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In this paper we report on the approach we have developed and the lessons we have learned in an implementation of the monitoring and control layer for continuous monitoring of business process controls (CMBPC) in the US internal IT audit department of Siemens Corporation. The architecture developed by us implements a completely independent CMBPC system running on top of Siemens’ own enterprise information system which has read-only interaction with the application tier of the enterprise system. Among our key conclusions is that “formalizability” of audit procedures and audit judgment is grossly underestimated. Additionally, while cost savings and expedience force the implementation to closely follow the existing and approved internal audit program, a certain level of reengineering of audit processes is inevitable due to the necessity to separate formalizable and non-formalizable parts of the program. Our study identifies the management of audit alarms and the prevention of the alarm floods as critical tasks in the CMBPC implementation process. We develop an approach to solving these problems utilizing the hierarchical structure of alarms and the role-based approach to assigning alarm destinations. We also discuss the content of the audit trail of CMBPC.

Purpose – In this chapter, we seek to resolve the conflicting implications that emerge from status quo theories of justice, on the one hand, and theories of distributive, procedural, and interactional justice on the other. Specifically, status quo theories depict individuals as resistant to perceptions of injustice in their social environments, whereas theories of distributive, procedural, and interactional justice depict individuals as quite sensitive to the justice that characterizes outcomes and treatment.

Methodology/approach – We build on previous research on the justice judgment process to consider ways in which the findings from these two research streams can be integrated.

Findings – We suggest that the two overarching streams of research have identified and empirically explored two distinct modes of justice evaluation: a system justification mode and a system critique mode.

Originality/value of chapter – We develop a model of the justice judgment process that specifies the circumstances under which each of the two modes is likely to operate.

Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal of this study was to perform a three-year median follow-up review on the longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality rates across the medical center. A secondary goal was to determine the effect of smaller-scale interventions focused on reeducating the nursing population on the importance of cardiac alarms.

A system-wide policy was developed at The Ohio State University in December 2013 based on guidelines for selective CCM in all patient populations. Patients were stratified into Critical Class I, II, and III with 72 hours, 48 hours, or 36 hours of CCM, respectively. Pre- and post-implementation measures included average cardiac monitoring days (CMD), emergency department (ED) boarding rate, mortality rates, and LOS. A 12-week evaluation period was analyzed prior to, directly after, and three years after implementation.

There was an overall decrease of 53.5% CMDs directly after implementation of selective CCM. This had remained stable at the three-year follow-up with slight increase of 0.5% (p = 0.2764). Subsequent analysis by hospital type revealed that the largest and most stable reductions in CMD were in noncardiac hospitals. The cardiac hospital CMD reduction was stable for roughly one year, then dipped into a lower stable level for nine months, then returned to the previous post-implementation levels. This change coincided with a smaller intervention to further reduce CMD in the cardiac hospital. There was no significant change in mortality rates with a slight decrease of 3.1% at follow-up (p = 0.781). Furthermore, there was no significant difference in LOS with a slight increase of 1.1% on follow-up (p = 0.649). However, there was a significant increase in ED boarding rate of 7.7% (p < 0.001) likely due to other hospital factors altering boarding times.

Implementing selective CCM decreases average cardiac monitoring rate without affecting LOS or overall mortality rate. Selective cardiac monitoring is also a sustainable way to decrease overall hospital resource utilization and more appropriately focus on patient care.

The evolution of MIS technology has affected traditional auditing and created a new set of audit issues. This paper describes the Continuous Process Auditing System (CPAS) developed at AT&T Bell Laboratories for the internal audit organization that is designed to deal with the problems of auditing large paperless real-time systems. The paper discusses why the methodology is important and contrasts it with the traditional audit approach. CPAS is designed to measure and monitor large systems, drawing key metrics and analytics into a workstation environment. The data are displayed in an interactive mode, providing auditors with a work platform to examine extracted data and prepare auditing reports. CPAS monitors key operational analytics, compares these with standards, and calls the auditor’s attention to any problems that may exist. Ultimately, this technology will utilize system probes that will monitor the auditee system and intervene when needed.

Since the publication of the report “To Err Is Human: Building a Safer Health System” by the US Institute of Medicine in 2000, much has changed with regard to patient safety. Many of the more recent initiatives to improve patient safety target the behavior of health care staff (e.g., training, double-checking procedures, and standard operating procedures). System-based interventions have so far received less attention, even though they produce more substantial improvements, being less dependent on individuals’ behavior. One type of system-based intervention that can benefit patient safety involves improvements to hospital design. Given that people’s working environments affect their behavior, good design at a systemic level not only enables staff to work more efficiently; it can also prevent errors and mishaps, which can have serious consequences for patients. While an increasing number of studies have demonstrated the effect of hospital design on patient safety, this knowledge is not easily accessible to clinicians, practitioners, risk managers, and other decision-makers, such as designers and architects of health care facilities. This is why the Swiss Patient Safety Foundation launched its project, “More Patient Safety by Design: Systemic Approaches for Hospitals,” which is presented in this chapter.

