Improvement through inspection? The development of the new Commission for Health Improvement in England and Wales

Walshe, Kieran

doi:10.1136/qshc.8.3.191

Cited by 16 publications

(11 citation statements)

References 6 publications

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“…In comparison to clinical outcomes, the subjective aspects of patient neglect (e.g. failures to demonstrate compassion) are difficult to measure or regulate [53], and complex to reward and prioritise [54]. Yet despite their subjectivity, the interactions between healthcare staff and patients are consistently cited by patients as fundamental to good care [55-57], and are therefore essential for understanding why patient neglect occurs.…”

Section: Resultsmentioning

confidence: 99%

Patient neglect in healthcare institutions: a systematic review and conceptual model

Reader

Gillespie

2013

BMC Health Serv Res

132

130

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BackgroundPatient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error.MethodThe Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated (1) the definition of patient neglect, (2) the forms of behaviour associated with neglect, (3) the reported frequency of neglect, and (4) the causes of neglect.ResultsPatient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients.ConclusionA social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of i) differences between patients and healthcare staff in how they perceive neglect, ii) the association with patient neglect and health outcomes, iii) the relative importance of system and organisational factors in causing neglect, and iv) the design of interventions and health policy to reduce patient neglect.

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Section: Resultsmentioning

confidence: 99%

Patient neglect in healthcare institutions: a systematic review and conceptual model

Reader

Gillespie

2013

BMC Health Serv Res

132

130

View full text Add to dashboard Cite

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“…At a local level, a new responsibility of 'clinical governance' from April 1999 was laid on the Chief Executives of NHS hospital and community trusts, including establishing clear lines of accountability for the quality of clinical care and establishing comprehensive programmes of quality improvement activity including those relating to the clinical standards set out by NICE (Donaldson & Muir Gray, 1998;Buetow & Roland, 1999). At a national level, a new Commission for Health Improvement was established, to undertake a rolling programme of reviews of clinical governance arrangements in Trusts, and, in relation specifically to clinical effectiveness, to undertake national reviews of the implementation of NICE guidance (Walshe, 1999).…”

Section: Level Of Evidence Quality Improvement Methodsmentioning

confidence: 99%

“…Outcomes benchmarking can also be used at a local level to examine if clinical outcomes are in line with expectations, where there is normative or other benchmarking data on what outcomes should be expected (Ellwood, 1988). There is also a monitoring role regarding the system in place to promote use of evidence-based health care locally, and at a national level this is a key role of the reviews of Trusts' clinical governance arrangements by the Commission for Health Improvement (Walshe, 1999).…”

Section: Components Of a Clinical Effectiveness Programmementioning

confidence: 99%

Clinical effectiveness in the UK: Definitions, history and policy trends

Cape

2000

Journal of Mental Health

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In the last 5 years there has been a huge increase in interest in clinical effectiveness. Clinical effectiveness is often used loosely to describe health care that is based on scientific evidence, but properly refers to population based approaches to quality improvement involving facilitation of evidence-based and cost effective practice. It overlaps with evidence-based medicine, which is individually and clinically based. The history of development of clinical effectiveness in the UK is reviewed, including the significant NHS policy initiatives of the last decade. Key components of clinical effectiveness programs are methods to inform clinicians of research evidence as to the effectiveness of interventions, methods to encourage practitioners to use this information to change practice, and methods to monitor changes to practice and clinical outcomes. The minimum requirements to use clinical effectiveness as an approach to quality improvement in mental health and psychotherapy are outlined.

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“…14 If reports of reviews had, however, been limited to covering these seven technical components only, there would have been two significant omissions: 'the crucial -if elusive -characteristics of culture and leadership' (Day and Klein, 2004: 19); and 'it is unlikely that the public and the politicians will be satisfied by reports which say nothing about the quality of care' (Walshe, 1999). CHI sought to cover these omissions with two chapters in each report on strategic capacity and quality, in terms of patient experience based largely on cross-cutting analysis of evidence generated from analysis of seven technical components.…”

Section: Nature Of the Sectorsmentioning

confidence: 99%

Structure and logic of regulation and governance of quality of health care: was OFSTED a model for the Commission for Health Improvement?

Bevan

Cornwell

2006

HEPL

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The Labour Government elected in 1997 faced similar problems in health care to those faced by the Conservative Government in schools in the early 1990s. And the policies developed for health care in the late 1990s echoed those that had been implemented for schools. This paper considers one of those common policies, namely the creation of new central inspectorates required to visit all organizations over a four-year period: the Office for Standards in Education (OFSTED) to inspect the quality of teaching in schools, and the Commission for Health Improvement (CHI) to review the implementation of the systems and processes of clinical governance in every organization in the National Health Service (NHS). At its creation, CHI was described as an OFSTED for the NHS. This paper compares these two inspectorates; describes origins of policies and institutions; considers their rhetoric and practices; describes the processes the two organizations used and considers their impacts. It argues that structural differences meant that CHI could never have been an OFSTED for the NHS; relational distance is a key aspect of inspection/regulation; and that the key to effective regulation in the case of the NHS was the relational proximity between CHI and the NHS, with the added weight of a strong performance management regime.

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Improvement through inspection? The development of the new Commission for Health Improvement in England and Wales

Cited by 16 publications

References 6 publications

Patient neglect in healthcare institutions: a systematic review and conceptual model

Patient neglect in healthcare institutions: a systematic review and conceptual model

Clinical effectiveness in the UK: Definitions, history and policy trends

Structure and logic of regulation and governance of quality of health care: was OFSTED a model for the Commission for Health Improvement?

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