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11
Skills for the New Skills for the New Healthcare Internal Healthcare Internal
AuditorAuditor
22
Training ObjectivesTraining Objectives
Discover or verify underlying business needs Discover or verify underlying business needs driving a projectdriving a project
Identify key stakeholders and contacts for Identify key stakeholders and contacts for their projecttheir project
Determine project scope and objectivesDetermine project scope and objectives Identify the elements of a audit programIdentify the elements of a audit program Use appropriate audit tools to complete a Use appropriate audit tools to complete a
projectproject Structure and conduct fieldworkStructure and conduct fieldwork Discuss findings and recommendations with Discuss findings and recommendations with
key stakeholders at an exit conferencekey stakeholders at an exit conference Understand elements of project wrap upUnderstand elements of project wrap up
33
Project ManagementProject Management
““The nicest thing about not The nicest thing about not planning is that failure comes planning is that failure comes as a complete surprise and is as a complete surprise and is not preceded by a period of not preceded by a period of worry and depression.”worry and depression.”
John Preston, Boston CollegeJohn Preston, Boston College
44
Project ManagementProject Management
““If you don’t know where If you don’t know where you’re going, you may not get you’re going, you may not get there.”there.”
Forrest GumpForrest Gump
55
Overview of Audit Overview of Audit ProcessProcess
1.1. Auditee SelectionAuditee Selection
2.2. Audit PlanningAudit Planning
3.3. Preliminary SurveyPreliminary Survey
4.4. Internal Control ReviewInternal Control Review
5.5. Detail TestingDetail Testing
6.6. Audit Results/Findings and Audit Results/Findings and RecommendationsRecommendations
7.7. Results ReportingResults Reporting
8.8. Closing/Exit ConferenceClosing/Exit Conference
9.9. Issue Follow-upIssue Follow-up
66
Presented by:Presented by:Kelly NueskeKelly Nueske
Emergency Department
Overview
77
4 Phases of ED4 Phases of ED
Entry/TriageEntry/Triage DiagnosticDiagnostic TreatmentTreatment DispositionDisposition
88
Triage PhaseTriage Phase
Emergent arrivals typically by Emergent arrivals typically by pass triage pass triage
Non emergent arrivals are Non emergent arrivals are assessed by a Triage Nurseassessed by a Triage Nurse Ask a series of questions Ask a series of questions
related to present complaintrelated to present complaint Assess patientAssess patient Prioritize/rank on 1 – 5 scalePrioritize/rank on 1 – 5 scale
99
Triage PhaseTriage Phase
Prioritization is dynamicPrioritization is dynamic Adjustments made after each Adjustments made after each
patient is assessedpatient is assessed Ranking system determines who Ranking system determines who
sees the resources firstsees the resources first Registration typically occurs after Registration typically occurs after
triagetriage Only place in healthcare you can’t Only place in healthcare you can’t
refuse to treatrefuse to treat
1010
Diagnostic PhaseDiagnostic Phase
Provider reviews triage informationProvider reviews triage information Gathers more detail & exams patientGathers more detail & exams patient Waiting period while data is Waiting period while data is
collected [i.e. lab tests, radiology collected [i.e. lab tests, radiology exams]exams]
May order more tests after initial set May order more tests after initial set reviewedreviewed
Working diagnosis is determined by Working diagnosis is determined by providerprovider
1111
Treatment PhaseTreatment Phase
Provider determines follow up Provider determines follow up care or treatmentcare or treatment Inpatient admissionInpatient admission Transfer to another facilityTransfer to another facility Follow up with primary care Follow up with primary care
providerprovider
1212
Disposition PhaseDisposition Phase
Written plan of care is created by Written plan of care is created by providerprovider
Nurse reviews plan of care & Nurse reviews plan of care & educational materials with patienteducational materials with patient
Discharge instructions provided in Discharge instructions provided in writing to patientwriting to patient
1313
Health Unit CoordinatorHealth Unit Coordinator
