The effect of external inspections on safety in acute hospitals in the National Health Service in England: A controlled interrupted time-series analysis

Abstract

Objectives To evaluate the effect of Care Quality Commission external inspections of acute trusts on adverse event rates in the English National Health Service. Methods Interrupted time-series analysis including all acute NHS trusts in England ( n = 155) using two control groups (new versus historical inspection regime and trusts not inspected). Multilevel random-coefficient modelling of (1) rates of falls with harm and (2) pressure ulcers, from April 2012 to June 2016, was undertaken using the new, resource-intensive regime of Care Quality Commission inspections as an intervention. Data used in the model included dates and type of inspection, patient safety indicators, demographic characteristics and financial risk of hospitals. Results In one year, Care Quality Commission inspected 66 acute trusts (42% of all English trusts) using their new regime and 46 (30%) using their previous one. Prior to inspections being announced, rates of falls with harm and pressure ulcers were improving in both intervention and control hospitals. The announcement of an inspection did not affect either indicator. After inspections, rates of falls with harm improved more slowly, and pressure ulcer rates no longer improved for trusts inspected using both regimes. Conclusions Neither form of external inspection was associated with positive, clinically significant effects on adverse event rates. Any improvement happening before the announced Care Quality Commission inspections slowed after the inspection.

Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis

“…32 35 49 61 66 76 96 105Problem areas identified during inspections can receive increased attention by the inspected organisation. 8 41 42 51 56 77 95Qualitative studies indicate that feedback from the inspection can be used to define improvement goals for the inspected organisation. 56 66 80 103 Organizational incentives and rewards Survey data suggest that internal recognition and rewards were associated with perceived quality results in accreditation.…”

“…5 Evidence on the effect of external inspections on the quality of care remains unclear and contradictory. [6][7][8][9][10] The way in which external inspections might mediate change in organisations is poorly understood. 11 12 Better knowledge of how external inspections can contribute to improve quality of care may increase our understanding of why the effects of external inspections seem to vary and facilitate more effective ways of conducting inspections.…”

The measurement and improvement of maternity service performance through inspection and rating: An observational study of maternity services in acute hospitals in England

“…Healthcare regulation, often using some form of inspection of healthcare providers and the subsequent publication of reports and inspection ratings or outcomes, is widely used in many countries with the twin aims of quality improvement and quality assurance [ 1 ]. However, evidence on effectiveness of regulation is quite limited, and inspections are quite resource-intensive interventions [ [2] , [3] , [4] , [5] , [6] , [7] ]. Regulators often seek to use routine data from healthcare providers to produce performance indicators which can then be used to target or focus the use of inspection (for example, helping to decide which providers to inspect, when to undertake inspections, or what aspects of care should be assessed during inspection).…”

“…Each service receives a rating on a four-point scale (Outstanding, Good, Requires Improvement or Inadequate) on five domains (Effectiveness, Safety, Care, Responsiveness and Leadership) plus an Overall rating. Recent research has examined the CQC inspection process and its impact [ 6 , [9] , [10] , [11] , [12] , [13] , [14] ].…”

Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation

“…Three other studies that used time-series design and a before-and-after design also did not find improvement in performance indicators of care delivery that could be attributed to external assessments. [14][15][16] Considering the widespread and growing use of external assessments and the resources spent on conducting and participating in them, there is a need for high-quality studies evaluating their effectiveness on quality of care. 10 The overall aim of this study is to evaluate the effect of statutory inspections at the patient level by assessing detection and treatment of sepsis in emergency departments in Norwegian hospitals.…”