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Source publication
![Figure 10: Auditor style typology adopted from [63]. The interrogator...](profile/Dag-Tomas-Johannesen/publication/346096508/figure/fig5/AS:960966489563147@1606123673981/Auditor-style-typology-adopted-from-63-The-interrogator-conducts-interviews-in-a_Q320.jpg)
Contexts in source publication
Context 1
... analysis of case 2 were guided by an analytical model ( figure 9) related to the certification body's approach to ISO 9001 certification. The model represents the organizational field [110,113,224] where the certification approach materialized as a connection between the key elements in the resilience perspective: work as imagined and work as done [172,173]. ...
Context 2
... a comparison of results from the auditors' certification practice (WAD, case unit 1), the certification body's perceived approach (WAI, case unit 2), and the certification approach in standards and guidances (WAI, case unit 3) was done reflexively to look for discrepancies [196] among the case units (elements A, B and C in the analytical model. ( figure 9). ...
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Citations
... Achieving cross-country learning about system design According to recent studies there is an ongoing turning point in the context of accreditation: moving from a culture of means towards evaluation of results, addressing the organizational core (Brubakk et al., 2015;Johannesen and Wiig, 2017;Johannesen et al., 2020;Johannesen, 2020). In late 2022, the Joint Commission announced a reduction in the number of standards with 168 accreditation requirements, as well as the revision of 14 standards Accreditation and external inspection (Joint Commission, 2022). ...
Purpose
The authors compare perspectives on external evaluation of health service provision between Norway and the USA. External inspection and accreditation are examples of internationally wide-spread external evaluation methods used to assess the quality of care given to patients. Different countries have different national policy strategies and arrangements set up to do these evaluations. Although there is growing attention to the impact and effects on quality and safety from external evaluation, there is still a gap in knowledge to how structures and processes influence these outcomes. Accordingly, the purpose of this article is to describe the structures and processes in external evaluation designed to promote quality improvement in Norway and the USA with attention to comparison of enablers and barriers in external evaluation systems.
Design/methodology/approach
Data collection consisted of documentary evidence retrieved from governmental policies, and reviews of the Joint Commission (the US), international guidelines, recommendations and reports from the International Society for Quality in Health Care, and the World Health Organization, and policies and regulations related to Norwegian governmental bodies such as the Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Norwegian Board of Health Supervision . Data were analyzed inspired by a deductive, direct content analytical framework.
Findings
The authors found that both accreditation and inspection are strategies put in place to ensure that healthcare providers have adequate quality systems as well as contributing to the wider risk and safety enhancing management and implementation processes in the organizations subjected to evaluation. The US and the Norwegian external regulatory landscapes are complex and include several policymaking and governing institutions. The Norwegian regulatory framework for inspection has replaced an individual blame logic with a model which “blames” the system for inadequate quality and patient harm. This contrasts with the US accreditation system, which focuses on accreditation visits. Although findings indicate an ongoing turning point in accreditation, findings also demonstrate that involving patients and next of kin directly in adverse event inspections is a bigger part of a change in external inspection culture and methods than in processes of accreditation.
Research limitations/implications
The message of this paper is important for policymakers, and bodies of inspection and accreditation because knowledge retrieved from the comparative document study may contribute to better understanding of the implications from the different system designs and in turn contribute to improving external evaluations.
Originality/value
Although there is a growing attention to the impact and effects on quality and safety from external evaluation, the implications of different regulatory strategies and arrangements for evaluation on quality and safety remain unclear.
