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Assessing and regulating patient safety Sandra Eismann via Alex Mears. The Care Quality Commission . The Care Quality Commission is the regulator for England Created 1 st April 2009 (just over a year old) Remit covers all aspects of health (NHS and privately owned) and adult social care

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the care quality commission
The Care Quality Commission
  • The Care Quality Commission is the regulator for England
  • Created 1st April 2009 (just over a year old)
  • Remit covers all aspects of health (NHS and privately owned) and adult social care
  • Does not include medical or clinical personnel (other bodies do that)
  • Registration-based model- initial registration then ongoing monitoring of compliance
  • Information is delivered to field staff through statistical risk model into the Quality and Risk Profile (QRP), indicating risk level for a number of outcomes for each service/ provider
  • QRP used by field staff to prioritise regulatory activity
  • QRP uses information from many sources including users of services
regulation and assessment
Regulation and assessment
  • The regulation or supervision of healthcare has been present in much of Europe for many years
  • Levers for change differ:
    • Improvement of performance and quality- through setting ambitious standards and targets
    • Minimally acceptable standards- improves the poor performers but does not go further
    • Accountability for performance and value for money
  • All levers require information and judgement leading to intervention or enforcement where appropriate
patient safety
Patient safety
  • Focus for regulatory efforts
  • Core domain of quality in healthcare (with effectiveness and patient experience)
  • Requires system-wide change to effect improvement
  • Influenced by:
    • Organisational leadership
    • Clinical engagement
    • Work-place safety
    • Other influences
proposed research
Proposed research
  • Fits between existing work by Savio (very high level, principles) and Alex (at indicator level in patient safety)
  • Three sections for the proposed research
    • Summarise and compare high-level regulatory approach of EPSO members
      • Background on regulatory approaches
      • Types of regulatory intervention, based on Wouter Sparreboum’s research
      • Principles of regulation, based on Savio Toson’s survey
    • Identify and compare high-level regulatory approaches of EPSO members to patient safety
      • Unpack regulatory approaches using patient safety as a vehicle
      • Possibly use Donabedian categorisation of quality (structure, process, outcome)
      • Use of a short electronic survey, followed up by telephone interviews if necessary
    • Proposal for areas for further collaboration & development
      • Using information gained from the previous sections
proposed steps
Proposed steps
  • Engage EPSO partners
  • Collate and structure background information on regulatory approaches, fitting EPSO members into this typology
  • Develop structured questionnaire looking at regulatory approaches to patient safety, hopefully through an EPSO working group
  • Send out questionnaires, then collate and analyse responses
  • Compare and identify common approaches to patient safety
  • Agree findings via consultation
  • Identify areas for further collaboration
  • Write final report
limitations
Limitations
  • Limited to EPSO members and to healthcare
  • Partly based on existing research (albeit of high quality)
  • Information may not be available for all EPSO members
  • Focus only on top-down regulatory driver of improvement. Bottom-up approaches and other drivers are not heavily considered
outputs and first steps
Outputs and first steps
  • Outputs
    • The primary output will be a report to be presented by Sandra at the EPSO meeting in London in October 2010
    • It is also anticipated that a research paper will be written and submitted to a peer-reviewed journal
  • First steps
    • The proposal has been signed off within CQC
    • Initial discussion with EPSO board members took place in May 2010, with support forthcoming
    • Presentation to EPSO meeting in Tallinn, May 2010
    • Any members interested in being involved in the working group should contact Sandra or myself:
      • sandra.eismann@cqc.org.uk
      • alex.mears@cqc.org.uk
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