The Internal Control (Audit) Service was established in 2011 as a structural division of healthcare organizations in Kazakhstan to oversee quality management of medical care. The service coordinates activities related to patient complaints, assessing resource use, clinical audits, and developing programs to improve care quality. It analyzes healthcare organization effectiveness, activities of clinical commissions, and provides management with information to increase staff knowledge and optimize treatment. The examination of medical service quality involves analyzing documentation, conducting clinical audits, assessing patient satisfaction, and developing measures to address deficiencies. During examinations and audits, technologies, resources, rights, and results are evaluated based on established healthcare standards.

1. Internal Control(Audit) Service Department
of the Medical and Pharmaceutical Activities
Control Committee

2. On the basis of the Decree of the
Government of the Republic of
Kazakhstan dated December 22, 2011,
1577, the Internal Control (audit) service
was established. Internal Control (Audit)
Service- this is a structural subdivision of
a healthcare organization that carries out
activities on quality management of
medical care at the level of a healthcare
organization and is endowed with
appropriate powers.

3. Quality management system
The current situation The direction of development of the system 2 3
internal audit external audit with led. NE external audit internal audit
internal audit with NE external audit with led.
Examination of the quality of medical services is a set of organizational,
analytical and practical measures carried out to make an opinion on the
level of quality of medical services provided by individuals and legal
entities using indicators for assessing the quality of medical services
(hereinafter referred to as indicators) reflecting the indicator of efficiency,
completeness and compliance of medical services with standards in the
field of healthcare including

4. indicators of the structure – indicators of the availability of human, financial and
technical resources; process indicators – indicators of the assessment of the
implementation of prevention, diagnosis, treatment and rehabilitation technologies;
result indicators – indicators of the assessment of health consequences as a result of
the provision or non-provision of medical care by healthcare entities

5. 1) consistency – the examination of the quality of medical services is
carried out in the relationship of indicators of structure, process and
result;
2) objectivity – the examination of the quality of medical services is
carried out with the application of standards in the field of healthcare;
3) openness – the examination of the quality of medical services is
carried out with the participation of independent experts or
independently by independent experts without the participation of
specialists of the authorized body in the field of healthcare in the
presence of representatives of healthcare entities.
The basic principles of the examination of the
quality of medical services:

6. During the examination of the quality of medical
services, an assessment is carried out:
1) actions of medical workers to comply with the
requirements of standards in the field of healthcare,
including diagnostic and treatment protocols approved
by the authorized body in the field of healthcare;
2) compliance of the material and technical resources
of the subjects of healthcare with the equipment
standards approved by the authorized body in the field
of healthcare.

7. Organization and conduct of internal examination of the
quality of medical services:
1. Internal examination of the quality of medical services
2. The structure and composition of the Internal Control
(Audit) Service are approved by the head of the healthcare
organization, depending on the volume of medical services
provided.

8. The Internal Control (Audit) Service coordinates the activities of healthcare
organizations on quality management of medical care in the following areas:
1) solving problems (complaints) of patients on the spot as they appear and
within a period not exceeding 5 calendar days, with the study of the degree of
satisfaction of patients with the level and quality of medical services by
conducting their questionnaires;
2) assessment of the state and efficiency of the use of human and logistical
resources;
3) assessment of technologies for providing medical care to patients for
compliance with established standards in the field of healthcare (clinical audit)
and selection of cases subject to commission assessment;
4) compliance with the rules for providing a guaranteed amount of free
medical care;
5) development of program measures aimed at preventing and eliminating
defects in work and contributing to improving the quality and effectiveness of
medical care.

9. The functions of the Internal Control (Audit) Service are :
1) analysis of the effectiveness of the activities of the departments of the
health organization to evaluate their own processes and procedures, the
introduction of standards in the field of health, the use of internal
indicators.
2) analysis of the activities of hospital commissions;
3) providing the management of the health organization with information
about the problems identified as a result of the analysis for making
appropriate management decisions;
4) training and methodological assistance to the staff of a healthcare
organization on issues of ensuring the quality of medical care;
5) studying the opinion of employees of the healthcare organization and
informing the staff about measures to improve the quality and ensure the
safety of patients in the organization.

10. During the internal examination
1) technologies of medical care are evaluated for compliance with established standards in the field of healthcare;
2) the security and efficiency of the use of human and logistical resources are evaluated;
3) the degree of satisfaction of citizens with the level and quality of medical care provided is determined by the
number of substantiated complaints about the quality of medical services and by conducting questionnaires of
patients and (or) their relatives;
4) compliance with the rights of patients to receive a guaranteed amount of free medical care and informing
patients about invasive interventions are evaluated;
5) recommendations are being developed to eliminate and prevent the identified deficiencies.
The results of the internal examination are submitted and analyzed at meetings of hospital commissions, at
medical conferences, followed by management decisions, in order to increase the level of knowledge of medical
workers and develop optimal approaches to the treatment and diagnostic process.

11. Stages of examination of the quality
of medical services:
1) the analysis of accounting and reporting documentation of a healthcare subject is carried out for the
purpose of comparative analysis of performance indicators of a healthcare subject for a certain period
of work, with indicators for the previous period of work, as well as with republican and regional
indicators of the health status of the population;
2) conducting a clinical audit by examining a detailed retrospective and/or current analysis of the
conducted therapeutic and diagnostic measures for their compliance with established standards in the
field of healthcare;
3) determination of the degree of satisfaction of citizens with the level and quality of medical care
provided is carried out by questioning patients and (or) their relatives and by the number of justified
appeals of citizens to the activities of the healthcare subject; 4) analysis and generalization of the
results of the examination of the quality of medical services; 5) taking measures aimed at eliminating
and preventing the identified deficiencies based on the results of the quality examination medical
services.

12. During the analysis of medical
documentation, it is estimated:
1) the quality of anamnesis collection; 2) the completeness
and validity of diagnostic studies; 3) the correctness,
timeliness and validity of the clinical diagnosis made during
the first 3 days, taking into account the results of the studies
conducted at the pre-hospital stage; 4) the validity of being
treated, receiving medical care in this form (outpatient,
inpatient, inpatient replacement); 5) timeliness and quality of
expert consultations;

13. 6) the volume, quality and validity of medical
measures, including dispensary, preventive and
rehabilitation;
7) development of complications after medical
interventions;
8) the achieved result;
9) satisfaction with the quality of medical care
provided;
10) the quality of medical records. At the level of
outpatient care, dispensary, preventive and
rehabilitation measures are additionally evaluated.

14. According to the order of the Ministry of Health of the Republic of
Kazakhstan 96 dated by the Internal Control (Audit) Service of a medical
organization, in case of detection of defects in the provision of medical
services, during an internal examination, fills out a SHEET of expert
evaluation of medical services
The list of expert evaluation of medical services is provided to the territorial
department of the Committee by the 20th of each month. The Territorial
Department of the Committee, in case of confirmation of defects in the
provision of medical services identified by the Internal Control (Audit)
Service of a medical organization, enters the evaluation results from the
Expert Evaluation Sheet of medical services into the module "Defect in the
provision of medical services" (HOME) of the software package "Quality
Management System of medical Services" (SUKMU)
Internal Audit Service of the Ministry of Defense Expert Evaluation Sheet
TD KKMFD TD TO UZ Results of expert evaluation

15. References:
https://online.zakon.kz/Document/?doc_id=31485269
https://med.mcfr.kz/article/412-vnutrenniy-audit-meditsinskih-uslug