Audit as a hospital management tool: a qualitative analysis

To analyze, from the managers perspective, the factors that favor and hinder the use of auditing as a management tool in hospitals.

A qualitative, descriptive study, based on the Critical Incident Technique, conducted in a general hospital in the interior of São Paulo, Brazil. Semi-structured interviews were conducted with managers (March-June/2023). The incidents were organized into situation-behavior-consequence and subjected to content analysis, with thematic categorization.

A total of 34 critical incidents were identified, highlighting 41% (n=14) of aspects that favor and 59% (n=20) that hinder the use of auditing in hospital management. The incidents were grouped into thematic categories: Supporting documentation, Audit activities, and Electronic medical records. The results show that managers recognize auditing as a strategic tool for healthcare and financial management, particularly in monitoring document compliance, preventing claim denials, standardizing care flows, and strengthening patient safety. By focusing on processes such as clinical records, prescriptions, billing, and indicator control, auditing objectively contributes to improving the quality of care and institutional sustainability. However, the results also indicate that the use of digital health records remains a significant challenge for managers and healthcare professionals.

The use of auditing as a management tool in hospitals is favored by adequate supporting documentation and the possibility of reviewing both operational and care processes, but hindered by weaknesses in medical records that reveal noncompliance with institutional protocols and in the technical-operational structuring of the audit, particularly regarding the insufficient definition of monitoring indicators, unclear delimitation of work scope, low standardization of evaluation instruments, assignment of responsibilities, as well as lack of team training and contractual deficiencies with health insurance plans.