Inspecting teams’ and organisations’ expectations regarding external inspections in health care: a qualitative study

Abstract

Background: There is a gap in the literature regarding what takes place between the announcement of a regulatory intervention, such as an external inspection of a health care organisation, and the inspecting body's site visit. This study aimed to explore inspecting bodies' expectations of how inspected organisations should prepare before an external inspection and to elucidate how inspected health care organisations prepare before site visits. Methods: This qualitative study was based on data from 17 group interviews with a total of 75 participants representing inspection teams, organisation leaders and clinicians in inspected health care organisations. The data were analysed using a qualitative content analysis method. Results: We identified two approaches to how the inspection teams expected that the inspected organisations should prepare before site visits. In the first approach the inspection teams did not expect any improvement activities to be initiated during this period and focused on identifying inadequacies that the inspected organisations should subsequently improve. In the second approach the inspection teams expected organisations to review their own practices and begin improvement activities if necessary. The inspected organisations responded in different ways to an upcoming site visit, and the organisations' leaders were important in determining which activities would be initiated. Organisations in which leaders involved clinicians in assessing care delivery tended to initiate action to improve and expected inspection teams to assess their ongoing improvement work and provide guidance on further improvements. Leaders who did not involve clinicians in assessing the quality of care tended to perceive the current quality of care as adequate on the basis of reviewing written guidelines. They did not initiate action to improve care delivery apart from updating written guidelines describing how care should be delivered, and they expected the inspection team to confirm that their current practices were in line with the guidelines and external standards. Conclusions: To promote anticipatory effects in inspected organisations, inspecting bodies should stress the importance of assessing clinical practice and involving frontline clinical staff and leaders in the assessment and in improvement work before the site visit.

Healthcare Regulation and Resilience: a Norwegian Multilevel Case Study

“…Moreover, it came to light through Paper III findings that it was essential to have institutional trust between hospital managers and governmental supervisory bodies if inspection was meant to encourage learning. Connecting these findings with Paper II, where inspectors argued for an increased application of expert inspectors, this thesis reflects another recent study showing that for the inspected organization to trust the outcome of the inspection, inspectors needed the appropriate knowledge and skills (Hovlid et al, 2020 a). This is also consistent with research showing that the efficiency of management-oriented regulation may be undermined by the absence of or supported by the presence of organizational trust (Gunningham & Sinclair, 2009).…”

“…A recent study did however link the promotion of leadership with external inspection, stressing how external inspection may "boost" the way hospitals manage their internal work of improving quality and patient safety (Husabø et al, 2020). Moreover, for healthcare organizations to trust the outcome of inspections, inspectors need to possess the appropriate knowledge and skills (Hovlid et al, 2020 a). The quality of how regulatory practice is formed should therefore be considered imperative, also to gain legitimacy in the public in general (Sparrow, 2000).…”

“…This thesis focuses on organizational performance. Supervision assessments are based on a regulatory framework of ideas and legal standards for sound professional practice and prudent conduct, and the minimum standards required (Shaw et al, 2019;Hovlid et al, 2020 a).…”

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

“…Moreover, previous research has shown that involving healthcare professionals can be a critical factor for implementing and sustaining change. For example, a study by Hovlid et al (2020) have showed that if organisations involve healthcare professionals in assessing care delivery for external audits, they are able to gain a better understanding of their current practice and consequently initiate action to improve quality of care. In organisations were involvement of healthcare professionals was low, no actual improvements were initiated or realized apart from updating written guidelines describing how care should be delivered [135].…”

Hospital managers’ perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study

“…72 ► How to improve the collaboration between inspectors and hospital managers. 99 ► It would also be valuable to engage in cross-country comparative research to investigate how different regulatory regimes value flexibility in regulatory strategies for quality improvement and patient safety.…”