Clinical audit, guidelines and standards : a productive relation for managing clinical practices

This paper contributes to the knowledge about the process of standardisation within the domain of medicine. Standardisation has become an important form of governance and co-ordination, and there is limited empirical knowledge about its nature and consequences (Brunsson et al., 2000). This paper aims to explore the development, circulation and standardisation process of a specific clinical audit programme: the Scottish Hip Fracture Audit. This audit started as a local initiative and now has developed into a sophisticated arena (Sahlin-Andersson, 2000) which provides Scottish hospitals with monthly ‘real-time reports’ outlining their performance against Scottish government targets. The paper argues that the interrelation between clinical audit and evidence-based medicine (EBM) can become a ‘productive relation’ (Mykhalovskiy, 2003), that opens up spaces of intervention, in which the clinical communities engage with processes of change of clinical procedures, and in these spaces, clinicians and managers are in a position to refine clinical practice and service organisation, to reflect upon their own actions and to allow insight into the rationalities of their work (Berg, 1997).

Audit of the Douglas Hocking Research Institute bone bank : ten years of non-irradiated bone graft

Background:  An audit performed in the use of non-irradiated femoral head bone graft at the Geelong Hospital over a 10-year period. While it is thought the non-irradiated bone graft provides a better structural construct there is theoretical increased risk of infection transmission.

Methods:  We performed a retrospective review of prospectively collected data in the use of non-irradiated bone allograft used from the Geelong Hospital Douglas Hosking Research Institute bone bank over a 10-year period. The review was performed using data collected from the bone bank and correlating it with the patient’s medical record. All complications, including infections, related to the use of the allograft were recorded.

Results:  We found that over the 10 years to 2004 that 811 femoral heads were donated, with 555 being used over 362 procedures in 316 patients. We identified a total of nine deep infections, of which seven were in joint replacements. Overall this was a 2.5% deep infection rate, which was lowered to 1.4% if the previously infected joints that were operated on were excluded.

Conclusion:  The use of non-irradiated femoral head bone graft was safe in a regional setting.

Reporting large-scale assessment on a single formative-summative scale

This thesis explored the possibilities for effective formative-summative reporting of large-scale assessment programme data. The result was the creation of an interactive reporting format that provides teachers with feedback on students’ performance in a form, defined by the teacher, to assist in the preparation of effective educational experiences for students.

Data warehouse design and legal visualization – the applicability of H2 for reporting

The steady increase of regulations and its acceleration due to the financial crisis heavily affect the management of regulatory compliance. Regulations, such as Basel III and Solvency II particularly impact data warehouses and lead to many organizational and technical changes. From an IS perspective modeling techniques for data warehouse requirement elicitation help to manage conceptual requirements. From a legal perspective attempts to visualize regulatory requirements – so called legal visualization approaches – have been developed. This paper investigates whether a conceptual modeling technique for regulatory-driven data warehouse requirements is applicable for representing data warehouse requirements in a legal environment. Applying the modeling technique H2 for Reporting in three extensive modeling projects provides three contributions. First, evidence for the applicability of a modeling technique for regulatory-driven data warehouse requirements is given. Second, lessons learned for further modeling projects are provided. Third, a discussion towards a combined perspective of information modeling and legal visualization is presented.

Feedback reporting of survey data to healthcare aides

Background

This project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides’ (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed.

Methods
A convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews.

Results
One hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs’ opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating.

Conclusions
This study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites.

Internal audit attributes and external audit's reliance on internal audit : implications for audit fees

This study aims to examine two aspects of internal audit quality, namely internal audit competency and internal audit contribution to financial statement audits. Consistent with the substitution view, this study predicts a negative relationship between the competency aspects of internal audit (the tenure of the existence of internal audit in the organization, internal audit staff expertise in IT and computer skills, training hours, internal audit staff professional certifications in accounting and auditing, and internal audit staff experience in auditing) and audit fees. Second, this study tests whether the contribution of internal auditors to financial statement audit reduces audit fees. The data analysis is based on a cross-sectional regression model with observations of 73 public-listed firms in Malaysia, which include publicly available data matched with survey responses from their internal and external auditors. The results of the study suggest that the competency of internal audit, namely the tenure of the existence of internal audit in the organization, training, internal audit staff prior experience in auditing and accounting, and certifications are associated with lower audit fees. Our findings for both aspects of internal audit quality (competency and internal audit contribution) lend support to the substitution view for explaining the links between internal audit quality and audit fees.

