How to improve the quality of healthcare audits

How to improve the quality of healthcare audits.

Most organizations audit using one or more statistical sampling approaches. The sampling rate is usually low because of the high cost.

All of the usual guidelines and concerns about costs and sampling risks go out the window for auditing of Office Services work where the auditing can be done by background software systems at a ‘sampling’ rate of 100%.

 Consider process flow instances where work is being guided by best practices workflow templates but where users are free to skip over steps, perform steps in a different sequence, add steps not in the template and provide incomplete data at some forms.

 The obvious question here is how can good outcomes be maintained in an environment such as this?

 The solution lies in embedded Process Control Points (PCPs) at key steps along workflows that background software alone consults.

 When a PCP becomes the current step in a process, the system consults a checklist that is built up automatically as a result of routine processing for a case (users are not allowed to view such checklists). 

 If the checklist at a PCP calls for say nine (9) deliverables with specific attributes and the system discovers deficiencies, we either get to a hard stop or a warning is issued and is logged in the transaction file. True hard stops require supervisory override and this also results in an exception that is logged.

 It’s important systems be user-friendly with in-line auditing.  Too many PCPs make it next to impossible for users to do their work, too few PCPs result in bad transactions.

 If a patient healthcare form, for example, asks for an address, it might be an acceptable practice to backlight the address field at the time the user tries to leave the form, issue a warning and ask if the user might want to go back and input an address, on the basis that until some downstream task actually involves sending out a letter, the absence of an on-file address, however undesirable, may not be critical. 

 If the system, on the other hand, includes a top-level ‘Emergency Contact Sheet,’ then a soft stop at the initial registration form for the patient address would not be considered good practice.


Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, connect-the-dots law enforcement investigations, healthcare services delivery, job shop manufacturing and b2b/b2c/b2d transactions. (C) 2010-2018 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
This entry was posted in FIXING HEALTHCARE, Process auditing and tagged , . Bookmark the permalink.

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