How to evaluate effects of inspections on the quality of care? Project manager Einar Hovlid Foredrag av Statens helsetilsyn

Foredrag av Statens helsetilsyn Background We need more knowledge about what effect inspections have on the quality of care Den engelske “riksrevisjonen” har nyleg evaluerte det “engelske helsetilsynet “ og I konklusjonen blir det framhev at ei sentral utfordring er å vise kva effekt tilsynet faktisk har: “The Commission has made substantial progress in the face of sustained criticism, and is developing a more intelligence-driven approach to regulation. Further challenges lie ahead for the Commission to demonstrate, in practice, effectiveness and value for money.  It now needs to build an organisational culture that gives its people the confidence, as well as the skills, to apply the regulatory model assertively, fairly and consistently.” Amyas Morse, head of the National Audit Office, 22 July 2015 http://www.nao.org.uk/report/capacity-and-capability-to-regulate-the-quality-and-safety-of-health-and-adult-social-care/ Foredrag av Statens helsetilsyn

Foredrag av Statens helsetilsyn http://www.biomedcentral.com/1472-6963/15/405 Foredrag av Statens helsetilsyn

General challanges when doing research on inspections We need to do studies with experiemental design Control group What should we use as effect meassures How do we obtain relevant data Research ethics – inspections are mandatory Tilsyn er ikkje friviljug Det vil vere uråd å få til ei kontorlgruppe der det er «ingen» intervensjon fordi eit landsomfattade tilsyn alltid vil ha ein generell effekt. Foredrag av Statens helsetilsyn

Foredrag av Statens helsetilsyn Sepsis The Norwegian Board of Health Supervision plans to conduct nationwide inspections on sepsis identification and treatment during 2016 Can be suitable for evaluating effects on quality of care The inspection adresses know risk factors Effect meassures – change in: Process indicators Result indicators Foredrag av Statens helsetilsyn

Challanges in sepsis project Design RCT Step wedge Complexity - many participants and stakeholders The Board 18 county governors 6 regional inspection teams About 40 hospitals We have 6 regional inspection teams. A cluster randomization within these groups can produce uneven groups, particularly with regard to size. RTC will come into conflicte with the fact that the insepcted organizations are choosen based on information about riks How do we collect data in the contorl group, collecting data will be an intervention and these data might be necesary to react on Foredrag av Statens helsetilsyn

Foredrag av Statens helsetilsyn Viktige moment: Spreie intervensjonen utover ei lengre tidsperiode. Overlapp mellom før og ettermåling Tilfelig rekkefølge av intervensjon 3 målingar Foredrag av Statens helsetilsyn