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!!