۱٫ Introduction

۲٫ Methods

۳٫ Results

۴٫ Discussion

۵٫ Conclusion

Acknowledgements

Appendix A. Supplementary data

References

Abstract

Many working hours of healthcare professionals are spent on administrative tasks.Administrative burden is caused by political choices, legislation, the requirements of health insurers and supervisors. Coordination between the parties involved, is lacking. Therefore, we studied to what extent sharing internal audit results of hospitals with external supervisors is possible and the necessary preconditions.We interviewed 42 individuals from six hospitals and the Dutch Health and Youth Care Inspectorate

The interviewees expressed thatthere is no coordination in timing and content between internal audits and external supervision. They were in favour of sharing internal audit results with external supervisors to reduce the supervisory burden. They stated that internal audits give insight into quality problems and improvements, how hospital directors govern quality and safety, and the culture of improvement within healthcare provider teams. With this information, the inspectorate can judge to what extent hospitals are learning organisations. The interviewees mentioned the following preconditions for sharing audit results: reliable and risk-based information about quality and safety, collected by expert, trained auditors, and careful use of this information by the inspectorate in order to maintain openness among audited healthcare professionals.

In conclusion, internal audit results can be shared conditionally with external supervisors. When internal audit results show that hospitals are open, learning and self-reflecting organisations, the healthcare inspectorate can reduce their supervisory burden.

Introduction

Healthcare professionals spend 40 % of their working hours on administrative tasks, including registering and supplying quality [1–۳]. The administrative burden is caused by political choices, legislation, the requirements of health insurers, and internal and external supervisors (Table 1) [4–۶]. There is a lack of coordination between the parties involved: 69 % of medical specialists and 75 % of residents indicate that they have to perform certain registration actions twice for different parties [3].

In the Netherlands, administrative costs are 20 % higher than those in other European countries [7]. Boards of directors are also increasingly confronted with new and altered quality requirements; these are primarily intended for quality improvement by healthcare professionals, but are increasingly used for supervision and enforcement [8]. Every hospital is monitored by 19 inspection services, including nine government inspectorates [9].