Language-Games and Quality Improvement in Healthcare in England

Stephen Newman

doi:10.2174/1874220301704010073

Abstract

Background: Quality in healthcare is high on the political agenda in England. This paper examines the model of inspection used by the Care Quality Commission to inspect healthcare provison in England. Methods: The paper comprises a critical review of the literature to examine the model of judgement used by the Care Quality Commission in their inspection framework. Results: It is argued that the model of judgement used makes various assumptions which throw into doubt the notion that such inspections provide an objective picture of quality in healthcare. However, the contrary view, that such inspections are highly subjective, is rejected in favour of developing a perspective informed by the later philosophy of Wittgenstein; one which recognises the importance of social agreement and understanding in developing meaning. Conclusion: This perspective highlights the importance of the different social groups that work in healthcare, and those who are treated in the healthcare system, for developing shared understandings and meanings of terms such as ‘quality’.

Highlights

The Care Quality Commission has a high media profile, attracting headlines such as “Three Quarters of NHS Hospitals are ‘unsafe’ according to new report” [1] and “Inadequate celebrity mental health clinic ordered to improve” [2]
The difficulties in doing this in relation to Ofsted inspections have been highlighted by Gilroy and Wilcox, and similar difficulties can be seen in the approach adopted by the Care Quality Commission (CQC), taking as one example the requirement that inspectors should judge whether patients are safe
When we examine the CQC inspection documentation, we see that the regress is halted by the notion of the ‘professional judgement’ of the inspectors

Summary

Introduction

The Care Quality Commission has a high media profile, attracting headlines such as “Three Quarters of NHS Hospitals are ‘unsafe’ according to new report” [1] and “Inadequate celebrity mental health clinic ordered to improve” [2]. The notions of quality and inspection in healthcare have a high political profile, with the setting up of the Commission for Health Improvements in 2001; following the 2003 Health and Social Care Act, by the Healthcare Commission (HCC) [3], which was, by the 2008 Health and Social Care Act, replaced by the Care Quality Commission (CQC). The purposes of the CQC include setting quality and safety standards, inspecting services to “make sure they continue to meet our standards”, and making “fair and authoritative judgements, supported by the best information and evidence” [4]. Quality in healthcare is high on the political agenda in England.

Objectives

Discussion

Conclusion