目的:目的是从检查员的角度了解严重事件后的外部检查如何在挪威医院进行。以及利益相关者的意见是否参与了检查。
方法:基于定性混合方法设计,位于挪威国家卫生监督委员会的10名政府官员和检查员以及三名州长,被战略性地招募,并进行了个人半结构化访谈。政府主要官方文件被选中,收集,并与采访数据一起进行主题分析。
结果:我们的研究结果总体上展示了两个总体主题:主题(1)对不同外部检查方法的看法,即在严重事件后响应并使利益相关者参与外部检查,主题(2)检查员内部工作实践与外部期望。文件和所有与会者都报告了外部检查新方法的发展,随着更多的政策和监管关注利益相关者的明智参与。与患者和非正式护理人员的参与和互动可能会潜在地告知案件的复杂性和检查员的决策过程。然而,利益相关者的参与有时是复杂和具有挑战性的,因为例如,与患者和/或非正式护理人员难以沟通和互动,由于资源需求和/或检查员缺乏经验和/或相关能力,对健全专业实践原则的不同看法,质量,和安全。视察员考虑平衡正式目标和期望,随着公众和不同利益相关者的期望(即医院,患者和/或非正式护理人员)工作中具有挑战性的部分。这种平衡被视为确保外部检查过程中公众信任和合法性的持续发展的重要组成部分。
结论:我们的研究表明,在挪威环境中,外部检查的监管系统及其应对严重事故的可用方法目前尚未设计为适应利益相关者的复杂性需求。医院组织的级别,病人,和非正式的护理人员。进一步的研究应直接关注更广泛的问责制结构系统如何支持监管系统的内部工作实践,更好地实现其正式目标与公众的期望。
OBJECTIVE: The objective was to gain knowledge about how external inspections following serious incidents are played out in a Norwegian hospital context from the perspective of the inspectors, and whether stakeholders\' views are involved in the inspection.
METHODS: Based on a qualitative mixed methods design, 10 government bureaucrats and inspectors situated at the National Board of Health Supervision and three County Governors in Norway, were strategically recruited, and individual semi-structured interviews were conducted. Key official government documents were selected, collected, and thematically analyzed along with the interview data.
RESULTS: Our findings overall demonstrate two overarching themes: Theme (1) Perspectives on different external inspection approaches of responding and involving stakeholders in external inspection following serious incidents, Theme (2) Inspectors\' internal work practices versus external expectations. Documents and all participants reported a development towards new approaches in external inspection, with more policies and regulatory attention to sensible involvement of stakeholders. Involvement and interaction with patients and informal caregivers could potentially inform the case complexity and the inspector\'s decision-making process. However, stakeholder involvement was sometimes complex and challenging due to e.g., difficult communication and interaction with patients and/or informal caregivers, due to resource demands and/or the inspector\'s lack of experience and/or relevant competence, different perceptions of the principle of sound professional practice, quality, and safety. The inspectors considered balancing the formal objectives and expectations, with the expectations of the public and different stakeholders (i.e. hospitals, patients and/or informal caregivers) a challenging part of their job. This balance was seen as an important part of the continuous development of ensuring public trust and legitimacy in external inspection processes.
CONCLUSIONS: Our study suggests that the regulatory system of external inspection and its available approaches of responding to a serious incident in the Norwegian setting is currently not designed to accommodate the complexity of needs from stakeholders at the levels of hospital organizations, patients, and informal caregivers altogether. Further studies should direct attention to how the wider system of accountability structures may support the internal work practices in the regulatory system, to better algin its formal objectives with expectations of the public.