Using regulatory enforcement theory to explain compliance with quality and patient safety regulations: the case of internal audits
Abstract Background Implementing an accredited quality and patient safety management system is inevitable for hospitals. Even in the case of an obligatory rule system, different approaches to implement such a system can be used: coercive (based on monitoring and threats of punishment) and catalytic...
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| Format: | Article |
| Language: | English |
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BMC
2018-01-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-018-2865-8 |
| _version_ | 1828517416700739584 |
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| author | Ulrike Weske Paul Boselie Elizabeth L. J. van Rensen Margriet M. E. Schneider |
| author_facet | Ulrike Weske Paul Boselie Elizabeth L. J. van Rensen Margriet M. E. Schneider |
| author_sort | Ulrike Weske |
| collection | DOAJ |
| description | Abstract Background Implementing an accredited quality and patient safety management system is inevitable for hospitals. Even in the case of an obligatory rule system, different approaches to implement such a system can be used: coercive (based on monitoring and threats of punishment) and catalytic (based on dialogue and suggestion). This study takes these different approaches as a starting point to explore whether and how implementation actions are linked to compliance. By doing so, this study aims to contribute to the knowledge on how to increase compliance with obligatory rules and regulations. Methods The internal audit system (the ‘tracer system’) of a large Dutch academic hospital is used as a case to investigate different implementation approaches and their effect on compliance. This case allowed us to use a multi-actor and multi-method approach for data collection. Internal audits (N = 16) were observed, audit reports were analyzed, and semi-structured interviews were conducted with both the internal auditors (N = 23) and the ward leaders (N = 14) responsible for compliance. Framework analysis was used to analyze the data. Results Although all auditors use catalytic enforcement actions, these do not lead to (intended) compliance of all ward leaders. Rather, the catalytic actions contribute to (intended) compliance of ward leaders that are motivated, whereas they do not for the ward leaders that are not motivated. For the motivated ward leaders, catalytic enforcement actions contribute to (intended) compliance by increasing ward leaders’ knowledge of the rules and how to comply with them. Conclusions Our findings suggest that the effectiveness of implementation actions depends not only on the actions themselves, but also on the pre-existing motivation to comply. These findings imply that there is not one ‘best’ approach to the implementation of obligatory rules. Rather, the most effective approach depends on the willingness to comply with rules and regulations. |
| first_indexed | 2024-12-11T18:41:13Z |
| format | Article |
| id | doaj.art-f671c435125a4504920974dc22eccd4b |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-11T18:41:13Z |
| publishDate | 2018-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-f671c435125a4504920974dc22eccd4b2022-12-22T00:54:37ZengBMCBMC Health Services Research1472-69632018-01-011811610.1186/s12913-018-2865-8Using regulatory enforcement theory to explain compliance with quality and patient safety regulations: the case of internal auditsUlrike Weske0Paul Boselie1Elizabeth L. J. van Rensen2Margriet M. E. Schneider3School of Governance, Utrecht UniversitySchool of Governance, Utrecht UniversityStaff Department Executive Board, University Medical Center UtrechtPresident of the Executive Board, University Medical Center UtrechtAbstract Background Implementing an accredited quality and patient safety management system is inevitable for hospitals. Even in the case of an obligatory rule system, different approaches to implement such a system can be used: coercive (based on monitoring and threats of punishment) and catalytic (based on dialogue and suggestion). This study takes these different approaches as a starting point to explore whether and how implementation actions are linked to compliance. By doing so, this study aims to contribute to the knowledge on how to increase compliance with obligatory rules and regulations. Methods The internal audit system (the ‘tracer system’) of a large Dutch academic hospital is used as a case to investigate different implementation approaches and their effect on compliance. This case allowed us to use a multi-actor and multi-method approach for data collection. Internal audits (N = 16) were observed, audit reports were analyzed, and semi-structured interviews were conducted with both the internal auditors (N = 23) and the ward leaders (N = 14) responsible for compliance. Framework analysis was used to analyze the data. Results Although all auditors use catalytic enforcement actions, these do not lead to (intended) compliance of all ward leaders. Rather, the catalytic actions contribute to (intended) compliance of ward leaders that are motivated, whereas they do not for the ward leaders that are not motivated. For the motivated ward leaders, catalytic enforcement actions contribute to (intended) compliance by increasing ward leaders’ knowledge of the rules and how to comply with them. Conclusions Our findings suggest that the effectiveness of implementation actions depends not only on the actions themselves, but also on the pre-existing motivation to comply. These findings imply that there is not one ‘best’ approach to the implementation of obligatory rules. Rather, the most effective approach depends on the willingness to comply with rules and regulations.http://link.springer.com/article/10.1186/s12913-018-2865-8ImplementationComplianceQuality and patient safetyHospitalsEnforcement styleInternal audit |
| spellingShingle | Ulrike Weske Paul Boselie Elizabeth L. J. van Rensen Margriet M. E. Schneider Using regulatory enforcement theory to explain compliance with quality and patient safety regulations: the case of internal audits BMC Health Services Research Implementation Compliance Quality and patient safety Hospitals Enforcement style Internal audit |
| title | Using regulatory enforcement theory to explain compliance with quality and patient safety regulations: the case of internal audits |
| title_full | Using regulatory enforcement theory to explain compliance with quality and patient safety regulations: the case of internal audits |
| title_fullStr | Using regulatory enforcement theory to explain compliance with quality and patient safety regulations: the case of internal audits |
| title_full_unstemmed | Using regulatory enforcement theory to explain compliance with quality and patient safety regulations: the case of internal audits |
| title_short | Using regulatory enforcement theory to explain compliance with quality and patient safety regulations: the case of internal audits |
| title_sort | using regulatory enforcement theory to explain compliance with quality and patient safety regulations the case of internal audits |
| topic | Implementation Compliance Quality and patient safety Hospitals Enforcement style Internal audit |
| url | http://link.springer.com/article/10.1186/s12913-018-2865-8 |
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