The Benefits and Barriers of Internal Quality Audits

Introduction

Internal quality audits are an important tool to promote quality improvement in health and social care organisations. They help to identify if a service or a particular department / area is operating as it should be and to a high standard which is in line with best practice and regulatory requirements. It is important for organisations to take the time to develop a robust auditing programme to ensure continuous improvement and effective oversight and monitoring of services.

In HCI’s research paper “The Healthcare System: Will We Ever Learn? – A Review of the Common Themes arising from UK and Ireland Healthcare Inquiries”, HCI found that audit was one of the common themes arising between Ireland and UK serious events. For example, in the Mid Staffordshire NHS Trust Public Inquiry one of the findings detailed was that when audits were carried out, there was no robust mechanism in place, to ensure changes were implemented. When re-audits were required, they were often not undertaken. Similarly, in the Portlaoise Perinatal Deaths Investigation it was found that there was no strategic plan for audit across the Hospital and there was no dedicated staff member with oversight of an audit programme. The Hospital did not have the structures necessary to support an effective system of multidisciplinary audit and applicable guidelines were not implemented within the audit processes.

In this blog we discuss some of the benefits and barriers to conducting internal quality audits.

The Benefits of Internal Quality Audits

• Regulatory compliance: The quality audit will help you to identify if your every-day-processes are in line with those set out in your internal policies and procedures and with regulatory requirements. By identifying any gaps in compliance, you can put in place the necessary Quality Improvement Plans (QIPs) to address these areas for improvement and achieve regulatory compliance.
• Improves Governance: Quality audits provide assurance and insight into the effectiveness of the processes carried out within the organisation.
• Drives continuous quality improvement: Organisations should not only be trying to achieve regulatory compliance, but they should look beyond this to also seek recommendations for improvement by incorporating best practice to drive continuous quality improvement.
• Promotes leadership and empowerment: By engaging individuals in the audit practice it helps to ensure that they feel a level of empowerment.
• Supports ongoing monitoring of services: A robust auditing schedule supports the monitoring and oversight of the key areas of service provision. Where areas of improvement are identified these QIPs can be monitored through robust governance arrangements.
• Improves organisational learnings and communication: Learnings and quality improvement initiatives gathered from internal audits should be shared across an organisation to ensure system-wide learnings. In addition, by allowing staff to conduct audits in different areas within the service, this helps to build organisational communication and staff can take learnings across to other departments.
• Low organisational disruption: Internal audits are generally more flexible and can be done with little organisational disruption. The audit preparation is key to ensuring its efficiency as is having an annual Audit Schedule and a clear Internal Audit Policy and Procedure so that the auditors are aware of the organisational processes for conducting internal audits.
• Low cost: Managing audits internally reduces costs as otherwise the organisation would be required to engage external auditors.
• Standardisation of methods: Organisations should try to build standardisation of processes in relation to audit so that audits are conducted effectively and the appropriate outcomes are achieved.
• Communication improved: Utilising auditors from different departments not only optimises your use of resources, but it allows staff members to engage with other staff members they previously may not have had an opportunity to work with. It improves communication and creates an awareness of other peoples’ roles within the organisation.

The Barriers of Internal Quality Audits

• Demands on resources: Internal audits can place demands on resources. However, organisations should avoid internal audits falling to the same staff members and rather incorporate participation across the board.
• Can be ineffective: Everyone involved in audit may not have the skills or expertise they may need to have to make sure the audit is effective. Ideally auditors need to have certain skills and attributes to enable them to get the root of an issue. To overcome this, organisations should ensure that they have a comprehensive Internal Audit Policy and Procedure that sets out the auditor’s roles and responsibilities and the standardised audit process. Shadowing an experienced auditor is another valuable tool to build up knowledge, understanding and confidence in audits.
• Can be difficult to close out: If the Governance model isn’t strong enough and you don’t have teams and committees in place to follow up on actions then there could be difficulties in closing out an audit. However, where the Governance model is sufficiently robust then there will be effective oversight to ensure the necessary actions are addressed timely and appropriately.
• Least independent: Independence is one of the primary challenges of internal audits. In particular, where organisations are small, there may be a limited number of staff to conduct audits that are truly independent.

Conclusion

Although there are barriers and challenges to Internal Quality Audits, these can be reduced with clear planning and organisation from the outset. Internal auditing is a valuable tool for all healthcare organisations to be able to identify areas of good practice and areas for improvement.

If you are concerned about the independence or quality of your audits, HCI can assist you. HCI works with our clients to maintain their programmes of independent quality assurance. Our audits incorporate documentation reviews, data analysis, staff interviews, and real time monitoring and observation. HCI Specialists will provide you with advice and guidance in line with the everchanging best practice standards.