Assessing and regulating patient safety Sandra Eismann via Alex Mears

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 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 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 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 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 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 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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