Audit and evaluation mechanisms in hospitals: a scoping review of governance, quality of care, and organizational performance

Abstract

In response to increasing demands for quality of care, transparency, and accountability, hospitals are required to strengthen their governance, control, and evaluation mechanisms. Audit and evaluation systems, including internal audit, clinical audit, and quality assurance mechanisms, now occupy a strategic role in hospital governance and organizational performance management. However, the scientific literature remains highly fragmented across clinical, organizational, quality, and data-driven approaches, limiting an integrated understanding of how these mechanisms interact and shape governance, quality, and performance outcomes within hospital systems. To address this fragmentation, this scoping review proposes an integrated typology of hospital audit mechanisms and a systemic conceptual model explaining their contributions to governance, quality of care, organizational performance, and hospital resilience.

This research is based on a scoping review conducted in accordance with the PRISMA-ScR methodological guidelines. A systematic search strategy was carried out in the Scopus, Web of Science, and PubMed databases over the 2010–2025 period, complemented by sources of institutional grey literature. The inclusion criteria covered studies addressing audit or evaluation systems applied to hospital organizations, mainly drawn from peer-reviewed scientific publications.

Thirty studies were retained and analyzed using a thematic approach, enabling the identification of a structured typology of six complementary categories: clinical audit, organizational internal audit, quality audits and accreditation, audit and feedback, peer audit, and digital systems based on Business Intelligence and data governance. The analysis also highlights four systemic impact mechanisms: strengthening hospital governance, improving quality and patient safety, optimizing organizational performance, and fostering learning and continuous transformation dynamics.

Audit and evaluation mechanisms occupy a strategic position in continuous improvement initiatives within hospital organizations. This scoping review provides an integrated governance-oriented reading linking audit, clinical governance, quality of care, performance, hospital resilience, and data-driven management, opening promising perspectives for modeling a governance framework adapted to transforming public hospital systems, notably in the Moroccan context.

JEL Classification: M42, I18, G32

Paper type: Theoretical Research