RQIA Inspection Methodology 200910

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RQIA Inspection Methodology 2009-10

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2006 Consultation

• Four new principles
• Improving care and outcomes for service users
• Provider responsibility for the quality
• Targeting resources where they are most needed
• Provision of timely, user friendly reports

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2006 Consultation

• Other issues
• Risk consequence assessment
• Inspection frequencies determined by risk
• Content and style of inspection reports
• Inclusion of reports on the website
• (RQIA, 2006, p.5)

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Consultation Outcomes

• Principles strongly supported
• Responders wanted set minimum inspection
  frequency - agreed
• Risk consequence assessment caused concern not
  implemented
• Self-evaluation seen as possible burden
  alternative tools developed
• User engagement seen as valuable but hard to
  secure new approaches
• Desire for clear report formats - piloted

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RQIA Developments since 2006

• Internal structures and processes drive
  consistency
• Further thought about target groups for reports
• Increasing focus upon user engagement
• Developments in regulatory best practice

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Best Practice Inspection Principles

• Purpose of improvement there should be an
  explicit concern to improve service inspected
• Focus on outcomes considering service delivery
  to the end users of the services rather than
  concentrating on internal management
  arrangements
• User perspective focus on the experience of
  those for whom the service is provided, as well
  as on internal management arrangements
• (Better Regulation Commission, 2003, p.34)

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Best Practice Inspection Principles

• Proportionate to risk inspectors should modify
  the extent of future inspection according to the
  quality of performance
• Self-assessment Inspectors should challenge the
  outcomes of managers self-assessments
• Impartial evidence Evidence, whether
  quantitative or qualitative, should be validated
  and credible
• (Better Regulation Commission, 2003, p.34)

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Best Practice Inspection Principles

• Value for money Inspection itself should be
  able to demonstrate it delivers benefits
  commensurate with its cost, including the cost to
  those inspected
• Continually learn assessing their own impact on
  the service providers ability to improve
  increasing effectiveness
• (Better Regulation Commission, 2003, p.34)

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Conventional Role of Regulators
Policy
Customers
Delivery
Inspection
(Office of Public Services Reform, 2003, p.30)
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Inclusive Regulation
Policy
Service Users
Delivery
Self-Assessment
Inspection
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Three Inspection Elements
1 - Information
2 - Accountability
3 - Performance

Detecting presence of good professional
practice Confirming the accuracy of
self-report Providing information about regional
service patterns Assessing policy initiative
success
Judging individual provider achievement Comparing
local provider performance Empowering citizens
and users to hold local providers to account
Using professional judgement to provide
pre-conditions for improvement Identifying
barriers to change Assessing impact of
performance on users Contributing to the process
of improvement
Assurance
Challenge
Inspiration
(Office of Public Services Reform, 2003, p.14)
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Proportional Approach

• All inspection is essentially based on sampling
  unless it is decided to have inspectors sit in
  care services 24 hours a day. Sampling for the
  purpose of judging quality is a perfectly
  respectable approach and one which has a long
  history in many fields.
• (Duncan, 2007, p.26)

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Preparing for Inspection

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Selection of Inspection Focus

• 4 or 5 Standards selected
• Criteria within Standards
• Common themes
• Recruitment
• Staffing
• Other themes vary by service

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Selection of Inspection Focus

• Prioritisation Matrix
• DHSSPS Minimum Standards
• Identified quality or risk issue
• Public concern
• Impact on population
• Issue from complaints/investigations
• Perceived inequalities

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Announced Inspection Processes

• Inspection Date Notified
• Returns about service issued
• Email issue and return strongly preferred
• Self-assessment workbook
• Excel format, guidance included
• Contact inspector if unable to use

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Announced Inspection Processes

• Self-Assessment Completion
• Provider assessment within report
• Each criterion 2000 characters
• Referring to evidence
• Opportunity to present good practice
• Provider rating of achievement levels
• Achievement levels in report

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Announced Inspection Processes

• Inspection
• Inspector also uses workbook
• Issues from previous inspections
• Previous enforcement activity
• Validating/ confirming self-assessment
• Also rating levels of achievement
• Service user comments
• Staff comments

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Announced Inspection Processes

• Report
• Sets provider and inspector comments together
  against each element of Standards
• Reflects comments made by service users
• Represents achievement levels identified by
  providers and inspector
• Summary and Maturity Matrix statement for each
  Standard
• Quality Improvement Plan

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Inspection Report
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Levels of Achievement
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Levels of Achievement
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Maturity Matrix