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HELP! The State is Coming: Surviving an audit

The first time I was in a professional mental health audit was 2004. Prior to that time I had been involved in the Joint Commission accreditation process and had heard the tale of the dreaded state and county audits. My first audit lasted for two days and it seemed fairly painless. We failed. I did not know what that meant until I spoke with my clinical director and got the details of the findings. Over the years I would have several more audits from the city, the county, the state, federal funders, and private funders. Some of these went as planned and others went sideways fast. The mental health industry is and always will be under scrutiny to "prove" the validity and value of our work. For those of you who plan to continue to provide mental health services under the state or federal funding sources here are some ways to survive your next audit, keep your program open, and stay in business. These tips are also helpful for non-mental health program and can be used for any industry.

Stay prepared- Many organizations only review their records when they know an audit is coming. In many places audits are unannounced. When you do have notice of the audit it is usually only a few days which is not much time. The best way to combat this is always having your records ready for review. If your organization does not have a quality assurance department you need to find the money for this support service. It may be an additional expense but it will save you the trouble of having to pay back money to the insurance company, state agency or having your agency saddled with fines and citations. A quality assurance specialist can develop a schedule for internal audits which will create a shift in your agency culture around compliance and clinical improvement.

Don’t be hostile- Program leadership can become defensive and mean when talking with auditors. Bad move. They also have a stake in your success. If you look bad they look bad and nobody wins. Being an asshole to the auditors only makes it harder to develop the type of ongoing working relationship you will need for future success.

Be honest- This suggestion may seem obvious but my first audit as the head of a program was a few weeks after I joined the organization. The audit was run by the agency contract manager and he made things worse by lying about practices that were outlined in the contract. We were cited for major violations. When the auditors came back in three months I requested that the contract manager not be a part of the audit and I informed the auditors of our challenges. They were understanding and worked with us to make some much-needed corrections and education about better ways to execute parts of the contract. People feel the need to lie during audits about items that are easy to check and they assume the auditors have not heard it all. They have and you are not a good liar. So tell the truth. It will serve you and your organization better in the long run.

Collaborate with your auditor- When you establish an honest relationship with your auditors and contracts use them to your advantage. They have worked with many organizations and have a lot of useful knowledge. Be willing to humble yourself and ask questions to get the information you need to make sure your program is operating effectively and efficiently. Contractors are much more likely to shoulder the responsibility of your program being successful if they feel like they are a part of your program.

Involve staff at all levels- The responsibility of an audit should not fall on just the program leadership or the direct care staff. Everyone in the organization from the senior leadership to the support staff should be aware when audits take place and the outcomes. While staff at all levels may have different roles people have different levels of skills and expertise they may help in the preparation for the audit, the day of the audit, the debriefing process and any corrective action plan that may need to be created and executed.

As a senior leader in an organization, I welcome audits. It is an opportunity to get an outside perspective on how your organization is performing and provide a lot of needed insight into the health of your programs. Sometimes those of us who are in the programs do not have the best point of view and it is easy to get lazy around the quality of the work. Use the auditing process to make your organization better.

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