Contextual factors of external inspections and mechanisms for improvement in healthcare organizations: A realist evaluation

Hovlid, Einar; Husabø, Gunnar; Теиг, Ингер Лисе; Halvorsen, Kjersti; Frich, Jan C.

doi:10.1016/j.socscimed.2022.114872

Cited by 12 publications

(9 citation statements)

References 24 publications

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“…This was reported to weaken health professionals’ trust in the processes and decisions made. Literature indeed points to the important aspects of inspectors and the police having sufficient knowledge and competence as crucial factors to legitimacy and public trust 46 60–62…”

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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“…Although there is growing attention to the impact and effects on quality and safety from external evaluation, we know too little about real impact of these methods (Brubakk et al, 2015;World Health Organization, 2022). This applies especially to how structure and process versus performance play on outcomes, which enablers and/or barriers external evaluation may entail, and to how and to what extent perspectives from healthcare professionals and patients are included in the evaluation processes (Wiig and Fahlbruch, 2019;Allen et al, 2019;Øyri et al, 2021;Weenink et al, 2022;Hovlid et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Comparison of external evaluation policies and regulations for quality improvement and safety of health services in Norway and the United States

Øyri,

Bates,

Wiig

2023

IJHG

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Purpose The authors compare perspectives on external evaluation of health service provision between Norway and the USA. External inspection and accreditation are examples of internationally wide-spread external evaluation methods used to assess the quality of care given to patients. Different countries have different national policy strategies and arrangements set up to do these evaluations. Although there is growing attention to the impact and effects on quality and safety from external evaluation, there is still a gap in knowledge to how structures and processes influence these outcomes. Accordingly, the purpose of this article is to describe the structures and processes in external evaluation designed to promote quality improvement in Norway and the USA with attention to comparison of enablers and barriers in external evaluation systems.Design/methodology/approach Data collection consisted of documentary evidence retrieved from governmental policies, and reviews of the Joint Commission (the US), international guidelines, recommendations and reports from the International Society for Quality in Health Care, and the World Health Organization, and policies and regulations related to Norwegian governmental bodies such as the Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Norwegian Board of Health Supervision . Data were analyzed inspired by a deductive, direct content analytical framework.Findings The authors found that both accreditation and inspection are strategies put in place to ensure that healthcare providers have adequate quality systems as well as contributing to the wider risk and safety enhancing management and implementation processes in the organizations subjected to evaluation. The US and the Norwegian external regulatory landscapes are complex and include several policymaking and governing institutions. The Norwegian regulatory framework for inspection has replaced an individual blame logic with a model which “blames” the system for inadequate quality and patient harm. This contrasts with the US accreditation system, which focuses on accreditation visits. Although findings indicate an ongoing turning point in accreditation, findings also demonstrate that involving patients and next of kin directly in adverse event inspections is a bigger part of a change in external inspection culture and methods than in processes of accreditation.Research limitations/implications The message of this paper is important for policymakers, and bodies of inspection and accreditation because knowledge retrieved from the comparative document study may contribute to better understanding of the implications from the different system designs and in turn contribute to improving external evaluations.Originality/value Although there is a growing attention to the impact and effects on quality and safety from external evaluation, the implications of different regulatory strategies and arrangements for evaluation on quality and safety remain unclear.

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“…These different objectives may require different inspection strategies (Leistikow, 2018). They should go hand-in-hand with a deeper understanding of mechanisms of change and implementation strategies in order to have an impact on daily practice (Hovlid et al ., 2022; Pot et al ., 2023). When findings of inspection procedures cannot be transferred to effective interventions, regulation will not have any added public value.…”

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confidence: 99%

“…Up to now, theoretical program theories are seldomly explicated in studies on impacts of regulation. Program theories are useful for understanding which mechanisms bring about which outcomes under which conditions (Hovlid et al ., 2022). As regulation processes are layered (Pot et al ., 2023), research designs need to allow for complexity, multilayeredness, flexibility, and various contexts.…”

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confidence: 99%

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Perspectives on regulating long-term care

Nies

2023

Int. Psychogeriatr.

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Contextual factors of external inspections and mechanisms for improvement in healthcare organizations: A realist evaluation

Cited by 12 publications

References 24 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

Comparison of external evaluation policies and regulations for quality improvement and safety of health services in Norway and the United States

Perspectives on regulating long-term care

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