPG-2023.pdf