Maintains log for EMTALA Maintains log for EMTALA requirementsrequirements Time inTime in Time outTime out Patient namePatient name Chief complaintChief complaint Treating providerTreating provider Discharge dispositionDischarge disposition
1414
Health Unit CoordinatorHealth Unit Coordinator
Enters ordersEnters orders Telephone management [i.e. similar Telephone management [i.e. similar
to air traffic controller]to air traffic controller] Places calls for orders & consultsPlaces calls for orders & consults Monitor activities to ensure they Monitor activities to ensure they
happenhappen Follow up on test resultsFollow up on test results Prompt people to keep things Prompt people to keep things
movingmoving
1515
Charge SpecialistCharge Specialist
Three main components to ED Three main components to ED charging [facility billing]charging [facility billing] Level charge [acuity system]Level charge [acuity system] Procedure chargeProcedure charge Supply chargesSupply charges
Professional billing could include E&M Professional billing could include E&M level and/or procedure codelevel and/or procedure code
Monitors charge tickets to ensure Monitors charge tickets to ensure there is one for each patient on the logthere is one for each patient on the log
1616
Charge NurseCharge Nurse
Assures patient flow through EDAssures patient flow through ED Removes barriers to flowRemoves barriers to flow Looks at equity of assignments Looks at equity of assignments
among staffamong staff Provides transfer report to next Provides transfer report to next
shiftshift
1717
Divert StatusDivert Status
““Divert” is when the ED is closed to Divert” is when the ED is closed to ambulance servicesambulance services
Determined jointly by charge nurse & lead Determined jointly by charge nurse & lead physicianphysician
Some cities/metro areas allow subcategories Some cities/metro areas allow subcategories i.e. OB, Trauma, Mental Healthi.e. OB, Trauma, Mental Health
If more than 2 EDs on divert, typically If more than 2 EDs on divert, typically everyone goes off. This is determined based everyone goes off. This is determined based on the city agreement.on the city agreement.
Cause generally by inpatient staffing Cause generally by inpatient staffing shortage, not ED staffing shortage.shortage, not ED staffing shortage.
1818
ED StaffingED Staffing
Will not see traditional Day, Will not see traditional Day, Evening, Night shiftsEvening, Night shifts
Staff stagger start every couple Staff stagger start every couple hourshours
Weekday heaviest patient flow Weekday heaviest patient flow typically 11am – 11pmtypically 11am – 11pm
Weekend heaviest patient flow Weekend heaviest patient flow typically 9am – 5pm and 7pm – 2amtypically 9am – 5pm and 7pm – 2am
1919
Department ReadinessDepartment Readiness
See a larger level of supplies and See a larger level of supplies and pharmaceutical agents in EDpharmaceutical agents in ED
Try to be prepared for 80 – 90% Try to be prepared for 80 – 90% of what presents in the EDof what presents in the ED
Closets partners are registration, Closets partners are registration, radiology, pharmacy, lab with radiology, pharmacy, lab with horizontal or vertical access to horizontal or vertical access to surgical suitessurgical suites
2020
Trauma DesignationTrauma Designation
American College of Surgeons assigns American College of Surgeons assigns trauma level based on applicationtrauma level based on application Level 1: teaching/research focused Level 1: teaching/research focused
facilityfacility Level 2: same as 1 without Level 2: same as 1 without
teaching/researchteaching/research Level 3 – 5: defined at state level. Can Level 3 – 5: defined at state level. Can
deal with most walk in trauma, stabilize deal with most walk in trauma, stabilize and transfer to another facility and transfer to another facility
Currently 4 – 6 states don’t have trauma Currently 4 – 6 states don’t have trauma designation.designation.
2121
Other ED ServicesOther ED Services
Sometimes used for scheduled Sometimes used for scheduled procedures. More typical in smaller procedures. More typical in smaller facilities/rural communities.facilities/rural communities.
Fast Track used to treat level 4 – 5 Fast Track used to treat level 4 – 5 rated patients. Method to avoid rated patients. Method to avoid these patients constantly being these patients constantly being moved to bottom of priority list.moved to bottom of priority list.
Urgent Care is different than fast Urgent Care is different than fast track.track.
