Strategy and practise of external inspection in healthcare services – a Norwegian comparative case study

Schaefer, Charlotta; Wiig, Siri

doi:10.1186/s40886-017-0054-9

Cited by 14 publications

(18 citation statements)

References 28 publications

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“…Such challenges include but may not be limited to social, cultural, organization, and contextual ones [3]. In many healthcare settings, inspection is done by external personnel who make sure that laws and standards are adhered to by practitioners [4]. In public health care settings, inspection is offered in an orderly and well-structured manner with clear audit-and-feedback channels which have proved to complement training leading to desired treatment outcomes [5].…”

Section: Introductionmentioning

confidence: 99%

Regulatory inspection of registered private drug shops in East-Central Uganda—what it is versus what it should be: a qualitative study

Bagonza

Peterson

Mårtensson

et al. 2020

J of Pharm Policy and Pract

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Background Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers. Methods Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done. Results Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection. Conclusion The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.

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Section: Introductionmentioning

confidence: 99%

Regulatory inspection of registered private drug shops in East-Central Uganda—what it is versus what it should be: a qualitative study

Bagonza

Peterson

Mårtensson

et al. 2020

J of Pharm Policy and Pract

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“…However, the traditional focus in research on quality and safety in healthcare has been on work done at the sharp-end, and less research effort has examined the detailed relationship between regulatory activities and quality and safety improvement [23][24][25][26][27][28][29]. Likewise, there has been limited macro-level research exploring how regulatory activities at a national level relate to resilience in healthcare.…”

Section: Introductionmentioning

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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“…External inspection can thus be seen as a way of boosting the internal quality and patient safety improvement work. 4 Strength and limitations of this study ► Focus group interviews in hospitals that had achieved improvement in key clinical procedures following an inspection provided information-rich cases of how inspections can contribute to quality improvement. ► The interviews elicited new insights into how inspections can enhance understanding of the clinical system and promote leadership in quality improvement efforts.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Strategy and practise of external inspection in healthcare services – a Norwegian comparative case study

Cited by 14 publications

References 28 publications

Regulatory inspection of registered private drug shops in East-Central Uganda—what it is versus what it should be: a qualitative study

Regulatory inspection of registered private drug shops in East-Central Uganda—what it is versus what it should be: a qualitative study

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

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

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