Learning from regulatory interventions in healthcare

Abstract

If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -This paper aims to present the findings from research commissioned by the Commission for Health Improvement (CHI), which set out to examine the impact of CHI's clinical governance reviews on NHS trusts in England. Design/methodology/approach -This paper, giving a stratified random sample of 30 NHS trusts, was taken from a set of 75 trusts reviewed by CHI during a period from 2001 to 2003. Documents from these trusts' reviews were analysed. A postal questionnaire was sent to key stakeholders with an involvement or direct interest in each trust's review. Semi-structured telephone interviews were held with five to six people from each of four trusts selected as case studies. Findings -In this paper the clinical governance review process was characterized by wide variability in methods, application and effects, in the initial CHI visit and report, and the subsequent NHS trust action plan and SHA progress review. The recommendations made by reviews for change in an NHS trust were often of a nature or expressed in terms, which made measuring their subsequent implementation and impact problematic. CHI recommendations concentrated on management and support processes rather than on direct patient care and outcomes. Trusts were generally willing to accept and then enact CHI review recommendations. Practical implications -The paper concluded that a more focused and controlled review process would support greater change and improvement. There was evidence to suggest that this kind of regulatory intervention can have largely positive impacts on the organisational performance of NHS trusts, although these positive effects were mainly indirectly related to the delivery of patient care and health improvement. Any future review or inspection processes should place a greater focus upon patient outcomes if such reviews are to demonstrate their value in making a contribution to improving health. Originality/value -The paper shows that, internationally, there have been few empirical studies analysing the work of health care regulators and their impact on the organisations they regulate. While the work of CHI has been examined by others, this study is the first empirical and largely quantit...

A retrospective review of how nonconformities are expressed and finalized in external inspections of health-care facilities

“…In line with previous research, we found that the nonconformities identified in external inspections addressed deficiencies in the management system, support processes, and clinical processes, but not clinical outcomes [11, 25–27]. The standards used for inspections in our case study are based on requirements in Norwegian legislation, which do not contain specific outcome requirements.…”

“…We found that many of the observations addressed deficiencies in the management system and the support processes. Power [28] suggested that, “if auditing processes get decoupled from core organizational activities, these effects may be minimal and the audit process becomes an expensive but harmless ritual, which is important for external legitimacy.” Benson et al [11] found that the corrective measures that addressed deficiencies in support processes had limited effect on patient care, and in line with Power [26], they state that when the feedback concern system processes in general, the intended benefit for the patients should be made clear. We identified two general patterns for how the observations supported the nonconformities: one in which the observations regarding the management system did not explicitly demonstrate how they affected the clinical processes, and one in which they did.…”

“…Previous research has found that external inspections in health care can provide the inspected organizations with useful information for their initiatives and efforts to improve their quality of care [9, 10]. External inspections seem to affect organizational practice, but there is sparse knowledge about how and if such changes in organizational practice lead to improved quality of care [11–13]. …”

“…The way external inspection systems affect the involved organization is poorly understood [6, 11, 14, 15]. A better understanding of these processes is important to improve our understanding of why effects of external inspections seem to vary between organizations.…”

Measuring progress with clinical governance development in New Zealand: perceptions of senior doctors in 2010 and 2012

“…Elsewhere, studies show the struggle continues with attempting to bridge the managerial-clinical divide and build entities with strong clinical leadership focused on quality and safety [2,29,30]. The reasons for this may, again, be due to leadership capacity, as well as the context-dependent nature of any management and organisational development project which means it is difficult to simply transplant a well-functioning model of clinical governance from one organisation into another.…”