HIQA ’s monitoring approach against the National Standards for Safer Better Healthcare

Earlier this year, the Health Information and Quality Authority (HIQA) commenced a new monitoring and inspection programme in all public acute hospitals and rehabilitation and community inpatient healthcare services in Ireland. Read on to find out everything you need to know.

Background

Since the National Standards for Safer Better Healthcare were published in 2012, HIQA has strived to drive improvements in the quality and safety of healthcare services in Ireland through its role in monitoring public hospitals. In the last number of years, HIQA has focussed its monitoring role on thematic programmes of inspection, such as the assessment of medication safety practices, infection prevention and control, nutrition and hydration, and maternity services

Over the last number of years, the focus on compliance with national standards, combined with increased investment and dedicated resourcing by the HSE in enacting better, more effective systems of oversight of performance in services — such as ongoing surveillance and audit — has contributed to improved quality and safety of healthcare services. HIQA had seen notable improvements in services in the areas of infection prevention and control and medication safety. For example, in infection prevention and control there have been improvements in governance and leadership structures at hospital and national level, strengthened coordination of infection prevention and control at national HSE level, aided by the Antimicrobial Resistance and Infection Control (AMRIC) team and increases in numbers of specialised staff to implement antimicrobial stewardship, infection prevention and control and medication safety measures.

Rationale for change

Despite improvements in certain areas, healthcare services have faced numerous challenges in the past few years, most notably COVID-19, the cyberattack and capacity issues. These have all had a lasting impact on the health service, and major efforts are required to enable services to fully recover. HIQA recognised the need to develop and commence a new monitoring programme as services adapt to the changing healthcare landscape, while also establishing a proactive and responsive regulatory role.

The experience and learning gathered from the thematic inspections conducted over the years has informed the revised consolidated approach which aims to evaluate if care is person centred, safe and effective in public acute and community healthcare services.

The programme focuses on key known areas of harm, governance of services and the voices of patients, while also being adaptable to any healthcare setting and can be applied to all potential services HIQA will monitor in future as our role expands.

Revised monitoring approach

A new programme of inspection against the National Standards for Safer Better Healthcare was launched in April 2022. HIQA published a Guide to the Assessment Judgment Framework for monitoring healthcare services against the National Standards for Safer Better Healthcare and a short monitoring guidance which explained the new approach.

Almost 300 staff from public acute and community healthcare settings attended a webinar outlining the new programme.

As part of the initial phase of monitoring, HIQA’s core assessment includes assessment of 11 standards relating to:

• Governance, leadership and management,

• Support of workforce,

• Person-centred care,

• Effective care

• Safe care (protecting patients from harm), with a particular focus on four key risk areas

o Infection prevention and control

o Medication safety

o Transitions of care (into the hospital, within the hospital and discharges out of the service)

o Assessment of the deteriorating patient, including use of early warning scores and assessment of sepsis.

The inspection approach will also ensure that the voices of patients and staff are considered in evaluating the safety and culture of our healthcare services. This will incorporate a ‘floor-to-board approach’, which means that inspectors will focus on everyday practice and the experiences of people using the healthcare service, and less time speaking with managers of the services.

In order to make judgments about compliance, inspectors will:

• communicate with people who use the service, whenever it is appropriate, to find out about their views and experience of the service

• observe practice to see if it reflects what is outlined in relevant documents such as national guidelines and local policies

• review documents to see if appropriate records are being kept which reflect practice and what people have stated

• speak with staff and management to find out how they plan, deliver and evaluate care and services. These conversations may concentrate on:

o the structures and processes in place

o how care is delivered and how outcomes are measured and monitored

o other aspects of their role, such as their experience and training.

Looking forward

As we continue to navigate the very difficult times facing the healthcare sector, adapting our monitoring approach will help ensure that healthcare professionals are supported by hospital management to deliver safe effective healthcare for everyone who uses the service.

Ongoing challenges such as increased waiting lists, emergency department overcrowding and the continuing consequences associated with the COVID-19 pandemic have undoubtedly created a difficult environment for clinicians, nurses and health and social care professionals to further progress clinical and alternate pathways to address the pressures on the health system. As regulator in this area, HIQA is keen to utilise the learning from our previous monitoring programmes to build on systems already implemented and drive quality improvement. The vast learning and coordinated systemic application of best practice that has been gleaned throughout the COVID-19 pandemic will become all the more important in preparation for the winter season and beyond.

As we hopefully move out of the acute phase of the COVID-19 pandemic, designated resourcing and applied learning will hopefully maintain focus on the full implementation of effective infection prevention and control practice and other supports in relation to the key known areas of harm.

This new monitoring programme places emphasis on a forward-facing approach to monitoring which aims to drive quality improvement while also continuing to respond to concerns as they arise. It aims to enable a proactive, consistent and effective approach to monitoring of compliance.

The first inspection reports under the new monitoring programme have been published and are available on www.hiqa.ie.

Written by John Tuffy, HIQA’s Health of Healthcare

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