Factors affecting capital program performance audit findings

Complex capital programs require specialized management techniques, in order to address the volatility, cost overruns, significant delays in completion, and failures with which such programs are typically associated. The need is greater than ever for careful oversight, especially for programs that expend public monies.

Audit is commonly a statutory or governance requirement on such programs, but traditional performance audit techniques and standards may be insufficient for certain types of programs and industries, providing a mere illusion of oversight adequacy instead of the assurance that is needed. In order to most appropriately define the performance audit scope, phrase the solicitation for services, select the audit team, and provide support to the auditors during the engagement, public and private sector entity auditees need to understand the factors that impact performance audit results and effectiveness. The question becomes one of how performance audit can be improved, and stakeholders satisfied regarding program achievements, accountability for resource use, transparency in operations, and risk management.

The author considered program complexity, governance, project controls, the history and evolution of the audit function, stakeholder expectations, assurance, and obstacles to audit, and used this information in conjunction with data from a large sample of 775 audit reports from complex construction programs, to derive questions and conclusions about performance audit results and effectiveness, and comparisons to expenditure audit results. The ultimate goal was to define key components in the execution of performance audits, based on theconclusions of the analysis, in order to improve performance audit findings and thus their applicability and usefulness.

While this study focused on program performance audit, it was also related to the field of program management. Although the data population was concentrated in the area of construction programs, conclusions from this research may also be applied to other complex, multifaceted or phased activities such as projects and programs in other industries (manufacturing, information technology), and also pursuits such as major event planning, company launch, mergers, and large program implementations or rollouts.

The research results clearly demonstrated that different types of findings were generated by different audit scopes. The author observed that typical audit findings focused on routine procedural, accounting, and controls errors. On average, contract expenditure audits questioned only 2.65% of expenditures, and performance audits of large complex programs questioned only 0.03% of expenditures. The majority (72.56%) of the performance audits in the sample yielded no findings or questioned costs.

There were significant positive correlations between: the number of expenditures tested and the number of qualitative findings, inclusion of construction experts on the audit team and the percentage of expenditures questioned, inclusion of construction experts on the audit team and the number of qualitative findings, broader audit scope and the percentage of expenditures questioned, and broader audit scope and the number of qualitative findings. Of these, auditor expertise and audit scope were the driving factors.

There were significant negative correlations between the application of agreed-upon procedures and the percentage of expenditures questioned, and the application of agreed upon-procedures and the number of qualitative findings. It was determined that the significant negative correlation between the application of audit standards and the number of qualitative findings was due to other factors, such as the application of agreed-upon procedures and the lack of construction experts on the audit team.

Other findings, resulting from review of the data, were unrelated to the research questions yet of considerable importance to industry. An extremely high percentage (81%) of the “performance audits” instead applied a very limited set of agreed-upon-procedures (AUP) in the engagement, According to the American Institute of Certified Public Accountants (CPAs), AUP engagements could not be classified as audits. Thus, it was inappropriate for the accounting firms to apply AUP engagements in lieu of a performance audit, and it was especially egregious for them to state in their report that the engagements were conducted in accordance with audit standards, as AUP engagements and the specific audit standards were by their very nature mutually exclusive.

The quality of dietary intake methodology and reporting in child and adolescent obesity intervention trials : a systematic review

Assessing dietary intake is important in evaluating childhood obesity intervention effectiveness. The purpose of this review was to evaluate the dietary intake methods and reporting in intervention studies that included a dietary component to treat overweight or obese children. A systematic review of studies published in the English language, between 1985 and August 2010 in health databases. The search identified 2,295 papers, of which 335 were retrieved and 31 met the inclusion criteria. Twenty-three studies reported energy intake as an outcome measure, 20 reported macronutrient intakes and 10 studies reported food intake outcomes. The most common dietary method employed was the food diary (n = 13), followed by 24-h recall (n = 5), food frequency questionnaire (FFQ) (n = 4) and dietary questionnaire (n = 4). The quality of the dietary intake methods reporting was rated as ‘poor’ in 15 studies (52%) and only 3 were rated as ‘excellent’. The reporting quality of FFQs tended to be higher than food diaries/recalls. Deficiencies in the quality of dietary intake methods reporting in child obesity studies were identified. Use of a dietary intake methods reporting checklist is recommended. This will enable the quality of dietary intake results to be evaluated, and an increased ability to replicate study methodology by other researchers.