State of Alaska Division of Legislative Audit

Organizational and Administrative Structure Performance Review

Improving Administrative Functions

Summary: The report notes areas in which the department satisfactorily administers programs as well as reveals a number of administrative processes and functions which need improvement to better meet the needs of Alaskans.

Click here for the table of all recommendations for improving administrative functions

Key Finding for Improving Administrative Functions

  1. DHSS did not provide its list of proposed 10 percent budget reductions in general funds as required by AS 44.66.020(c)(2). (pg. 122)

 

Key Recommendations for Improving Administrative Functions

  1. Establish an internal audit section for the entire department.
    (Recommendation 3.2.B.1)

Several recent audits and assessments found weaknesses in the internal controls throughout DHSS. Public Works recommends that DHSS establish an internal audit section with an enterprise-wide focus on internal controls and reviews, thus reducing errors, reducing adverse and costly federal audit/investigation findings, and improving efficiency.

  1. Consider creating a formal process for coordinating site visits and expand cross-training opportunities so staff can conduct multi-purpose site visits.
    (Recommendation 3.1.D.1)
    (Recommendation 3.2.D.2)
    (Recommendation 3.2.D.3)

Multiple DHSS divisions conduct site visits for a variety of purposes, including the review of 555 grants to about 250 grantees. With limited resources for on-site compliance reviews, coordinating site visits can reduce travel costs and increase compliance monitoring at sites where staff limitations result in infrequent or untimely visits.

  1. Elevate the Medicaid continuous quality improvement function within DHSS.
    (Recommendation 3.3.C.1)

A continuous quality improvement process is an integral and required component of Medicaid which ensures programs are systematically and intentionally improving services and increasing positive outcomes for the individuals they serve. This function should report directly to the deputy commissioner for Medicaid and Health Care Policy and should include the entire Medicaid program, including behavioral health and long-term care services.

  1. Prioritize migration to electronic health records for all divisions.
    (Recommendation 7.5.1)
    (Recommendation 7.5.2)

Electronic health records help to reduce medical errors, maximize operational efficiency, and minimize redundant training. Due to its technological limitations, the Public Health Nursing section still maintains a paper charting system in all of its health centers. New nurses require training on paper charting protocols because nursing schools today utilize only electronic records in their teaching.