Promoting leadership and quality improvement through external inspections of management of sepsis in Norwegian hospitals: a focus group study

Abstract

ObjectiveInspections and other forms of external assessment may contribute to positive changes in the health services, but the mechanisms of such change remain unclear. We did a study to explore how external inspections may foster clinical improvement in hospitals.DesignFocus group study.SettingStatutory inspections of sepsis treatment in hospital emergency departments in Norway.ParticipantsClinicians, managers and inspection teams involved with the inspections of sepsis treatment in emergency departments at four different hospitals. Twelve focus group interviews were carried out, with a total of 47 participants.ResultsThree themes emerged as central for understanding how the inspections could contribute to clinical improvement in the emergency departments: (1) increasing awareness about the need to improve the quality of care by providing data on clinical performance, (2) building acceptance for improvement through professional credibility and focus on clinical practice, and (3) fostering leadership commitment.ConclusionOur findings suggest that the inspections have the potential to enhance hospital management and staff’s understanding of complicated care processes and help strengthen the organisational commitment to bring about systemic quality improvements.

Management of the Sepsis Protocol: An integrative litera-ture review

“…[6] The findings of article 7 agree with article 5, since they demonstrate how inspections and audits collaborate with the improvement of clinical practice and serve as a warning alert for professionals who deal with the diagnosis of sepsis, so that they pay attention to the management of care. [16] Article 8, in turn, provides results that, similar to article 2, show that there was no significant change in death indicators, changes in lactate levels and use of broadspectrum antibiotics with the implementation of the protocol for managing sepsis. [17] Article 9 addresses the qSOFA score, which is a novelty in the field and serves as a screening for patients at risk of developing sepsis.…”

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

“…These indications were corroborated by our findings showing reports of extensive government attention to stakeholder views and the approaches applied by the inspectors. Adding to this is the increasing emphasis on management and the internal work processes of managers in healthcare organizations, set to improve quality and safety, which in turn may have implications for external inspection [ 69 – 72 ]. For instance, in the Norwegian setting, internal incentives to work systematically on all organizational levels to improve quality and safety became stronger as a result from the introduction of the Quality Improvement Regulation.…”

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"

“…Clinical knowledge and knowledge of health systems are vital for the inspections to succeed, and the competency of inspectors is an important prerequisite for inspections to be considered legitimate. 16 Regulators should strive for a balanced fairness, designing inspections that engender trust in the process, ensure that facilities are safe, contribute to quality improvement, and are sensitive to the users' perspectives on quality. This means that regulators need to engage with the dilemmas that inevitably will present themselves in the course of an inspection process.…”

“…Clinical knowledge and knowledge of health systems are vital for the inspections to succeed, and the competency of inspectors is an important prerequisite for inspections to be considered legitimate. 16 …”