Audit in Occupational Health: 4

Classification of Audit

Several definitions, types and taxonomies of audit have been described, some of which require clarification for the reader. Audit of the quality of assessment, communication, advice and of the individual outcome is very important for the purposes of continuing education of the health care professional. (Agius & Seaton Practical Occupational Medicine, ) Moreover it is essential to ensure that quality of care for the individual(s) is paramount before embarking upon other quantitative performance indicators.

When classified along the lines advocated by Donabedian, audit can be subdivided into audit of structure, process and outcome (Quality and Audit in Occupational Health - Faculty of Occupational Medicine, 1995).

Structure deals with the quantity, type of resources available and the organisational framework.

Process deals with what is carried out by way of assessment, advice and other intervention in relation to the worker.

Outcome measures the results of the intervention by the (occupational) physician or (occupational) health service, such as reduction in morbidity or in health risks.

At a higher and wider organisational level, audit should cover the effectiveness and efficiency of the occupational health service, and provide benchmarking comparisons with other similar organisations. Effectiveness is defined as the extent to which a specific intervention, procedure, regimen or service, when deployed in the field, does what it is intended to do for a defined population. Efficiency measures the effects or end-results achieved in relation to the effort expended in terms of money, resources and time.

This educational resource places emphasis on the quality of care. Nevertheless, effective resource management should be an important part of the training in occupational health service management.

General Methods

The complexity of the classifications of audit is paralleled by the methods available. Most of these are complementary ie few are exclusive. The following outlines some methods based on audit of "structure", "process" and "outcome".

Audit of Structure

An extensive list of points that could be addressed in an audit mainly of structure appear in Appendix B of Occupational Medicine (Ed. C Zenz, Mosby 1994).

Audit of Process

One means of formal audit, especially of occupational medical care, relies on the getting together of what could be described as an "audit circle". This consists of a small group of professional practitioners who, for the purposes of internal audit of the process or outcome of health care, are in turn audited themselves, or act as auditors. The minutes are retained and can be used as confirmatory evidence of the audit and to assist the pursuit of remedial action. The detailed audit notes can then be destroyed. An example of points to consider is given in the next section, but before you read it try and list what common features of good occupational medical consultation you can think of.

This page is:
http://www.agius.com/hew/audit/4.htm

You may also wish to access the following URL:
http://www.agius.com/hew/resource/quality.htm

NOW.... Remember that whatever type of audit you embark on, valid standards are necessary. Consider how you would derive a standard - perhaps by discussion with your colleagues? How would you derive an evidence-based standard? Choose an example and work on it. (The example in the next page relates to respiratory health surveillance.) Make a few notes. Only then proceed to the next page.

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