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.
