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Table 1 The development of an audit system

From: Effects of auditing patient safety in hospital care: design of a mixed-method evaluation

Year Steps for developing the audit system in the Radboud University Nijmegen Medical Centre
2000 Introduction of an audit system for a test accreditation of hospital care from the Dutch Institute for Accreditation in Healthcare (NIAZ) → formal test of preconditions for good hospital care.
2002 The first accreditation from the NIAZ was achieved.
2006 The second accreditation from the NIAZ was achieved. However, despite the second accreditation, the Radboud case occurred. After the Radboud case, more focus on professional practice, leadership, team work, and patient safety outcomes were incorporated into the audit system. Valid and reliable instruments were selected to measure these aspects.
2009 An independent Institute for Quality Assurance and Patient Safety to monitor patient safety and quality of care was established.
The audit process was professionalised:
• The audit team must report to the Board of the Institute for Quality Assurance and Patient Safety instead of to the Board of Directors of the hospital.
• The audit team was expanded with carefully selected physicians, nurses, and allied healthcare workers.
• Extensive training for internal auditors to increasing the inter-rater agreement was set up.
• The use of a reference framework made the audits more normative.
• Follow-up: revisiting was implemented to examine the progress of patient safety.
2012 The audit system was optimised with:
• Structural audit analyses.
  • Standard evaluation of experiences with auditing.