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