Prevention of infections with highly resistant microorganisms:Maximizing transparency by using outcome indicators

In the Netherlands the quality of health care is supervised by the Health Care Inspectorate. Since 2013 the Health Care Inspectorate has been specifically checking hospital practices for reducing transmission of highly resistant microorganisms. Its mode of operation, using process indicators, has been criticised. Here, it is proposed that this quality control be based on relevant outcome parameters of infection prevention strategies. This would also maximise transparency regarding the occurrence of infections caused by highly resistant microorganisms in Dutch hospitals.</p

The public's voice about healthcare quality regulation policies. A population-based survey

Background: In the wake of various high-profile incidents in a number of countries, regulators of healthcare quality have been criticised for their 'soft' approach. In politics, concerns were expressed about public confidence. It was claimed that there are discrepancies between public opinions related to values and the values guiding regulation policies. Although the general public are final clients of regulators' work, their opinion has only been discussed in research to a limited extent. The aim of this study is to explore possible discrepancies between public values and opinions and current healthcare quality regulation policies. Methods: A questionnaire was submitted to 1500 members of the Dutch Healthcare Consumer Panel. Questions were developed around central ideas underlying healthcare quality regulation policies. Results: The response rate was 58.3 %. The regulator was seen as being more responsible for quality of care than care providers. Patients were rated as having the least responsibility. Similar patterns were observed for the food service industry and the education sector. Complaints by patients' associations were seen as an important source of information for quality regulation, while fewer respondents trusted information delivered by care providers. However, respondents supported the regulator's imposition of lighter measures firstly. Conclusions: There are discrepancies and similarities between public opinion and regulation policies. The discrepancies correspond to fundamental concepts; decentralisation of responsibilities is not what the public wants. There is little confidence in the regulator's use of information obtained by care providers' internal monitoring, while a larger role is seen for complaints of patient organisations. This discrepancy seems not to exist regarding the regulator's approach of imposing measures. A gradual, and often soft approach, is favoured by the majority of the public in spite of the criticism that is voiced in the media regarding this approach. Our study contributes to the limited knowledge of public opinion on government regulation policies. This knowledge is needed in order to effectively assess different approaches to involve the public in regulation policies

Inquiries into Fatal Child Abuse in the Netherlands

In some Western societies, inquiries into fatal abuse of children known to agencies are nowadays a common phenomenon. They have been carried out in the UK for many years, but have recently also emerged in the Netherlands. The main aim of these inquiries is to improve child welfare and protection practice in order to reduce the chance of further child deaths. However, there is reason to critically consider the feasibility of this aim, as British research into child death investigations suggests that they have hardly worked and even may have had counter productive consequences. This paper examines for the first time all Dutch public inquiry reports into child abuse fatalities. It is shown that the problems highlighted in the reports are highly similar to those recurring in their British counterparts. Furthermore, there are considerable similarities between Dutch and British investigations regarding the solutions they propose. Like British inquiries and reviews, Dutch inquiries largely focus on changing procedures, introducing decision-making instruments and increasing monitoring. This one-sided emphasis on bureaucratic measures, the paper argues, does not rate the human side of child protection work at its true value, and makes it questionable whether the inquiries will contribute to improving practice

Supervision practice in the face of emerging health risks: How market dynamics are forcing enforcement officials to stretch their mandate

The modern health care landscape is increasingly hard to capture in regulation and difficult to control by supervision agencies since, due to technological innovation and societal developments, new products and new health risks often emerge that extant regulation does not cover adequately. To counteract potentially harmful conduct, supervision agencies may frequently apply pressure on regulatees through regulatory conversations or negative publicity, even if their conduct may be legal. In this paper we provide context for such interventions beyond the law, outline the broad range of such interventions and discuss their efficacy and legitimacy. We recommend that relevant stakeholders engage in a dialogue that may result in institutional guidelines for supervision agencies on informal supervision practices and interventions beyond the law