2222
QuestionsQuestions
2323
Presented by:Presented by:Debi WeatherfordDebi Weatherford
Developing a Risk Assessment Approach
2424
Annual Risk AssessmentAnnual Risk Assessment
Key deliverables:Key deliverables: Completed risk assessmentCompleted risk assessment Company risk profileCompany risk profile Annual audit plan for audit Annual audit plan for audit
committee approvalcommittee approval
2525
Annual Audit Plan Annual Audit Plan ObjectivesObjectives
Focus on high risk activities.Focus on high risk activities. Focus significant financial and Focus significant financial and
operational impact/risk.operational impact/risk. Provide coverage of regulatory Provide coverage of regulatory
compliance risks.compliance risks. Provide coverage of information Provide coverage of information
technology risks.technology risks. Provide proactive coverage of Provide proactive coverage of
emerging areas.emerging areas.
2626
Conducting the Annual Conducting the Annual Risk AssessmentRisk Assessment
InterviewsInterviewsSenior managementSenior managementMembers of the Audit CommitteeMembers of the Audit Committee
Risk factors to consider (see Risk factors to consider (see questionnaires)questionnaires)
Review of past resultsReview of past results OtherOther
2727
Potential Audit AreasPotential Audit Areas
Business units or departmentsBusiness units or departments TransactionsTransactions Trans-departmental processesTrans-departmental processes Specific programs and service Specific programs and service
lineslines Information systemsInformation systems Other Other
2828
Business Models and Business Models and Risk FrameworksRisk Frameworks
Healthcare business modelHealthcare business model COSO Internal Control FrameworkCOSO Internal Control Framework COSO-Enterprise Risk COSO-Enterprise Risk
Management FrameworkManagement Framework Risk Framework from ASHRMRisk Framework from ASHRM
2929
Strategic Analysis - Strategic Analysis - Enterprise Level Business Enterprise Level Business ModelModel
Strategic Management Process
External business drivers and stakeholders
Political Regulatory/ Environmental Economy Stakeholders / Shareholders TechnologyCustomers Suppliers Competitors Substitutes New Entrants Alliances
ChemicalsPlasticsPharmaceuticalsOil & GasMining & building
materialsAgricultureForestryPaper & PulpWood ProductsPotteryGlassFurnitureTextilesFood & DrinkHousehold
chemicalsPhotographicsElectricalsRetail &
DistributionOther consumer
productsEngineeringAerospaceShipbuildingTransportationUtilities
Suppliers
Customers
Finance
Providers
Government &
Govt Agencies
Academic
Institutions
Trade
Associations
Competitors
Skill / Service /Resource Providers
Machinery
Parts & Components
Machine Tools
Industrial & Analytical
controls
Industrial Commodity
Items
Turnkey Solutions
Maintenance /
Overhaul Services
Agents
Commercial
Customers
Governments
Other Manufacturers &
Engineering
Service Providers
Financial Institutions
Prime / Secondary Tier
Contractors
Resource Management Processes
Core Business Processes
Design, Development & Manufacturing Engineering
Marketing
Sales
Order Fulfillment
Service and Support
Quality Management
HumanResources
Environmental Management
InformationManagement
Financial Resources
Markets/Formats Business Processes Alliances Core Services/ Products
Customers
RiskManagement
Human Resources
FacilitiesManagement
Healthcare Business Model
Managed Care Organizations
Markets Business Processes Alliances Core Customers Services
Strategic Management
External Forces
Core Business Processes
Resource Management Processes
•
•
•
•
Attract patients/covered lives
Provide/manage patient care
and improve community health status
Provide for long-term care
Community medical awareness education
Financial Reporting
Human Resources
Information Management
Materials
Strategic Management
Facilities
Physicians
Individuals
Employer and self-administered
plans
(direct contracting)
Government
Research & Education
Hospitals
Alternative Delivery
Providers
Other Payors
Managed Care
Organizations
Physicians
Employers
Other Networks Fundraising
Inpatient: • Acute • Tertiary • Extended
Outpatient
Physician Services
Home-based
Community Wellness Programs
Resarch / Education Programs
Employers
Individuals
Physicans
Commercial Payors and
managed Care Organizations
Government Programs:
• Medicare
• Medicaid
• Local
• Research
Community
Covered Lives/Patients Physicians Payors (Managed Care Orgs., Govt., Insurers, etc)
Employers Unions Suppliers Regulators/Legislators Financial Markets Technology Competitors Academic Programs Community/Owners
3030
Enterprise Risk Enterprise Risk ManagementManagement
Key elements of ERM:Key elements of ERM:
Interrelationships and Interrelationships and interdependencies among risks.interdependencies among risks.
