What Might Be Required for Inspections to Be Considered Fair? Comment on "What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms"

Husabø, Gunnar; Hovlid, Einar

doi:10.34172/ijhpm.2022.7296

Cited by 2 publications

(1 citation statement)

References 11 publications

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“…Previous research has demonstrated that a proper regulatory design may provide a fair and broad assessment of the complexity involved in the case 9 15 36 37. Involvement of several stakeholders in the process may serve as a way of restoring trust between the healthcare provider and the patient or next of kin, as well as reinforcing the public’s trust in the health services altogether 9 38–45.…”

Section: Discussionmentioning

confidence: 99%

Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons’ perspectives

Øyri,

Wiig,

Tjomsland

2024

BMJ Open Qual

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IntroductionTransparency about the occurrence of adverse events has been a decades-long governmental priority, defining external feedback to healthcare providers as a key measure to improve the services and reduce the number of adverse events. This study aimed to explore surgeons’ experiences of assessment by external bodies, with a focus on its impact on transparency, reporting and learning from serious adverse events. External bodies were defined as external inspection, police internal investigation, systems of patient injury compensation and media.MethodsBased on a qualitative study design, 15 surgeons were recruited from four Norwegian university hospitals and examined with individual semi-structured interviews. Data were analysed by deductive content analysis.ResultsFour overarching themes were identified, related to influence of external inspection, police investigation, patient injury compensation and media publicity, (re)presented by three categories: (1) sense of criminalisation and reinforcement of guilt, being treated as suspects, (2) lack of knowledge and competence among external bodies causing and reinforcing a sense of clashing cultures between the ‘medical and the outside world’ with minor influence on quality improvement and (3) involving external bodies could stimulate awareness about internal issues of quality and safety, depending on relevant competence, knowledge and communication skills.Conclusions and implicationsThis study found that external assessment might generate criminalisation and scapegoating, reinforcing the sense of having medical perspectives on one hand and external regulatory perspectives on the other, which might hinder efforts to improve quality and safety. External bodies could, however, inspire useful adjustment of internal routines and procedures. The study implies that the variety and interconnections between external bodies may expose the surgeons to challenging pressure. Further studies are required to investigate these challenges to quality and safety in surgery.

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Section: Discussionmentioning

confidence: 99%

Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons’ perspectives

Øyri,

Wiig,

Tjomsland

2024

BMJ Open Qual

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External inspection approaches and involvement of stakeholders’ views in inspection following serious incidents - a qualitative mixed methods study from the perspectives of regulatory inspectors

Øyri,

Wiig,

Anderson

et al. 2024

BMC Health Serv Res

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Objective The objective was to gain knowledge about how external inspections following serious incidents are played out in a Norwegian hospital context from the perspective of the inspectors, and whether stakeholders’ views are involved in the inspection. Methods Based on a qualitative mixed methods design, 10 government bureaucrats and inspectors situated at the National Board of Health Supervision and three County Governors in Norway, were strategically recruited, and individual semi-structured interviews were conducted. Key official government documents were selected, collected, and thematically analyzed along with the interview data. Results Our findings overall demonstrate two overarching themes: Theme (1) Perspectives on different external inspection approaches of responding and involving stakeholders in external inspection following serious incidents, Theme (2) Inspectors’ internal work practices versus external expectations. Documents and all participants reported a development towards new approaches in external inspection, with more policies and regulatory attention to sensible involvement of stakeholders. Involvement and interaction with patients and informal caregivers could potentially inform the case complexity and the inspector’s decision-making process. However, stakeholder involvement was sometimes complex and challenging due to e.g., difficult communication and interaction with patients and/or informal caregivers, due to resource demands and/or the inspector’s lack of experience and/or relevant competence, different perceptions of the principle of sound professional practice, quality, and safety. The inspectors considered balancing the formal objectives and expectations, with the expectations of the public and different stakeholders (i.e. hospitals, patients and/or informal caregivers) a challenging part of their job. This balance was seen as an important part of the continuous development of ensuring public trust and legitimacy in external inspection processes. Conclusions and implications Our study suggests that the regulatory system of external inspection and its available approaches of responding to a serious incident in the Norwegian setting is currently not designed to accommodate the complexity of needs from stakeholders at the levels of hospital organizations, patients, and informal caregivers altogether. Further studies should direct attention to how the wider system of accountability structures may support the internal work practices in the regulatory system, to better algin its formal objectives with expectations of the public.

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What Might Be Required for Inspections to Be Considered Fair? Comment on "What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms"

Cited by 2 publications

References 11 publications

Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons’ perspectives

Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons’ perspectives

External inspection approaches and involvement of stakeholders’ views in inspection following serious incidents - a qualitative mixed methods study from the perspectives of regulatory inspectors

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