Department of Social Science, Western Norway University of Applied Sciences, P.O. Box 133, 6851, Sogndal, Norway.
Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway.
BMC Health Serv Res. 2020 Jul 8;20(1):627. doi: 10.1186/s12913-020-05475-0.
There is a gap in the literature regarding what takes place between the announcement of a regulatory intervention, such as an external inspection of a health care organisation, and the inspecting body's site visit. This study aimed to explore inspecting bodies' expectations of how inspected organisations should prepare before an external inspection and to elucidate how inspected health care organisations prepare before site visits.
This qualitative study was based on data from 17 group interviews with a total of 75 participants representing inspection teams, organisation leaders and clinicians in inspected health care organisations. The data were analysed using a qualitative content analysis method.
We identified two approaches to how the inspection teams expected that the inspected organisations should prepare before site visits. In the first approach the inspection teams did not expect any improvement activities to be initiated during this period and focused on identifying inadequacies that the inspected organisations should subsequently improve. In the second approach the inspection teams expected organisations to review their own practices and begin improvement activities if necessary. The inspected organisations responded in different ways to an upcoming site visit, and the organisations' leaders were important in determining which activities would be initiated. Organisations in which leaders involved clinicians in assessing care delivery tended to initiate action to improve and expected inspection teams to assess their ongoing improvement work and provide guidance on further improvements. Leaders who did not involve clinicians in assessing the quality of care tended to perceive the current quality of care as adequate on the basis of reviewing written guidelines. They did not initiate action to improve care delivery apart from updating written guidelines describing how care should be delivered, and they expected the inspection team to confirm that their current practices were in line with the guidelines and external standards.
To promote anticipatory effects in inspected organisations, inspecting bodies should stress the importance of assessing clinical practice and involving frontline clinical staff and leaders in the assessment and in improvement work before the site visit.
在监管干预措施（如对医疗保健组织进行外部检查）的宣布与检查机构现场访问之间，文献中存在空白。本研究旨在探讨检查机构对受检组织在外部检查前应如何准备的期望，并阐明受检医疗保健组织在现场访问前的准备情况。
本定性研究基于来自 17 次小组访谈的数据，共涉及 75 名参与者，代表检查团队、组织领导人和受检医疗保健组织的临床医生。使用定性内容分析方法对数据进行分析。
我们确定了检查团队期望受检组织在现场访问前应如何准备的两种方法。第一种方法是，检查团队不期望在此期间启动任何改进活动，而是侧重于发现受检组织随后应改进的不足之处。第二种方法是，检查团队期望组织审查自身实践情况，并在必要时启动改进活动。受检组织对即将进行的现场访问做出了不同的反应，组织领导在确定将启动哪些活动方面发挥了重要作用。在那些让临床医生参与评估护理提供情况的领导的组织中，往往会采取行动来改进，并期望检查团队评估其正在进行的改进工作并提供进一步改进的指导。那些没有让临床医生参与评估护理质量的领导往往会根据审查书面指南来认为当前的护理质量是足够的。他们不会主动采取行动来改进护理提供，除了更新描述护理应如何提供的书面指南外，他们期望检查团队确认他们当前的做法符合指南和外部标准。
为了在受检组织中促进预期效果，检查机构应强调在现场访问前评估临床实践的重要性，并让一线临床工作人员和领导参与评估和改进工作。
