A community health center internal audit is more than just a checklist to be completed. It's a strategic tool for assessing process compliance, identifying hidden risks, and providing a basis for data-driven decision-making.
Without a systematic approach, audits can potentially lose the essence of quality control. This article will further explain the objectives, guidelines, auditor duties, audit stages, and examples of implementation.
What is a Community Health Center Internal Audit?
An internal audit of a community health center is an assessment conducted by comparing agreed-upon standards (audit criteria) with actual practices (audit evidence). This audit is not intended to identify management errors, but rather to assist management in improving the organization's quality or performance.
Simply put, audits conducted on healthcare units such as community health centers (Puskesmas) are a monitoring and internal control measure for the center's management. This allows for early detection of potential risks, more efficient resource management, and more accurate decision-making.
In this context, the internal audit implementer is a community health center employee selected by the Head of the Community Health Center to conduct the internal audit. Like other auditors, community health center auditors must apply ethical, open, diplomatic, flexible, resilient, assertive, and confident auditing principles while carrying out their duties.
Purpose of Internal Audit of Health Center
- Conducting assessments of the suitability of resources, service processes, service performance of UKM, UKP, and administration as a basis for improving quality and increasing performance.
- Assisting leaders in carrying out their responsibilities through analysis, assessment, providing suggestions and comments related to UKM activities.
- Identify and minimize risks that may occur in the implementation of services.
- As a basis for consideration in decision making by management.
Internal Audit Guidelines for Community Health Centers That Need to be Understood
Internal audits at community health centers are a crucial mechanism for ensuring the quality of healthcare services, compliance with accreditation standards, and transparency in management. Therefore, those conducting audits in this context must possess relevant competencies.
Furthermore, it is crucial for auditors to understand the audit guidelines used in the audit process, including the primary objectives, basic principles of internal audit, audit stages for community health centers, and the role of the internal audit team. By understanding these principles, auditors can perform their duties in accordance with applicable standards.
Duties of the Community Health Center Internal Audit Team
In general, the task of the community health center's internal audit team is to carry out the audit process itself. Furthermore, the audit team's duties include the following:
- Prepare an internal audit work plan.
- Prepare a schedule for implementing internal audits.
- Conducting internal audits on the service performance of the Technical Implementation Unit (UPT) of the community health center.
- Prepare internal audit reports in accordance with the Internal Audit Guidelines.
- Report the audit findings to the head of the health center.
- Participate in management review meetings to follow up on audit findings.
Stages of Internal Audit of Health Center
1. Preparation of Audit Plan
The first step in a community health center internal audit is audit planning. This stage includes determining the work units to be audited, the audit objectives, the audit schedule, and preparing the audit instruments.
All audit activities throughout the year must be planned as an internal audit program. This internal audit program will then serve as the basis for developing audit plans for each work unit to be audited.
2. Data Collection
Next, the auditor collects data using audit instruments based on applicable official standards or criteria. The goal is to ensure the assessment is objective and measurable. For example, accreditation standards, Minimum Service Standards (SPM), program standards or guidelines, and performance standards or indicators.
3. Audit Data Analysis
The next stage is audit data analysis. This stage also includes problem formulation, prioritization, and audit follow-up plans. This analysis process is carried out by comparing the data with standards or criteria used by the community health center.
This will allow for the identification of discrepancies between existing practices and standards. These findings will then be discussed with the auditee to determine priority issues for follow-up.
4. Reporting and Dissemination of Audit Results
The final stage is reporting and dissemination, or providing recommendations, to the auditee. Once the report is prepared, the auditor is required to submit it to the Head of the Primary Health Facility (FTKP), and the results are then conveyed to the audited unit.
Example of Internal Audit of Health Center
To get a clearer picture, here is an example of the 2019 Maju Jaya Community Health Center (fictitious) audit report.
1. Background, Objectives, and Scope of the Audit
- Background: it was found that in 2018, counter or registration services did not contain complete medical records.
- Objectives: to assess the suitability of the service process and the performance of the counter or registration, to audit the patient registration process, and to audit the patient registration implementation process.
- Scope: counter or patient registration section at Maju Jaya Health Center.
2. Audit Implementation Method
- Audit criteria: Minister of Health Regulation (PMK) No. 269 of 2008 concerning medical records, PMK No. 75 concerning personnel standards, and PMK No. 46 of 2015 concerning accreditation.
- Audit methods: interviews, observation, and simulation.
- Auditors: Sherly, Rahmat, and Bambang.
3. Audit Implementation
The audit was conducted using observation, interviews, and simulations of patient reception activities at the health center's counter or registration area. The interviews revealed that many counter staff failed to provide complete patient information in the medical record, including the name as per the Family Card (KK), address, and date of visit.
4. Findings
Based on interviews, observations, and simulations, the auditor found the following things.
- Non-conformity of filling in medical records with medical record management standards.
- Inconsistency of registration procedures with field practices.
- The number of counter staff is limited and there is no routine monitoring to check the completeness of medical records.
5. Recommendations and Follow-up Plans
- Nominate competent medical records personnel.
- Aligning perceptions between counter staff through socialization of procedures for writing complete patient medical records.
- Evaluate officer performance every three months.
Conclusion
Internal audits at community health centers are not merely an accreditation formality, but also a quality management tool. This assessment process enables the community health center to maintain service quality, enhance public trust, and ensure transparent and accountable resource utilization.
To optimize the audit process, having competent auditors alone is not enough. Community health centers need to consider using technology that can support a more effective and efficient audit process.
Use Audithink audit application to help each stage of the audit become more organized – from planning, implementation, reporting to monitoring, everything can be done in one centralized application. Try the app demo and find out how reliable our app is.
