Abstract
Background: Healthcare organisations in England rated as inadequate in terms of leadership and one other domain enter the Special Measures for Quality (SMQ) regime to receive increased support and oversight. There is also a ‘watch list’ of challenged National Health Service (NHS) providers at risk of going into SMQ that receive support. There is limited knowledge about whether the interventions used to deliver this support drive improvements in quality, their costs, and whether they strike the right balance between support and scrutiny. The study will seek to determine how provider organisations respond to these interventions, and whether and how these interventions impact organisations’ capacity to achieve and sustain quality improvements over time. Methods: This is a multi-site, mixed methods study. We will carry out interviews at national level to understand the programme theory underpinning the interventions. We will conduct 8 NHS case studies to explore the impact and implementation of the interventions that form part of the SMQ and challenged providers programme. We will use a conceptual framework based on models of organisational readiness for change and draw on board maturity research for implementing quality improvement. We will also review the use of quantitative metrics and data for tracking the progress of improvements in quality of care and sustainability upon leaving SMQ, as well as the costs and benefits of the interventions through a cost-consequence analysis (CCA). Discussion: High-quality interventions that successfully support struggling healthcare organisations are essential and an issue that is an international concern. Our study will allow a greater understanding of the programme theory, impact, and staff views and experiences of the SMQ and challenged providers regime. Formative feedback will be reported to key stakeholders.
Highlights
There is an internationally recognised need for transparent, integrated, and timely processes for identifying quality and patient safety issues across healthcare systems.[1]
We will devise a local involvement and engagement strategy and when the site sample is defined, we will contact local patient groups, or individual key informers to obtain their views. This mixed methods study will enable an analysis of the Special Measures for Quality (SMQ)/challenged providers regimes and the interventions within them that have been set out by NHS Improvement (NHSI) from the point of view of a wide range of stakeholders and multiple participating sites
Undertaking case studies of sites experienced with the SMQ/challenged provider regimes is a central component of the proposal
Summary
There is an internationally recognised need for transparent, integrated, and timely processes for identifying quality and patient safety issues across healthcare systems.[1]. Attention has been placed on failing healthcare organisations, their characteristics and the factors (internal and external) that might lead to low performance These include low leadership capability, lack of open culture, antagonistic external relationships,[2,3,4] inadequate infrastructure, lack of a cohesive mission, and system shocks.[5] A hierarchical culture and leadership focused on avoiding penalties and achieving financial targets - rather than a patient-centred mission - are characteristics identified in many failing organisations. The regime emerged following the Keogh Review into avoidable mortality in 2013.6 Trusts are put into SMQ only where serious care quality failings are identified and the leadership appear unable to resolve the problems without intensive support and external input.[7,8,9] The SMQ regime provides trusts with oversight and interventions from NHSI, the national regulator, to help them address specific quality failings identified in CQC inspections.
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