The report of the 20th National Congress of the Communist Party of China pointed out that it is necessary to improve the supervision system of the party's unified leadership, comprehensive coverage, authority and efficiency, improve the supervision and restraint mechanism of power, take intra-party supervision as the leading, promote the integration and coordination of various types of supervision, and let power run under the sun. Supervision is an intrinsic element of governance and occupies an important position in the management of the party, the party, and the country. The Decision of the Central Committee of the Communist Party of China on Several Major Issues Concerning Upholding and Improving the System of Socialism with Chinese Characteristics and Promoting the Modernization of the National Governance System and Governance Capacity (hereinafter referred to as the "Decision") points out that upholding and improving the supervision system of the Party and the state and strengthening the restraint and supervision of the exercise of power is one of the major measures and overall requirements for promoting the modernization of the national governance system and governance capacity. The "Decision" further strengthened the report of the 19th National Congress of the Communist Party of China to reform the audit management system and enhance the requirements of supervision, put forward a new development concept to further strengthen the joint force of intra-party supervision and the construction of the national supervision system, and clearly focused on the reform of the supervision system, forming the construction of intra-party supervision, supervision and supervision, audit supervision and other co-operation supervision systems, organically combining discipline inspection and internal audit construction, realizing the joint force of supervision, and building a supervision system of "treating both the symptoms and the root causes, punishing and preventing at the same time, strengthening supervision, focusing on prevention, and focusing on the main responsibility".
Background to the construction of the supervision system of public hospitals
With the deepening of medical reform, as the core component of the medical service system, the standardization and transparency of the operation and management of public hospitals have received extensive attention from all walks of life. In recent years, the number of patients in public hospitals has continued to grow, and the uneven quality of medical care is still prominent, and the problems in financial management and medical service quality in public hospitals have gradually increased, which not only affect the reputation and image of the hospital, but also pose a potential threat to the rights and interests of patients.
Public hospitals are facing an increasingly complex operating environment and higher social expectations, and the establishment of a supervision system is of vital significance to ensure the healthy, stable and efficient operation of public hospitals. At the same time, the problems existing in the discipline inspection, audit and supervision of public hospitals mainly include imperfect supervision system, insufficient supervision and single supervision means. On the one hand, due to the large number of supervision subjects and overlapping responsibilities, sometimes there will be gaps in supervision or duplication of supervision, which affects the effectiveness of supervision. On the other hand, with the continuous development of medical technology and the increasing complexity of the medical market, the difficulty and complexity of supervision are also increasing. The lack of scientificity and systematization in system construction makes it difficult to effectively play the supervisory function; At the same time, the limited number and level of expertise of supervisors make it difficult to cope with increasingly complex supervisory tasks. In addition, some hospitals rely too much on traditional audit and inspection methods in supervision methods, and lack the support of informatization and intelligence, resulting in low supervision efficiency.
The current situation and existing problems of internal audit and discipline inspection coordination
(1) The organizational structure is unreasonable and the synergy is insufficient
Public hospitals generally believe that internal audit belongs to the administrative department, and discipline inspection belongs to the party committee department, and there are differences between the two in key aspects such as working methods, responsibilities and authority, and position in the organizational structure. Moreover, most public hospitals have experienced the joint office of discipline inspection, supervision and audit, but due to the impact on the independence of internal audit, the department is split, but they do not realize the inherent commonality between the two, and do not look at the role of internal audit and discipline inspection in the construction of integrity, risk prevention and control, internal control and improvement of governance in the entire supervision system based on the perspective of synergy theory. The "three turns" of discipline inspection also require that internal audit be separated from the discipline inspection function.
(2) Information resources are not shared, and coordination and integration are insufficient
Due to the fact that internal audit and discipline inspection go their own way, no effective information resource sharing mechanism has been established, and a normalized information communication mechanism has not been established in the determination of work priorities, data inquiry, important information reports, etc., and this information asymmetry hinders the interconnection between audit supervision and discipline inspection supervision, the integration of data, and the important reason for the complementary advantages of coordinated action.
(3) Insufficient ability of relevant personnel to coordinate and adapt
Under the new situation, higher requirements are put forward for internal audit and discipline inspection, and new developments are made in terms of concepts, objectives, functions and contents, and the professional skill level and comprehensive ability of personnel in corresponding positions are facing new challenges. At present, the professional structure of internal auditors and discipline inspection personnel in public hospitals is relatively simple, and the ability to coordinate and adapt is weak, which virtually causes challenges to the sustainability and stability of the supervision talent team.
(4) The degree of informatization of supervision technology is insufficient, and the coordination efficiency is low
The "Informatization Work Plan (2018-2022)" issued by the Central Commission for Discipline Inspection and the State Supervision Commission proposes to focus on informatization to help the high-quality development of discipline inspection work, promote the deep integration of discipline inspection business and informatization, develop in the direction of data and refinement, and help improve the quality and efficiency of discipline inspection work. At the first meeting of the Central Audit Commission, General Secretary Xi Jinping emphasized that "we must adhere to the strong examination of science and technology and strengthen the construction of audit informatization." "Most public hospitals have invested less in the informatization construction of these two aspects, and there is a large gap with the relevant informatization requirements. The backwardness of supervision technology has a direct impact on the reduction of the synergistic effectiveness of supervision.
