[Clinic name]
Controlled document
[Address]
[Registration or licence number]
MOH and MSQH survey checklist
1Before you apply
- Your certificate of registration or licence current, and displayed where patients can see it.
- MSQH membership, twelve months of full operation, and MSQH's training for a first survey.
- The survey application signed by the person in charge, sent at least six months ahead.
- One owner for each standard, and one person who holds its evidence.
2Act 586 basics
- The complaints policy, billing procedure, staff identification and organisation chart displayed for patients.
- A grievance mechanism patients know how to use, and every complaint documented.
- Incident reporting that works, with a list, analysis and action taken.
- A person in charge named on the certificate, and any change notified within fourteen days.
3Ethical practice
- Informed consent forms, and consent discussions in the notes.
- A displayed notice on chaperones, and a written pledge on confidentiality.
- Medical reports provided on request, with a list of those sent.
- Complaints and compliments, with the action taken on each.
4Quality improvement
- A patient satisfaction survey, and what you changed because of it.
- One clinical audit this year, such as antibiotic prescribing or chronic disease care.
- Records of every quality activity, with its result.
- A self-assessment against every criterion, repeated until each one rates 3 or 4.
5What an MOH and MSQH inspector may ask
- Show me how a patient is told what their treatment will cost. What to show, fees available before care, and an itemised bill on request.
- How is informed consent obtained and recorded? What to show, what the patient was told, when they agreed, and where it is written.
- Who can see patient records, and how would you know? What to show, a written procedure on access, and evidence it is followed.
- Tell me about your last incident and what changed. What to show, the incident report, the analysis and the action taken.
- How do patients complain, and how fast do you answer? What to show, where patients are told to complain, samples of complaints and the action taken.
- What did your last patient satisfaction survey change? What to show, the survey, the result and the change.
AAppendix, Survey day request log
- A.1Time ______ Surveyor ______ Area ______
- A.2Asked for ______
- A.3Produced by ______ From ______ Minutes taken ______
- A.4Follow-up needed ______ Owner ______