Evaluating Internal Audit Practices in Public Hospitals: A Systematic Literature Review

Abstract

This systematic literature review (2020–2023) analyzes the role of internal audit in strengthening governance, transparency, and service quality in public hospitals. The findings show that effective audit practices depend on well structured units with competent and independent auditors, strong managerial support, and integration with risk management systems. Systematic feedback, benchmarking, and continuous monitoring further enhance audit contributions to service delivery. However, challenges such as resource limitations, complex regulations, and weak auditor independence particularly in developing countries continue to constrain effectiveness. Cross-country comparisons reveal that hospitals in robust governance environments integrate auditing more successfully into decision-making, while those in weaker contexts face persistent barriers. The review concludes that advancing internal audit requires a holistic approach that combines capacity building, governance alignment, and digital readiness to transform auditing into a strategic driver of healthcare quality and accountability.