Health Care Inspectorate role and position EPSO conference

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 regulations To secure public values The population must benefit The citizen is the “client” The inspectorate should be part of the solution (good governance) ………. not part of the problem Upholding 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 accessible Safe and of good quality Inspectorate should focus on safety and good quality Unique “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: Safe Effective Patient focused Accessible Equitable Efficient Good care is care that is safe, effective, patient focused, timely, equal for all and efficient Safety is a priority: Infection control Safe surgical procedures Proper 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 value Part 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 systems Accreditation and/or certification of health care providers Good governance Regulation 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

Inspectorate promoting health Final outcome Government (national. local) Outcome Citizens Input Throughput Output Inspectorate of health care National (professional) organizations Media

Inspectorate promoting health Government (national. local) Outcome Citizens Input Throughput Output Media Inspectorate of health care Koepels, branches, National wetenschappelijke (professional) verenigingen organizations Final outcome

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 damage Patient satisfaction Good 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 Measurable on health of patient Final outcome Death Disease Disability Discomfort Dissatisfaction

Inspectorate promoting health Government (national. local) Outcome Citizens Input Throughput Inspectorate of health care Output Media Koepels, branches, National wetenschappelijke (professional) verenigingen organizations Final outcome

Outcome = effect of inspectorate on compliance of rules, regulations and professional guidelines in health care Measurable on hospitals, doctors, pharmacies etc. Outcome • 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 compliance Stimulating guidelines for good practise Stimulating best practise • Other actors also influence compliance 6 dimensions of qualty: -Patiënt focused -Safety -Effectiviness -Timelinesss -Equity -Efficiency

Inspectorate promoting health Government (national. local) Outcome Citizens Input Throughput Inspectorate of health care Output Media Koepels, branches, National wetenschappelijke (professional) verenigingen organizations Final outcome

Output = products of inspectorate • Reports Measurable on inspectorate Government (national. local) • Advices Citizens • Measures • Recommendations Output • Fines • Licenses Media • Etc. National (professional) organizations

Inspectorate promoting health Measurable on inspectorate Measurable on hospitals, doctors, pharmacies etc. Final outcome Government (national. local) Outcome Citizens Input Throughput Measurable on health of patient Output Media Inspectorate of health care Koepels, branches, National wetenschappelijke (professional) verenigingen organizations

Stakeholders Patients Department of Health Professionals and their umbrella organisations Institutions/providers and their umbrella organisations Insurers (? ) Knowledge centers, universities, etc. Media

Important issues Independence Relation with the citizen The balance between compliance and deterrence Trust Restraint in standardization Risk-based inspections Reduction of regulatory burden Evidence based supervision

Independence is not the same as autonomous Independent judgment! Independent with respect to • Mo. H • Politics • Do. H • 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 supervision 1. Follows regulation 2. Calculates 3. 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: Professionals: Inspectorate: Insurers: choise information push to improvement supervision 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