Managing risks within and Managing risks within and across business units.across business units.
Identify and seize opportunities Identify and seize opportunities inherent in future events.inherent in future events.
3131
Enterprise Risk Enterprise Risk ManagementManagement
Other key elements of ERM:Other key elements of ERM:
Considers risk in the formulation Considers risk in the formulation of strategy.of strategy.
Applies at every level and unit Applies at every level and unit of an entity.of an entity.
Facilitates communication via Facilitates communication via common risk language.common risk language.
Portfolio view of risks Portfolio view of risks throughout the enterprise.throughout the enterprise.
3232
Risk DomainsRisk Domains
StrategicStrategic Operational Operational Financial Financial Human CapitalHuman Capital Legal and RegulatoryLegal and Regulatory TechnologyTechnology GovernanceGovernance
3333PRESENTATIONS & DELIVERABLES
PRESENTATIONS & DELIVERABLES
CORPORATE OBJECTIVESCORPORATE OBJECTIVES
Typically, outlined during the Strategic Analysis - interviews with ‘C’ level executives. These “corporate planks” are the foundation of the Risk Assessment effort.
STRATEGIES / INITIATIVES
STRATEGIES / INITIATIVES
The strategies/initiatives constitute the action plans for the execution of the Corporate Objectives. Strategies/Initiatives are generally developed at the Business Unit level. The strategies/initiatives are embedded in processes.
PROCESSES - CORE & RESOURCE
MANAGEMENT
PROCESSES - CORE & RESOURCE
MANAGEMENT
Processes support the Corporate Objectives; strategies/initiatives are executed at the process level. There are objectives at the process level.
GROSS RISKSGROSS RISKS
Gross Risks are best described as ‘threats’ or ‘impediments’ to the accomplishment of the Corporate Objectives or the Process Objectives. Risks are rated based on a pre-determined risk descriptors or risk intervals for Magnitude of Impact and Probability of Occurrence.
CONTROLSCONTROLS
RESIDUAL RISKSRESIDUAL RISKS
Controls are management’s response to the risk or impediments to the achievement of objectives. Controls or responses mitigate risks - impact or the probability of the risk. The effectiveness of the control is determined by the type of control for example: preventive vs. detective.
Depending on the effectiveness of the control or response, the impact and/or probability of the risk is affected. The risks are re-evaluated in the context of the controls in place. These re-evaluated risks constitute the Residual Risks.
NOT NECESSARILY LINEAR
Presentations and deliverables tailored to management.
Risks could occur at the strategic level or at the process level.
Risks at the strategic level
typically manifest themselves at the
process level.
In a Risk Assessment, controls are
evaluated based on management’s
perception rather than an
independent assessment.
Risk-Based Audit Risk-Based Audit Planning StructurePlanning Structure
3434
Residual Risk
Residual Risk is defined as
Residual Risk: Is the organization’s unmanaged vulnerability Is key to optimizing control structure Provides focused audit efforts Identifies areas/processes that are broken Helps make invisible risks visible Provides valuable insight to stakeholders
Total Risk- (Effective Process) = Residual RiskControls
3535
Strategic Analysis – Strategic Analysis – Risk Matrix (Residual)Risk Matrix (Residual)
Likely
Moderate
Likelihood ofOccurrence
Unlikely
Remote
Insignificant Minor Moderate Major Catastrophic
Magnitude of Impact
S S H H H
M
L
L
L L M S S
H
H
HH
H
S
S
SS
M
L M
AlmostCertain A1 A
B1
B
C1
C
D
D1
“TRAP”
3636
Aligning Controls with Risk Appetite
InsufficientRisk
InsufficientRisk
AppropriateRisk*
InsufficientRisk
AppropriateRisk*
AppropriateRisk*
ExcessiveRisk
ExcessiveRisk
ExcessiveRisk
High
Medium
Low
HighMediumLow
Risk Appetite
Level of Revised Risk
* based on your appetite for risk
3737
Risk Profile - Strategic Risk MatrixExample: “Heat Map” Based on Risk AssessmentExample: “Heat Map” Based on Risk Assessment
Insignificant Catastrophic
Remote
AlmostCertain
Magnitude of Impact
Billing,Credit Balances
MedicalEducation
Co-pays,Deductibles
Research
HIPAA
RiskManagement
Pharmacy
Hotline
Experimental Drugs, DevicesLabor
Credentialingand LicensureFLSA
(Overtime)
Environmental
Taxes
3838
Risk Profile - Risk Profile - Multiple Business Multiple Business UnitsUnits
Credentialing
Allows focused response
Supply Chain Mgmt. M H H M LLaboratory M M M M MPhysician Ops. M L L LOperations M M M M H
