Quality in Practice The internal audit of clinical areas: a pilot of the internal audit methodology in a health service emergency department ALISON BROWN 1 , MARIO SANTILLI 2 , and BELINDA SCOTT 3 1 Australian Centre for Healthcare Governance, Melbourne, Australia, 2 East Grampians Health Service, Ararat, Australia, and 3 Northern Health, Epping, Australia Address reprint requests to: Alison Brown, Australian Centre for Healthcare Governance, Melbourne, Australia. Tel: +61-3-9094-7777; Fax: +61-3-9094-7788; E-mail: alison.brown@healthcaregovernance.org.au Accepted 24 September 2015 Abstract Quality problem or issue: Governing bodies of health services need assurance that major risks to achieving the health service objectives are being controlled. Currently, the main assurance mechan- isms generated within the organization are through the review of implementation of policies and pro- cedures and review of clinical audits and quality data. Initial assessment: The governing bodies of health services need more robust, objective data to in- form their understanding of the control of clinical risks. Choice of solution: Internal audit provides a methodological framework that provides independent and objective assurance to the governing body on the control of significant risks. Implementation: The article describes the pilot of the internal audit methodology in an emergency unit in a health service. An internal auditor was partnered with a clinical expert to assess the appli- cation of clinical criteria based on best practice guidelines. Evaluation: The pilot of the internal audit of a clinical area was successful in identifying significant clinical risks that required further management. Lessons learned: The application of an internal audit methodology to a clinical area is a promising mechanism to gain robust assurance at the governance level regarding the management of signifi- cant clinical risks. This approach needs further exploration and trial in a range of health care settings. Key words: health care, clinical governance, risk Introduction A key responsibility of a governing body is gaining assurance that sig- nificant risks to the achievement of strategic objectives are being effect- ively managed. Risk assurance at a board level is gained through a variety of mechanisms including management and committee reports, external audits and internal audits. Internal audit has been defined as ‘an independent, objective assur- ance and consulting activity designed to add value and improve an organisation’s operations’ [1]. Internal audits in health care organiza- tions have been widely used in providing assurance to boards regard- ing the robustness of the various financial controls in place to manage financial risks and ensure financial objectives are met. In theory, best practice internal audit approaches should ‘direct their activities to the most significant risks of the entity and the controls in place to manage them’ [2]. It is well established in the literature that health care interventions carry significant risks to patients and consumers. Patients have a ‘one in two chance of getting the right care, a 1:10 likelihood of being harmed in association with a hospital admission and a 1:50 possibility of system-induced death or major disability’ [3]. It is logical then that the board would welcome a similar degree of assurance regarding the management of clinical risk as financial risk. International Journal for Quality in Health Care, 2015, 1–3 doi: 10.1093/intqhc/mzv085 Quality in Practice © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved 1 International Journal for Quality in Health Care Advance Access published October 13, 2015 by guest on October 20, 2015 Downloaded from