Hospital Internal Control through Criticality Mapping: An FMECA Application - Case of the Beni Mellal-Khenifra Region

Abstract

Public hospitals operate through tightly connected clinical, administrative, financial and logistical processes, so weaknesses in one area may propagate across the organization. Internal control can therefore serve not only compliance purposes but also the prioritization of vulnerabilities and control responses. This study examines a criticality-mapping approach based on Failure Mode, Effects and Criticality Analysis (FMECA) in public hospitals in Morocco’s Béni Mellal-Khénifra region. The empirical portfolio comprises 17 failure modes across six management areas, pre-identified through field knowledge and process examination. Thirty-nine hospital managers and staff members contributed severity and occurrence assessments. The complete FMECA expression is retained (RPN = O × S × D), while D is set to 1 within this study because the portfolio is restricted to risks that were already known, pre-identified and directly observable. R7, concerning the monitoring of hospitalization records, reaches the highest criticality (RPN = 9). R1, R5, R10, R11 and R17 form the second priority tier (RPN = 6). The resulting map gives internal control an explicit basis for sequencing mitigation actions. The study also provides a pre-GST diagnosis and identifies conditions for periodically updating the risk matrix.