Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis
Objectives External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to exte...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/8/e038850.full |
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| author | Jan C Frich Kieran Walshe Signe Flottorp Einar Hovlid Geir Sverre Braut Einar Hannisdal Oddbjørn Bukve Per Stensland |
| author_facet | Jan C Frich Kieran Walshe Signe Flottorp Einar Hovlid Geir Sverre Braut Einar Hannisdal Oddbjørn Bukve Per Stensland |
| author_sort | Jan C Frich |
| collection | DOAJ |
| description | Objectives External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections.Methods We performed a literature search (1980–January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change.Results We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation’s current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance.Conclusions External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients. |
| format | Article |
| id | doaj-art-fcedba521fca4738b2d4ebf5668def32 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-fcedba521fca4738b2d4ebf5668def322024-12-03T07:35:12ZengBMJ Publishing GroupBMJ Open2044-60552020-08-0110810.1136/bmjopen-2020-038850Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesisJan C Frich0Kieran Walshe1Signe Flottorp2Einar Hovlid3Geir Sverre Braut4Einar Hannisdal5Oddbjørn Bukve6Per Stensland7Diakonhjemmet Hospital, Oslo, Norwayprofessor of health policy and management17 Centre for Epidemic Interventions Research, Division for Health Services, Norwegian Institute of Public Health, Oslo, NorwayDepartment of Social Science, Western Norway University of Applied Sciences, Sogndal, NorwayDepartment of Research, Stavanger University Hospital, Stavanger, NorwayDepartment of health, County Governor in Oslo and Akershus, Oslo, NorwayInstitute of Social Science, Western Norway University of Applied Sciences, Sogndal, NorwayDepartment of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, NorwayObjectives External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections.Methods We performed a literature search (1980–January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change.Results We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation’s current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance.Conclusions External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.https://bmjopen.bmj.com/content/10/8/e038850.full |
| spellingShingle | Jan C Frich Kieran Walshe Signe Flottorp Einar Hovlid Geir Sverre Braut Einar Hannisdal Oddbjørn Bukve Per Stensland Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis BMJ Open |
| title | Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis |
| title_full | Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis |
| title_fullStr | Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis |
| title_full_unstemmed | Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis |
| title_short | Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis |
| title_sort | mediators of change in healthcare organisations subject to external assessment a systematic review with narrative synthesis |
| url | https://bmjopen.bmj.com/content/10/8/e038850.full |
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