Follow-up Audit of Laboratory Management

March 2013

Table of Contents

• Executive summary

1. Introduction
   1. Background
   2. Audit objective
   3. Audit scope
   4. Audit approach
   5. Statement of assurance
2. Findings, recommendations and management responses
   1. Follow-up on the 2010 audit recommendations
      1.1. Progress made on 2010 audit recommendations

• Scorecard
• Appendix A - Lines of enquiry and audit criteria
• Appendix B - Assessment of recommendation implementation

Executive summary

The follow-up audit of recommendations from the 2010 Audit of Laboratory Management was carried out as part of the Public Health Agency of Canada's (the Agency's) 2012-13 Risk-Based Audit Plan. The objective of the follow-up audit was to determine whether the implementation of the management action plan has been effective in addressing the recommendations made in the Audit of Laboratory Management tabled in June 2010. An assessment of actions taken by management was performed to address the recommendations. The follow-up audit was conducted from October 2012 to January 2013.

The key objectives of the 2010 Audit of Laboratory Management were to assess the Agency's governance and accountability framework, systems and practices for managing its laboratories. Further, the audit assessed the extent to which the Agency's laboratory activities support its program needs and those of its internal and external clients and identified relevant opportunities and best practices for improvement.

In response to the federal Budget 2012, the Agency has reiterated that science and research remain a key priority. Through the implementation of its new Framework for Science and Research Excellence, the Agency will further focus on its federal role in public health science and research, clarify its leadership responsibilities and continue to put evidence and science information at the centre of its policies and programs.

The follow-up audit concludes that the implementation of the management action plan has been effective in addressing some of the recommendations made in the Audit of Laboratory Management. Of the seven recommendations, five (72%) have been fully implemented. The remaining two recommendations (28%) have achieved the preparation for implementation stage.

A major improvement has been the development and approval of the Infectious Disease Prevention and Control Branch's (IDPC) 2011-16 Strategic Plan. This is significant not only because it addresses one recommendation directly, but also because it details the mandate for the Infectious Disease Prevention and Control Branch, the centres and laboratories. The Strategic Plan commits to developing a human resources action plan. Once developed, this should address the recommendation related to human resources planning for the laboratories. Lastly, the Agency is in the process of developing an Office of the Chief Science Officer (OCSO) and has a draft job description for the Chief Science Officer. Once both are completed, these actions will address the recommendation related to roles and responsibilities of the Chief Science Officer.

A. Introduction

1. Background

As part of the Public Health Agency of Canada's (the Agency's) Risk-Based Audit Plan for 2012-13, the Portfolio Audit and Accountability Bureau undertook the follow-up audit of the management action plan commitments as outlined in the 2010 Audit of Laboratory Management.

The 2010 Audit of Laboratory Management concluded that program objectives and priorities exist for the laboratory activities, and the level of excellence of the science and research continues to meet the International Organization for Standardization (ISO) accreditation requirements and the needs of the clients and stakeholders. However, it was noted that the Agency would benefit from senior corporate management oversight of the science and research activities of the laboratories, and would benefit from strategic direction setting at the Branch level to guide and set priorities for the laboratories and the centres. Attention in the area of oversight and strategic direction setting would assist the Agency in better documenting the alignment of laboratory work with the strategic priorities of the Agency. Lastly, clearly defined authorities, accountabilities and roles and responsibilities for the laboratories and the centres would better demonstrate the best use of Agency resources. The audit had seven recommendations related to:

• the structure of the Agency's program delivery;
• governance and strategic directions;
• the role and responsibilities of the Chief Science Advisor/Officer; and
• the adequacy of resources.

In response to the federal Budget 2012, the Agency has reiterated that science and research remain a key priority. Through the implementation of its new Framework for Science and Research Excellence, the Agency will further focus on its federal role in public health science and research, clarify its leadership responsibilities and continue to put evidence and science information at the centre of its policies and programs. As recently as April 2012, the acting Deputy Head noted in an Agency communiqué that the Chief Science Officer will take on a more robust role that includes: leading the establishment and monitoring of the Agency's science priorities; supporting excellence and innovation in science; promoting science and science partnerships; and overseeing the Agency's science support infrastructure.