Shared Services H M M M MReimbursement
sL M H L L
Information Technology
L L L L LM M M M H
Regulatory
M M M M MHuman
ResourcesM M M M M
H M LHigh Moderate
Low
L
UNIT A UNIT B UNIT C UNIT D UNIT E
3939
Identifying Audit Identifying Audit CustomersCustomers
Key stakeholdersKey stakeholdersInside the audited functionInside the audited functionOutside the audited functionOutside the audited function
GovernanceGovernance OtherOther
4040
Risk Assessment in an Risk Assessment in an Audit ProjectAudit Project
Assessing risk in the current state Assessing risk in the current state – research customer’s business– research customer’s business
Targeting limited audit resourcesTargeting limited audit resources
4141
Questions
Directions: Review and get familiar with the preliminary survey documents for this case study. You will have a couple hours to gain an understanding of your customer’s environment.
4242
Developing Audit Developing Audit Programs & Programs &
QuestionnairesQuestionnaires
Presented by: Presented by: Ted WaltersTed Walters
4343
Role of Audit ProgramRole of Audit Program
What is to be doneWhat is to be done When it is to be doneWhen it is to be done How it is to be doneHow it is to be done Who will do itWho will do it How long it will takeHow long it will take Link between preliminary survey Link between preliminary survey
and fieldworkand fieldwork
4444
Audit Program ObjectiveAudit Program Objective
IIA’s Standards for the Professional Practice of IIA’s Standards for the Professional Practice of Internal Auditing (SPPIA) 2200 states that internal Internal Auditing (SPPIA) 2200 states that internal auditors should develop and record a plan for each auditors should develop and record a plan for each engagement.engagement.
SPPIA 2210 states that the audit objectives should SPPIA 2210 states that the audit objectives should address the risks, controls and governance processes address the risks, controls and governance processes associated with the activities under review.associated with the activities under review.
The auditor should identify and assess risk relevant to The auditor should identify and assess risk relevant to the activity under review. The audit objective(s) the activity under review. The audit objective(s) should reflect the results of the risk assessment.should reflect the results of the risk assessment.
The auditor should consider the probability of The auditor should consider the probability of significant errors, irregularities, noncompliance and significant errors, irregularities, noncompliance and other exposures when developing the engagement other exposures when developing the engagement objectives.objectives.
Source: IIA Standards for the Professional Practice of Internal AuditingSource: IIA Standards for the Professional Practice of Internal Auditing
4545
Internal Control Review Internal Control Review & & Preliminary SurveyPreliminary Survey
Conduct analytical procedures & Conduct analytical procedures & analysesanalyses
Complete internal control matrixComplete internal control matrix Complete internal control risk Complete internal control risk
assessment analysisassessment analysis Complete internal control questionnairesComplete internal control questionnaires Conduct documentation or process walk-Conduct documentation or process walk-
throughsthroughs Conduct probe testingConduct probe testing Complete information systems control Complete information systems control
reviewreview
4646
Audit Program Audit Program DevelopmentDevelopment The internal auditor should identify sufficient, reliable, relevant and The internal auditor should identify sufficient, reliable, relevant and
useful information to achieve the audit’s objectives.useful information to achieve the audit’s objectives.
Audit results and conclusions should be based on appropriate Audit results and conclusions should be based on appropriate analyses and evaluations.analyses and evaluations.
Audit findings and recommendations should be supported by Audit findings and recommendations should be supported by sufficient, competent, relevant and useful information documented sufficient, competent, relevant and useful information documented in the auditor’s working papers.in the auditor’s working papers.
The auditors is responsible for planning and conducting the audit.The auditors is responsible for planning and conducting the audit.
The audit program is your road map for the auditThe audit program is your road map for the audit..
