Table 1. Types of audits [9] (S1 Protocol).

Externally driven audits–For example, accreditation, certification and external peer reviews are strongly anchored in quality assurance (QA), referring to initiatives designed to assure compliance with minimum quality standards [10, 11]. Quality assurance is defined as: “The part of quality management focused on providing confidence that quality requirements will be fulfilled” [11]. External audits are used to assess the quality system of a healthcare organization based on specified standards and are conducted by external auditors [12].

Internal audits–This type of audit is conducted by internal auditors of the hospital’s own organisation, such as quality officers or healthcare professionals from another department than the one being audited to guarantee independent judgement. Internal audits are used to evaluate the quality system based on standards as well. They are conducted to prepare for external audits. Healthcare organisations also use internal audits to continuously improve the quality of healthcare. Internal audits are designed to evaluate and improve the effectiveness of the organisation’s quality management system and focus more on organisational conditions than on performance of healthcare professionals and patient outcomes [3].

Clinical audits–Clinical audits differ from other types of audits in that they are mostly initiated and undertaken by healthcare professionals. Clinical audits represent a shift from QA to QI, with a focus on increasing the ability to fulfil quality requirements, seeking to improve care, enhance performance and prevent poor care [11, 13]. This process takes place continuously as part of everyday routines [1, 12, 13]: healthcare professionals work together to collect data and evaluate their own practices. Following this, they intend to develop and apply improvements in daily practice, and then the audit cycle is repeated to demonstrate improved and sustained improvements [14]. Hence, clinical audits do not necessarily use external criteria and are not carried out in response to external demands as the initiative comes from the healthcare professionals themselves [15].