Feasibility of internal audit and discipline inspection coordination
The joint force of discipline inspection, audit and supervision refers to a new type of supervision mode in which the two major supervision systems of discipline inspection and audit are integrated and synergistic to jointly improve the efficiency of hospital governance in public hospitals under the new situation. The concept aims to solve the problem of fragmentation and decentralization in the supervision of public hospitals, and improve the efficiency and quality of supervision through the integration of supervision resources. Collaboration refers to the self-organizing process in which each system cooperates with each other in a certain way to make the system move from disorder to an orderly and stable state. Any unit or subsystem in the organization is influenced and acted together with other subsystems to promote the stable and normal operation of various functions of the organization and achieve the synergistic effect of 1+1>2. Synergy theory is widely used in the process of management practice, which can turn the internal non-equilibrium state of the multi-angle management system into an orderly state, promote the improvement of business strategic planning, and help the organization gain competitive advantage in the process of operation. Internal audit supervision and discipline inspection supervision is a typical representative of the use of power to restrain power, similar responsibilities, similar objects, complementary to each other, play an extremely important role in the entire supervision system, the professionalism of internal audit supervision and the rigidity of discipline inspection and supervision can form complementary advantages.
(1) The relevant duties are similar
Internal audit is mainly to supervise the financial revenue and expenditure, internal control, legality and compliance of economic activities of public hospitals, and prevent and control corruption from the source. Discipline inspection is the full coverage of the supervision of personnel exercising public power in public hospitals, performing the disciplinary inspection duties of supervision and discipline enforcement and accountability within the Party in accordance with the Party Constitution and Party regulations, and performing the supervision duties of supervision, investigation and disposal in accordance with the Constitution and the Supervision Law and according to the authorization, so as to prevent the occurrence of corruption.
(ii) Overlapping oversight content
Internal audit mainly focuses on the supervision of the economic activities of public hospitals, and carries out independent supervision and evaluation from the aspects of economic field and internal control. Discipline inspection focuses on the compliance of various groups of people, especially key groups, in the process of exercising public power and the prevention and control of integrity risk points. In the construction of a clean government, the development of economic activities is often inseparable from the exercise of public power, and it is also the top priority of internal audit and discipline inspection and supervision. The two have their own emphases in terms of the objects of supervision, the content of supervision, and the methods of supervision, but they are related to each other and support each other. By strengthening the communication and cooperation between the discipline inspection and audit departments, information sharing and resource complementarity can be realized, so as to more comprehensively reveal the problems and risks existing in the operation of the hospital.
(3) Complementarity of working methods
Internal audit mainly applies professional and systematic methods, such as sampling, correspondence, review inspection, monitoring, recalculation, supervision, evaluation and suggestions for economic activities, monitoring various risk points in the business process, and is good at discovering hidden clues. The professionalism of the working methods of internal audit is further highlighted. Discipline inspection mainly performs its supervisory duties through the investigation, handling, trial, and accountability of problems and clues, thus highlighting its rigid side. The synergy and complementary advantages of the two are conducive to the construction of the internal control system and the construction of the anti-corruption risk prevention and control mechanism, and form a joint force of supervision.
Discussion on the collaborative path of internal audit and discipline inspection in public hospitals
(1) Reshape the organizational structure, sort out the supervision and coordination mechanism, and eliminate the resistance at the top-level design level
The internal audit and discipline inspection departments are both the supervision departments of public hospitals, and should provide the authoritative support and resource allocation required for supervision responsibilities at the top-level design level. At the same time, the independence of internal audit in exercising audit supervision is guaranteed in accordance with the law, the advantages of audit supervision are stimulated, and the responsibilities and tasks of supervision and coordination are implemented. Public hospitals can build a three-dimensional cross-covering supervision system from the aspects of supervision leadership system, reporting and communication mechanism, personnel management and assessment, and information sharing.
(2) Establish a mechanism for sharing information resources, reduce duplication of supervision, and improve the effectiveness of supervision
The internal audit and discipline inspection departments of public hospitals should establish a normalized communication and exchange mechanism, take the initiative to share policy interpretation, business training and exchanges, and establish an information sharing platform for feedback on key supervision matters and the implementation of rectification. Reduce unnecessary duplicate audits and duplicate supervision, give full play to the joint advantages of collaborative supervision, and provide supervision effectiveness.
(3) Strengthen team building and improve the ability to adapt to coordination
The relevant internal auditing standards clearly stipulate that the internal audit team should be composed of personnel with professional qualities in economics, management, law, construction engineering, information systems, etc., and have the necessary professional qualifications. There are high requirements for the professionalism of internal auditors. Although the discipline inspection department does not have explicit regulations on the professionalism of personnel, there is an overlap between professional considerations and internal audit in actual recruitment. The first is to increase the frequency of personnel from the two departments to familiarize themselves with each other's business and improve the comprehensive coordination and adaptability of the supervision team. The second is to regularly carry out business discussions, joint audit inspections and other work between the two departments to continuously run in and improve the efficiency of inter-departmental cooperation.
(4) Establish a supervision information platform, and use information technology to improve the supervision tool system
Establish an information-based power operation monitoring system, raise the risk prevention and control measures based on "civil air defense" to a supervision and management sharing information system based on "technical defense", and fix the operation matters, processes, and relevant personnel authority and responsibilities of economic activities in economic activities "before-during-after" through the setting of the information platform, strengthen the standardization, institutionalization and precision of power operation, improve the visibility and timeliness of supervision, and ensure the traceability of economic activities. It also provides data support and basic guarantee for information audit for audit development.
In short, through the overall coordination and implementation coordination of internal audit and discipline inspection, public hospitals are conducive to improving the rigidity of the audit supervision system, promoting the maximization of audit effects, breaking the boundary barriers between corruption governance systems, realizing professional complementarity, information sharing, optimizing resource allocation, effectively saving the cost of corruption governance, maximizing the supervision and cooperation, and promoting the healthy development of public hospitals.
Author: Hunan Provincial Maternal and Child Health Hospital, Liu Baiyang