2. Audit objective

The objective of the follow-up audit was to determine whether the implementation of the management action plan has been effective in addressing the recommendations made in the Audit of Laboratory Management tabled in June 2010.

3. Audit scope

The follow-up audit focused on management action plan commitments contained in the 2010 Audit of Laboratory Management. The follow-up audit was conducted from October 2012 to January 2013.

4. Audit approach

For each recommendation, the progress achieved against action plan commitments was assessed. The follow-up methodology included interviews and the analysis of supporting documentation.

5. Statement of assurance

In the professional judgment of the Chief Audit Executive, sufficient and appropriate procedures were performed and evidence gathered to support the accuracy of the follow-up audit conclusion. The follow-up audit findings and conclusion are based on a comparison of the conditions that existed as of the date of the audit, against established criteria that were agreed upon with management. Further, the evidence was gathered in accordance with the Internal Auditing Standards for the Government of Canada and the International Standards for the Professional Practice of Internal Auditing.

B. Findings, recommendations and management responses

1. Follow-up on the 2010 audit recommendations

1.1. Progress made on 2010 audit recommendations

Audit criterion: Management's actions have been effective in addressing the recommendations identified in the audit tabled in 2010.

The follow-up audit concludes that the implementation of the management action plan has been effective in addressing some of the recommendations made in the 2010 Audit of Laboratory Management. Of the seven recommendations, five (72%) have been fully implemented. The remaining two recommendations (28%) are in the preparation for implementation stage.

A major improvement has been the development and approval of the Infectious Disease Prevention Centre Branch’s 2011-16 Strategic Plan. This is significant not only because it addresses one recommendation directly, but also because the document contains mandates for the Centre for Immunization and Respiratory Infectious Disease, the Centre for Communicable Diseases and Infection Control and the Centre for Foodborne Environmental and Zoonotic Infectious Diseases and the two laboratories which addresses another important recommendation. The Agency’s 2013-18 Strategic Horizons notes that laboratory operations will focus on core, high priority laboratory activities, while preserving the capacity to respond to new and emerging health issues and to supplement Canadian laboratory capacity when needed. This will mean, among other things, exploring more integrated management of Agency laboratories.

The acting Deputy Head stated in April 2012 that the Chief Science Officer will take on a more robust role that includes: leading the establishment and monitoring of the Agency’s science priorities; supporting excellence and innovation in science; promoting science and science partnerships; and overseeing the Agency’s science support infrastructure. Currently on the Science, Policy and Management Committee’s forward agenda is the “way forward” for the Office of the Chief Science Officer and the next steps on the implementation of Science Research Framework as well as the suite of science priorities for the new Office.

Please refer to Appendix A for the assessment rating guide and to Appendix B for the detailed assessments.

Scorecard

The table below summarizes the status of each audit recommendation.

Appendix A - Lines of enquiry and audit criteria

1. No progress or insignificant progress
No action taken by management or insignificant progress. Actions such as striking a new committee, having meetings and generating informal plans are insignificant progress.

2. Planning stage
Formal plans for organizational changes have been created and approved by the appropriate level of management (at a sufficiently senior level, usually at the Executive Committee level or equivalent) with appropriate resources and a reasonable timetable.

3. Preparation for implementation
The entity has begun necessary preparation for implementation, such as hiring or training staff, or developing or acquiring the necessary resources to implement the recommendation.

4. Substantial implementation
Structures and processes are in place and integrated in some parts of the organization, and some achieved results have been identified. The entity has a short-term plan and timetable for full implementation.

5. Full implementation
Structures and processes are operating as intended and are implemented fully in all intended areas of the organization.

6. Obsolete
Audit recommendations that are deemed to be obsolete or have been superseded by another recommendation.

Appendix B – Assessment of recommendation implementation