Abstract
Background: The delivery of high quality health and social care services is a fundamental goal for health systems worldwide. Identifying the determinants of quality is a complex task as there are a myriad of variables to choose from. Researchers in this field have assessed a range of organisational and environmental factors (for example: staff composition, facility ownership, facility size) for an association with various quality metrics. Less attention has been paid to the determinants of compliance with quality regulation. Identifying the determinants of compliance has the potential to improve regulatory processes and can inform quality improvement initiatives undertaken by service providers and policy makers. This protocol describes a systematic review which will review literature from a wide range of study designs and sources to develop an overview of the determinants of regulatory compliance in health and social care services. Methods: A wide range of study designs and grey literature will be sought for this review. Searches will be conducted using PubMed, MEDLINE, PsycInfo, SocINDEX and CINAHL databases. The studies included in the review will be subject to quality appraisal with reference to the collection of tools available from the Joanna Briggs Institute. Data extraction will be informed by the Consolidated Framework for Implementation Research (CFIR). A narrative synthesis will be conducted on the barriers, facilitators and factors associated with compliance, with reference to the concepts mapped onto the CFIR. GRADE-CERQual will be used to grade the overall body of evidence. Conclusion: The findings of this review will be useful to regulators to inform regulatory policy and practice. Service providers and policy makers may also use the findings to inform quality improvement initiatives aimed at improving compliance and quality across a range of health and social care services.
Highlights
The delivery of high quality health and social care services is a fundamental goal for health systems worldwide
The Consolidated Framework for Implementation Research (CFIR) may be applied to regulation by mapping any barriers, facilitators or factors associated with levels of compliance
The methodological approach allows for a comprehensive exploration of what factors are associated with the successful integration of regulatory requirements with an organisation’s goals
Summary
Any reports and responses or comments on the article can be found at the end of the article. The Care Quality Commission (CQC), regulator for health and adult social care in England, has four levels of compliance: outstanding, good, requires improvement, inadequate[14] These ratings are determined according to the professional judgment of a CQC inspector and assessed at the level of individual care components; services receive an overall rating. NPT facilitates an exploration of what factors are associated with the successful integration and alignment of an organisation’s goals with those of regulation Such an approach has been adopted elsewhere[36] but the author has found no studies that have used NPT as a theory to aid understanding of regulatory compliance in organisations. For example: adherence to voluntary standards or codes of conduct; where failure to comply does not result in regulatory sanctions of enforcement; compliance concerning individuals as opposed to organisations as is the case with regulations for specific health care professionals.
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