Quiz

In a system that is specifically designed for policy management In an in-house/intranet system that is not specifically for policy management In binders scattered across the hospital

By flipping through the binders until they locate the right one. Scrolling through an in-house system that has little to no search functionality. They can search through the system using a variety of functions, such as keywords, folder structure, date of next update, etc.

Our system prevents people without access to certain folders from seeing the policies in those folders. There is no way of implementing or enforcing any privacy/security measures. We have established an internal method that can be surpassed if the staff really want to access thoes policies.

There is an audit trail within our policy management system and also a section within each policy where users can confirm their compliance. There is no formal tracking method, we rely on our staff members to be aware of which policies they need to stay on top of. They manually report to policy administrators whenever they have read/complied to a policy.

Our policy administrators get sent notifications ahead of time whenever policies need to be updated. Our policy administrators record the dates for policy updates in their calendar, planner, etc. There isn't a formal process that we follow to update them - basically whenever we remember to.

We did not pass their evaluation, and are just as concerned about the state of our policy management for the next evaluation. We have not failed any of the survey checks, but we are struggling to stay on top of changes to pass our next evaluation. We have passed their survey checks with flying colours, and we are confident that we'll continue to do so in the future.