Assessing and regulating patient safety Sandra Eismann via Alex Mears

1. Assessing and regulating patient safetySandra Eismann via Alex Mears

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Lopp. Tänan teid!