Health Care Inspectorate:role and position
EPSO conference,Utrecht, 11 – 12 October 2012
Jan Vesseur, Chiefinspector Dutch Health Care Inspectorate
Content
1. Public values
2. Quality of care
3. Model for inspection
4. Important issues
5. Questions and discussion
Public values
• Why an inspectorate?To uphold and to promote compliance with (useful) laws and regulationsTo secure public values
• The population must benefitThe citizen is the “client”
• The inspectorate should be part of the solution (good governance)
• ……….not part of the problemUpholding useless regulations making life miserable for the population, or just extracting fines or being corrupt
Public values in health care
• What does everybody wants?• Everybody wants health care that is:
Affordable and accessibleSafe and of good quality
• Inspectorate should focus on safety and good qualityUnique “selling point”
• Focus on safety and good quality also applies to medicines, medical devices, food and the environment.
Safety and quality in health care• Quality of care as defined by Institute of Medicine
Six aspects:SafeEffectivePatient focusedAccessible EquitableEfficient
• Good care is care that is safe, effective, patient focused, timely, equal for all and efficient
• Safety is a priority:Infection controlSafe surgical proceduresProper transfusion procedures
Core business of inspectorate of health care
• Promoting and enforcing compliance with, laws, regulations and professional standards in health care with regard to safety and quality should be the core business of inspectorate of health care
• Health care inspectorate promotes, monitors and enforces good quality of care
• Safe care and care of good quality care serves the population:Important public valuePart of common good
• This is what citizens expect and why they are prepared to pay for the inspectorate with their own money (tax money)
• It is an important part of keeping confidence in the public system
Positioning
There are more organisations and instruments in health care with a role in promoting and enforcing good quality and safety of care
Professional quality systemsAccreditation and/or certification of health care providersGood governanceRegulation by market mechanisms (patient/ client, insurance companies)
Health care inspectorate is complementary to the other organisations and instruments
Model
• To prioritize the activities of the inspectorate• The clarify the role of and the relation with other stakeholders• To make clear what you will do and what not
Government (national. local)
Input Throughput Output
National (professional) organizations
Inspectorate promoting health
Inspectorate of health care
Finaloutcome
Outcome
Citizens
Media
Inspectorate promoting health
Government (national. local)
Input Throughput Output
Koepels, branches,wetenschappelijkeverenigingen
Inspectorate of health care
Finaloutcome
Outcome
Citizens
Media
National (professional) organizations
Final outcome = final (beneficial) effect on public health, resulting from the work of the inspectorate
•What do we want to promote?As little as possible death, disease, handicaps and damagePatient satisfactionGood quality of life
•Final outcome must be beginning of all work planning In the model: from right to left
•Many actors have influence on public health
•Inspectorate of health care is one of these actors (blue area) and should be accountable for it
DeathDiseaseDisabilityDiscomfortDissatisfaction
Finaloutcome
Measurable on health of patient
Government (national. local)
Input Throughput Output
Koepels, branches,wetenschappelijkeverenigingen
Inspectorate promoting health
Inspectorate of health care
Finaloutcome
Outcome
Citizens
Media
National (professional) organizations
Outcome = effect of inspectorate on compliance of rules, regulations and professional guidelines in health care
•The mission of the inspectorate should be maximizing compliance with primary focus on safety•Promote maximum level of compliance is core business of inspectorate of health care•Inspectorate should be accountable for
High level of complianceStimulating guidelines for good practiseStimulating best practise
•Other actors also influence compliance
Outcome
6 dimensions of qualty:
-Patiënt focused
-Safety-Effectiviness-Timelinesss-Equity
-Efficiency
Measurable on hospitals, doctors, pharmacies etc.
Government (national. local)
Input Throughput Output
Koepels, branches,wetenschappelijkeverenigingen
Inspectorate promoting health
Inspectorate of health care
Finaloutcome
Outcome
Citizens
Media
National (professional) organizations
Output = products of inspectorate
Output
• Reports
• Advices
• Measures
• Recommendations
• Fines
• Licenses
• Etc.
Government (national. local)
Measurable on inspectorate
Citizens
Media
National (professional) organizations
Government
(national. local)
InputOutput
Koepels, branches,wetenschappelijkeverenigingen
Inspectorate promoting health
Inspectorate of health care
Finaloutcome
Outcome
Measurable on health of patient
Measurable on hospitals, doctors, pharmacies etc.
Measurable on inspectorate
Citizens
Media
National (professional) organizations
Throughput
Stakeholders
Patients
Department of Health
Professionals and their umbrella organisations
Institutions/providers and their umbrella organisations
Insurers (?)
Knowledge centers, universities, etc.
Media
Important issues
IndependenceRelation with the citizenThe balance between compliance and deterrenceTrustRestraint in standardizationRisk-based inspectionsReduction of regulatory burdenEvidence based supervision
Independence
Independence is not the same as autonomous
Independent judgment!
Independent with respect to• MoH• Politics• DoH• Professionals and Institutions• Citizens• Media
Relation with the citizen
Complaints handling
Procedural justification• Honest and correct judgment• Correct procedures• Friendly and respectful treatment
Contact with patients at inspections• Patients as experts• Social media
The balance between compliance and deterrence
Stick and/or carrot
Difference between the style of the inspectorate and the inspector
Responsive regulation
Trust
Control okee, but distrust?
Trust in those who are subject to supervision1. Follows regulation2. Calculates3. Context-sensitives
‘High trust, high penalty’
Trust of the citizen in health care of good quality and safety
Restraint in standardization
Formal regulation (laws)Professional norms / ‘field’ norms
Standard norms versus target norms
Norms for….Citizen: choise informationProfessionals: push to improvementInspectorate: supervisionInsurers: purchase policy
Risk-based inspections
Use of indicators
Risk-analysis for prioritizing• Important health care problem?• Risky care?• Is it to inspect?• Is it enforceable?• Is the inspectorate the only to handle the problem?
Reduction of regulatory burden
Co-operation between inspectorates
(Re-)use of data of other parties
Role of politics and media more regulation
Quality of questions, indicators, etc. Relevance of inspections.
Evidence based supervision
Distance between the practice of inspections and the scientific knowledge about inspections
The use of instruments and methods that fits with the problem that has to be solved
Co-operation between inspectorates and universities
Thank you for your attention!
Questions and discussion