4747
Audit Program Audit Program DevelopmentDevelopment
The audit program should includeThe audit program should include:: Documenting the procedures and Documenting the procedures and
information used by the auditor during the information used by the auditor during the audit. audit.
State the audit objectiveState the audit objective State the scope and degree of testing to State the scope and degree of testing to
achieve the audit objectivesachieve the audit objectives Identify technical aspects, risks, processes Identify technical aspects, risks, processes
and transactions that should be examined.and transactions that should be examined. State the nature and extent of the testing State the nature and extent of the testing
required.required. Develop audit program prior to the start of Develop audit program prior to the start of
the audit and modify during the course of the audit and modify during the course of the audit, as necessary.the audit, as necessary.
4848
Testing TechniquesTesting Techniques
Defining the testing objectiveDefining the testing objective Identifying the type of testing that will Identifying the type of testing that will
achieve the objectiveachieve the objective Determining the sequencing of the testDetermining the sequencing of the test Defining or identifying the standards Defining or identifying the standards
or criteriaor criteria Identifying the testing populationIdentifying the testing population Determining the sampling Determining the sampling
methodologymethodology Examining the samplesExamining the samples
4949
Sampling MethodsSampling Methods
Unless 100% testing occurs, sampling will Unless 100% testing occurs, sampling will draw reasonably accurate inferences from draw reasonably accurate inferences from the sample to the total population. Sample the sample to the total population. Sample methods include:methods include: Random number samplingRandom number sampling Interval samplingInterval sampling Stratified random samplingStratified random sampling Cluster samplingCluster sampling Haphazard samplingHaphazard sampling Judgment sampling Judgment sampling
Statistical Sampling is using one of the above Statistical Sampling is using one of the above methods to reduce risk that the sample methods to reduce risk that the sample selected is not representative of the total selected is not representative of the total population. population.
Probe Sampling is used when little or no Probe Sampling is used when little or no errors are expected.errors are expected.
5050
Sample SizeSample Size
Sample size is based on:Sample size is based on:– Population size – all the items an auditor Population size – all the items an auditor
concludes on concludes on – Sampling Risk/Confidence Level – level Sampling Risk/Confidence Level – level
of risk/confidence that the sample is of risk/confidence that the sample is representative of the entire population representative of the entire population
– Maximum Tolerable Error Rate – Maximum Tolerable Error Rate – maximum error accepted maximum error accepted
– Precision Rate – the range of allowable Precision Rate – the range of allowable error expected in the sampleerror expected in the sample
5151
Testing AttributesTesting Attributes
Attributes are controls, procedures, Attributes are controls, procedures, practices or regulations that are practices or regulations that are expected to occur.expected to occur.
For example if a diagnosis code of “X” For example if a diagnosis code of “X” is required for medical necessity, then is required for medical necessity, then “X” is the attribute to be tested for. “X” is the attribute to be tested for. Another example is if all expenses of Another example is if all expenses of $5,000 are to be signed by the CFO, $5,000 are to be signed by the CFO, the attribute is the presence of the the attribute is the presence of the CFO signature on expenses.CFO signature on expenses.
5252
Audit QuestionnairesAudit Questionnaires
Develop questionnaires which investigate Develop questionnaires which investigate organizational, operational, personnel, and organizational, operational, personnel, and management controls.management controls.
Designed for Yes/No answers to establish reliability Designed for Yes/No answers to establish reliability and integrity of information; compliance with P&Ps, and integrity of information; compliance with P&Ps, laws and regulations; safeguarding assets and laws and regulations; safeguarding assets and efficiencies and effectiveness of resource usesefficiencies and effectiveness of resource uses– Internet searches (www.cms.gov; FI website; Internet searches (www.cms.gov; FI website;
CCH subscription service; CCH subscription service; www.oig.hhs.gov/publications/workplanwww.oig.hhs.gov/publications/workplan ) )
– AHIA library (www.ahia.org)AHIA library (www.ahia.org)– Develop questions using department’s policies Develop questions using department’s policies
and proceduresand procedures
5353
Questions
Directions: Your team is to develop an audit program for two audit objectives. Once the audit programs are done, develop an interview questionnaire for a health unit coordinator/unit clerk and a registration clerk.
