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).
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.
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.
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"
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.
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Raymond Agius ©