Although it is widely acknowledged that health care delivery systems are complex adaptive systems, there are gaps in understanding the application of systems engineering approaches to systems analysis and redesign in the health care domain. Commonly employed methods, such as statistical analysis of risk factors and outcomes, are simply not adequate to robustly characterize all system requirements and facilitate reliable design of complex care delivery systems. This is especially apparent in institutional-level systems, such as patient safety programs that must mitigate the risk of infections and other complications that can occur in virtually any setting providing direct and indirect patient care. The case example presented here illustrates the application of various system engineering methods to identify requirements and intervention candidates for a critical patient safety problem known as failure to rescue. Detailed descriptions of the analysis methods and their application are presented along with specific analysis artifacts related to the failure to rescue case study. Given the prevalence of complex systems in health care, this practical and effective approach provides an important example of how systems engineering methods can effectively address the shortcomings in current health care analysis and design, where complex systems are increasingly prevalent.

The advent of new enabling technologies and the surge in corporate scandals has combined to increase the supply, the demand, and the development of enabling technologies for a new system of continuous assurance and measurement. This paper positions continuous assurance (CA) as a methodology for the analytic monitoring of corporate business processes, taking advantage of the automation and integration of business processes brought about by information technologies. Continuous analytic monitoring-based assurance will change the objectives, timing, processes, tools, and outcomes of the assurance process.

The objectives of assurance will expand to encompass a wide set of qualitative and quantitative management reports. The nature of this assurance will be closer to supervisory activities and will involve intensive interchange with more of the firm s stakeholders than just its shareholders. The timing of the audit process will be very close to the event, automated, and will conform to the natural life cycle of the underlying business processes. The processes of assurance will change dramatically to being meta-supervisory in nature, intrusive with the potential of process interruption, and focusing on very different forms of evidential matter than the traditional audit. The tools of the audit will expand considerably with the emergence of major forms of new auditing methods relying heavily on an integrated set of automated information technology (IT) and analytical tools. These will include automatic confirmations (confirmatory extranets), control tags (transparent tagging) tools, continuity equations, and time-series cross-sectional analytics. Finally, the outcomes of the continuous assurance process will entail an expanded set of assurances, evergreen opinions, some future assurances, some improvement on control processes (through incorporating CA tests), and some improved data integrity.

A continuous audit is a methodology that enables independent auditors to provide written assurance on a subject matter, for which an entity’s management is responsible, using a series of auditors’ reports issued virtually simultaneously with, or a short period of time after, the occurrence of events underlying the subject matter.

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  CICA/AICPA Research Study on Continuous Auditing (1999)

CICA/AICPA Research Study on Continuous Auditing (1999)

Companies must disclose certain information on a current basis.

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  Corporate and Auditing Accountability, Responsibility, and Transparency (Sarbanes-Oxley) Act (2002)

Corporate and Auditing Accountability, Responsibility, and Transparency (Sarbanes-Oxley) Act (2002)

The main purpose of this chapter is to estimate a model for hedge fund returns that will endogenously generate failure probabilities using panel data where sample attrition due to fund failures is a dominant feature. We use the Lipper (TASS) hedge fund database, which includes all live and defunct hedge funds over the period January 1994 through March 2009, to estimate failure probabilities for hedge funds. Our results show that hedge fund failure prediction can be substantially improved by accounting for selectivity bias caused by censoring in the sample. After controlling for failure risk, we find that capital flow, lockup period, redemption notice period, and fund age are significant factors in explaining hedge fund returns. We also show that for an average hedge fund, failure risk increases substantially with age. Surprisingly, a 5-year-old fund on average has only a 65% survival rate.

Purpose – The purpose of this chapter is to illustrate that when produced through relations of power, West Nile virus (WNV), as it exists on the Public Health Agency of Canada's (PHAC) website, is an effect of the kinds of knowledge, techniques of power, and disciplinary apparatuses that operate on the website and in society.

Methodology/approach – The approach used in the in-depth research project which informs this chapter is an elaboration of Michel Foucault's work on relations of power which offers an effective way of studying the PHAC's website as a collection of authoritative knowledges and as a product of a set of systems, structures, and processes which have helped to assemble and distribute knowledge about WNV.

Findings – The findings discussed in this chapter offer a critical reading of the PHAC's overall production of WNV, focusing particularly on its initial emergence starting in 2001. Cumulatively, this chapter argues that myriad relations of power have produced WNV as a bio-socio-administrative construct.

Contribution to the field – This research illustrates one way that Foucault's theories of power can be used to conduct a critical analysis of both the discursive and material dimensions of the production of contemporary public health issues. Such an approach is useful to scholars who wish to place the emergence of a disease phenomenon within political, institutional, economic, cultural, and social relations of power; thereby drawing attention to how specific spaces, places, individuals, and institutions contribute to the production of contemporary health alarms.