European Supervisory Bodies and Patient Safety Presented by Sandra Eismann (CQC)

2 Research proposal Objective: The study aims to identify and compare the overall approach European health regulators take in regulating and assessing patient safety; and to identify further areas for collaborations between EPSO (European Partnership for Supervisory Organizations in Health Services and Social Care) members.

3 EPSO working group Jan Vesseur/ Dutch Health Care Inspectorate Geir Sverre Braut/ Norwegian Board of Health Supervision Vaida Momkuviene/ Lithuanian State Medical Audit Inspectorate Katja Peters/ Academy of Public Health in Düsseldorf Sandra Eismann/ Care Quality Commission England

4 Responses from 15 countries/regions Norway Netherlands Belgium France Lithuania Northern Ireland England Scotland Slovenia Estonia Ireland Denmark Germany Finland Sweden

5 Findings Divided into 3 sections: Patient safety initiatives in hospitals in different countries The approach EPSO members take when supervising hospitals in relation to patient safety; and The approach EPSO members take when supervising infection control.

6 Patient safety initiatives in hospitals Patient safety programmes aiming explicitly to reduce adverse events or mortality rates: For example, the Scottish Patient Safety Programme aims to reduce adverse events by 30% and mortality rates by 15%. The NHS Quality Improvement Scotland is leading and co- ordinating this programme.

7 Wider quality management programmes, including patient safety For example, in Norway, a nationwide campaign on patient safety was launched in autumn 2010 and is set to run through The campaign is co-ordinated by Norwegian Knowledge Centre for Health Services and focuses on acute as well as primary health services. The campaign focuses on safe practices at the intersection between patients and services. Norwegian Board of Health Supervision has no direct role in the campaign, but will implement some initiatives in their regular supervisory activity co- ordinated with issues promoted through the campaign. Patient safety initiatives in hospitals

8 Individual complaints or concerns For example, in Denmark, the National Board of Health receives information from the ombudsman and, if appropriate, undertakes disciplinary action against individual professionals. Project on patient safety For example. in Finland, VALVIRA issues guidance for health services on the importance of patient record keeping. Its senior officers also provide lectures in healthcare organisations. Patient safety initiatives in hospitals

9 Area of Patient safety supervised Area of patient safetyNo of supervisory bodies focusing on this area Infection control14 Work force (staff levels and/or qualifications)13 Medicine Management12 Safety and suitability of premises10 Reporting of adverse events (to an external national body) 10 Clinical audits (i.e. inter-hospital comparisons of clinical activity and/or outcomes) 9

10 What next? A further piece of research could focus on how supervisory bodies use these reporting systems, including: Are supervisory bodies pro-active or reactive when following up on incidents? If pro-active, which approach do they take? Do they use a risk assessment to decide which incidents to follow up? Do supervisory bodies review the implementation of patient safety alerts? The Northern Ireland RQIA has undertaken a review which has considered the implementation of some NPSA safety alerts. Further research could expand this review.

11 More depths work into how supervisory bodies approach patient safety more widely, or hygiene control more specifically. A case study could be undertaken to compare the Scottish and Dutch patient safety programmes, highlighting their features and identifying any early findings on what is and is not working well. Work has been undertaken already to share the approach the UK and Ireland take in regards to hygiene and inspection control, further work could be undertaken to systematically analyse different approaches taken across Europe. What next?