CHI's methods for inspecting trusts are flawed, says King's Fund
http://www.100md.com
《英国医生杂志》
The methods of the Commission for Health Improvement (CHI) for inspecting trusts has "significant weaknesses," says a report for the King抯 Fund, an independent health think tank.
"The authors question the process by which a rag bag of reflections (including variable attempts to capture the patient experience) are converted to global and quantified assessments," the report says.
The three year study concentrated on CHI抯 reviews of acute trusts. Its aim was to use CHI抯 experiences to look at the problems of inspection in the NHS. The researchers did this by analysing reports produced by the commission, sitting in board meetings, and interviewing a range of people, including policy makers, inspectors, CHI staff, and representatives of the trusts inspected.
The report goes on to say, "Like other inspectorates, CHI has had difficulty ensuring consistency between review teams. reports are only consistent in being inconsistent. They vary in the issues identified, in the way the evidence is presented and in the analysis梠r lack of analysis梠f data." The report admits that many of the problems with methodology are largely due to CHI having to work within the "straitjacket" of clinical governance set by the Department of Health.
CHI was launched in November 1999 to monitor quality in the NHS. From April 2004 it will cease to exist and will be superseded by the Commission for Healthcare Audit and Inspection, which will not only take on the responsibilities of CHI but will also engulf the National Care Standards Commission and the Audit Commission.
Even at CHI抯 inception there were tensions, says the report, which states that the government saw it as an inspectorate akin to the Office for Standards in Education (Ofsted), the inspectorial body for schools. CHI, however had differing view of itself, the report says, insisting that its role was to help trusts improve, not to "name and shame." Throughout the years the relationship between the Department of Health and CHI was one of "mutual exasperation, with occasional sparks of outright hostility," says the report.
Although largely critical, the report acknowledges the tremendous task CHI had achieved during its short life span. Not only had it built itself up from scratch with an initial budget of ￡1.5m ($2.8m; �2.2m) to an organisation with a budget of nearly ￡33m in 2003, it had also successfully achieved the overall target that the health department had set for it: a complete inspection of all trusts within four years.
CHI had also made inspection more palatable to NHS managers and professionals alike, after overcoming their initial suspicions, says the report.
Commenting on the report, Anna Walker, chief executive of the Commission for Healthcare Audit and Inspection (CHAI), said: "The report by Patricia Day and Rudolph Klein shows the tremendous amount of work that CHI did in a very short period of time and makes clear some important issues which CHAI will need to learn from. CHAI will have the statutory powers to tackle more effectively some of the issues identified in the report such as patient focus, co-ordination of inspection and the difficulties involved in assessing quality solely by looking at systems and processes."(London Debashis Singh)
"The authors question the process by which a rag bag of reflections (including variable attempts to capture the patient experience) are converted to global and quantified assessments," the report says.
The three year study concentrated on CHI抯 reviews of acute trusts. Its aim was to use CHI抯 experiences to look at the problems of inspection in the NHS. The researchers did this by analysing reports produced by the commission, sitting in board meetings, and interviewing a range of people, including policy makers, inspectors, CHI staff, and representatives of the trusts inspected.
The report goes on to say, "Like other inspectorates, CHI has had difficulty ensuring consistency between review teams. reports are only consistent in being inconsistent. They vary in the issues identified, in the way the evidence is presented and in the analysis梠r lack of analysis梠f data." The report admits that many of the problems with methodology are largely due to CHI having to work within the "straitjacket" of clinical governance set by the Department of Health.
CHI was launched in November 1999 to monitor quality in the NHS. From April 2004 it will cease to exist and will be superseded by the Commission for Healthcare Audit and Inspection, which will not only take on the responsibilities of CHI but will also engulf the National Care Standards Commission and the Audit Commission.
Even at CHI抯 inception there were tensions, says the report, which states that the government saw it as an inspectorate akin to the Office for Standards in Education (Ofsted), the inspectorial body for schools. CHI, however had differing view of itself, the report says, insisting that its role was to help trusts improve, not to "name and shame." Throughout the years the relationship between the Department of Health and CHI was one of "mutual exasperation, with occasional sparks of outright hostility," says the report.
Although largely critical, the report acknowledges the tremendous task CHI had achieved during its short life span. Not only had it built itself up from scratch with an initial budget of ￡1.5m ($2.8m; �2.2m) to an organisation with a budget of nearly ￡33m in 2003, it had also successfully achieved the overall target that the health department had set for it: a complete inspection of all trusts within four years.
CHI had also made inspection more palatable to NHS managers and professionals alike, after overcoming their initial suspicions, says the report.
Commenting on the report, Anna Walker, chief executive of the Commission for Healthcare Audit and Inspection (CHAI), said: "The report by Patricia Day and Rudolph Klein shows the tremendous amount of work that CHI did in a very short period of time and makes clear some important issues which CHAI will need to learn from. CHAI will have the statutory powers to tackle more effectively some of the issues identified in the report such as patient focus, co-ordination of inspection and the difficulties involved in assessing quality solely by looking at systems and processes."(London Debashis Singh)