5454
Presented by:Presented by:
Mark EddyMark Eddy
Report WritingReport Writing
5555
Potential AudiencePotential Audience
Board MembersBoard Members ExecutiveExecutive Front-line ManagementFront-line Management External Auditor (public or External Auditor (public or
government)government) General Public or MediaGeneral Public or Media
5656
Elements of an Audit Elements of an Audit ReportReport Table of ContentsTable of Contents Executive SummaryExecutive Summary Scope & ObjectivesScope & Objectives Background InformationBackground Information Detailed Recommendations Detailed Recommendations Appendix & ExhibitsAppendix & Exhibits
5757
4 Phases of Writing4 Phases of Writing
PlanningPlanning Outline IssuesOutline Issues Evaluate InformationEvaluate Information
DraftingDrafting Detailed RecommendationsDetailed Recommendations Executive SummaryExecutive Summary
EditingEditing OrganizationOrganization ReadabilityReadability MechanicsMechanics
FormattingFormatting
5858
5 Elements of Writing5 Elements of Writing
ApproachApproach Tone & Presentation MethodTone & Presentation Method
DevelopmentDevelopment Logical & Sequential PresentationLogical & Sequential Presentation
CorrectnessCorrectness Grammar, Spelling, and PunctuationGrammar, Spelling, and Punctuation
ClarityClarity Choice of Words & Presentation of Main Choice of Words & Presentation of Main
IdeaIdea StyleStyle
Active vs. Passive VoiceActive vs. Passive Voice
5959
Preparing to WritePreparing to Write
Eliminate distractionsEliminate distractions Mentally prepareMentally prepare Schedule timeSchedule time Use tools (grammar check, spell Use tools (grammar check, spell
check, etc.)check, etc.) Write 1st draft quicklyWrite 1st draft quickly Proofread 2nd and 3rd draftsProofread 2nd and 3rd drafts Take a step back and look at the big Take a step back and look at the big
picturepicture
6060
5 Elements of a 5 Elements of a RecommendationRecommendation
ConditionCondition– What is the problem/issue? What is happening?What is the problem/issue? What is happening?
EffectEffect– Why should the reader care? What is the impact?Why should the reader care? What is the impact?
Cause - focus on “Root Cause”Cause - focus on “Root Cause”– Why did the condition happen?Why did the condition happen?
CriteriaCriteria– How do you know it is a problem? What should happen?How do you know it is a problem? What should happen?
RecommendationRecommendation– How do we solve the condition? How can we prevent How do we solve the condition? How can we prevent
recurrence?recurrence?
6161
Recommendation Recommendation StructureStructure
ApproachApproach– Deductive or InductiveDeductive or Inductive
ToneTone– Positive wordsPositive words– Active voiceActive voice– Management ownershipManagement ownership
Recommendation TitleRecommendation Title– Action OrientedAction Oriented
Level of DetailLevel of Detail– Avoid more than 2 paragraphsAvoid more than 2 paragraphs
6262
Executive SummaryExecutive Summary
Identify most important issuesIdentify most important issues Describe significanceDescribe significance Include management’s response or Include management’s response or
corrective actioncorrective action May want to summarize number of May want to summarize number of
recommendations by general recommendations by general categoriescategories
6363
EditingEditing
OrganizationOrganization– Big picture to detail and flow of Big picture to detail and flow of
informationinformation ReadabilityReadability
– Clear and conciseClear and concise– What is the “Fog Index?”What is the “Fog Index?”
Grammar & PunctuationGrammar & Punctuation– Nothing is more distracting than poor Nothing is more distracting than poor
grammar and punctuationgrammar and punctuation
6464
Report FormatReport Format
Table StyleTable Style Paragraph StyleParagraph Style Bullet StyleBullet Style
6565
QuestionsDirections: Your team is to create a list of issues/findings using the information gathered in the two interviews. Group the issues into like categories to formulate recommendations. Each team is to write a minimum of five recommendations using the indirect approach and the five elements of a recommendation (condition, cause, effect, criteria, and recommendation).
Next, your team is to develop exit conference materials to communicate the recommendations.
6666
Wrap UpWrap Up
QuestionsQuestions Verbal FeedbackVerbal Feedback Complete Evaluation FormsComplete Evaluation Forms
Thanks!!Thanks!!