Regulation and resilience at the macro-level healthcare system – a literature review

Øyri, Sina Furnes; Wiig, Siri

doi:10.3850/978-981-11-2724-3_0075-cd

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…As our theoretical approach we have presented four potentials proposed to be necessary for resilient performance; to respond, monitor, learn and anticipate [26]. These potentials are interdependent, and it can be challenging to operationalize them and keep them apart in healthcare research [49,50]. E.g.…”

Section: Certification As Support For Resilient Performancementioning

confidence: 99%

Certification as support for resilience? Behind the curtains of a certification body — a qualitative study

Johannesen

Lindøe

Wiig

2020

BMC Health Serv Res

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Background: Certification in healthcare often involves independent private sector bodies performing legally required or voluntary external assurance activities. These certification practices are embedded in international standards founded in traditional beliefs about rational and predictable processes for quality and safety improvement. Certification can affect organizational and cultural changes, support collaboration and encourage improvement that may be conducive to resilient performance. This study explores whether ISO 9001 quality management system certification can support resilience in healthcare, by looking at characteristics in the objectives, methods, and practice of certification from a certification body's perspective. Methods: One of Norway's four certification bodies in healthcare was studied, using an explorative embedded single-case design. The study relies on document analysis of the international standards and associated guidances for the performance of certification bodies and thematic analyses of data from 60 h of observations of auditors in three certification processes and nine qualitative interviews with managers and personnel from the certification body. Results from the analyses were compared to identify discrepancies between the written and perceived certification approach and practice. Results: Standards and guidances for certification embed an elasticity between formal and consistent assessments of nonconformities in organizations and emphasize holistic approaches that brings added value. Auditors were then left with the latitude to navigate their auditing strategy during interaction with the auditees. Members of the certification body perceived and practiced a holistic and flexible auditing approach using opportunities to share knowledge, empower and make guidance for improvement. Conclusions: ISO certification expects structures and systems to ensure consistent and objective certification processes. At the same time, it embodies a latitude to adopt flexible and context-specific certification approaches, as demonstrated by a certification body in this study, to give added value to the certified organizations. Such an ISO 9001 certification approach may support resilient performance in healthcare by nurturing the potential to respond and learn. These results are important for further development of methods that certification bodies use in the auditing encounter.

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Section: Certification As Support For Resilient Performancementioning

confidence: 99%

Certification as support for resilience? Behind the curtains of a certification body — a qualitative study

Johannesen

Lindøe

Wiig

2020

BMC Health Serv Res

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“…This interaction between inspection team and organization is part of the self-regulation processes, which is viewed as essential in the Norwegian regulatory system in healthcare. Self-regulatory approaches may increase the feeling of responsibility for the risk management system, providing incentives for actively being involved in quality improvement due to autonomy, enabling the organizations to pay attention to and adapt to local conditions, uncertainties and variations (Øyri and Wiig, 2019). Stakeholder inclusion in external inspection in the Norwegian system therefore promotes decentralized implementation and decision-making , provided by a centralized regulatory system level.…”

Section: Resultsmentioning

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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“…Woods [82] describes it as looking beyond behavior in compliance with standards and norms: anticipatory aspects of resilient performance involve how people anticipate risks and bottlenecks. Organizations which emphasize proactive measures, such as monitoring, will most likely have a better potential to discover and anticipate weak signals compared to those with a less proactive approach [89]. Previous research from the Dutch healthcare system revealed that despite a complicated relationship between management and regulation of healthcare, hospitals built systems that enabled a more proactive approach to quality and safety work with the potential of facilitating innovative solutions [90].…”

Section: Anticipationmentioning

confidence: 99%

“…However, we believe that it is unrealistic to expect hospitals to understand and implement legislation without preknowledge or assistance either from internal resources or from governmental bodies [89,95]. If regulations are perceived as obstacles, rather than guidance, due to time-and resource consuming regulatory compliance and implementation work, regulation can compromise the ability to be flexible [89]. To promote resilience, Grote [6] suggests designing non-rigid rules specifying the underlying goals, priorities or preferred processes.…”

Section: Anticipationmentioning

confidence: 99%

Exploring links between resilience and the macro-level development of healthcare regulation- a Norwegian case study

Øyri

Braut

Macrae³

et al. 2020

BMC Health Serv Res

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Background: The relationship between quality and safety regulation and resilience in healthcare has received little systematic scrutiny. Accordingly, this study examines the introduction of a new regulatory framework (the Quality Improvement Regulation) in Norway that aimed to focus on developing the capacity of hospitals to continually improve quality and safety. The overall aim of the study was to explore the governmental rationale and expectations in relation to the Quality Improvement Regulation, and how it could potentially influence the management of resilience in hospitals. The study applies resilience in healthcare and risk regulation as theoretical perspectives. Methods: The design is a single embedded case study, investigating the Norwegian regulatory healthcare regime. Data was collected by approaching three regulatory bodies through formal letters, asking them to provide internal and public documents, and by searching through open Internet-sources. Based on this, we conducted a document analysis, supplemented by interviews with seven strategic informants in the regulatory bodies. Results: The rationale for introducing the Quality Improvement Regulation focused on challenges associated with implementation, lack of management competencies; need to promote quality improvement as a managerial responsibility. Some informants worried that the generic regulatory design made it less helpful for managers and clinicians, others claimed a non-detailed regulation was key to make it fit all hospital-contexts. The Government expected hospital managers to obtain an overview of risks and to adapt risk management and quality improvement measures to their specific context and activities. Conclusions: Based on the rationale of making the Quality Improvement Regulation flexible to hospital context, encouraging the ability to anticipate local risks, along with expectations about the generic design as challenging for managers and clinicians, we found that the regulators did consider work as done as important when designing the Quality Improvement Regulation. These perspectives are in line with ideas of resilience. However, the Quality Improvement Regulation might be open for adaptation by the regulatees, but this may not necessarily mean that it promotes or encourages adaptive behavior in actual practice. Limited involvement of clinicians in the regulatory development process and a lack of reflexive spaces might hamper quality improvement efforts.

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Regulation and resilience at the macro-level healthcare system – a literature review

Cited by 7 publications

References 20 publications

Certification as support for resilience? Behind the curtains of a certification body — a qualitative study

Certification as support for resilience? Behind the curtains of a certification body — a qualitative study

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

Exploring links between resilience and the macro-level development of healthcare regulation- a Norwegian case study

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