The rise of regulation in the NHS.
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England↗
Biomedical subjects
Kieran Walshe
Publications and source records attributed to Kieran Walshe.
NHS scrutiny. Powers of observation.
Local authority scrutiny of the NHS, to come into effect in January next year, will bring health services into local politics more directly than ever before. The scrutiny committees will be able to call chief executives and directors to account and scrutinize service decisions. Health organisations should become involved in scrutiny arrangements now.
Cooperative Behavior↗
Regulation of nursing facilities in the United States: an analysis of resources and performance of state survey agencies.
PURPOSE: This study was undertaken to examine the resources, staffing, and performance of the state survey agencies that have primary responsibility for regulating nursing facilities-licensing them at a state level and certifying them for participation in Medicare and Medicaid on behalf of the Center for Medicare and Medicaid Services (CMS; formerly the Health Care Financing Administration). DESIGN AND METHODS: A telephone and fax survey of survey agencies in all 50 states and the District of Columbia was used, supplemented by secondary data collected from CMS's On-Line Certification and Reporting (OSCAR) system. RESULTS: Total state agency expenditures on nursing facility regulation in 2000 were $382.2 million, which is less than one half of 1% of the total expenditures on nursing facilities in the United States. About 3,000 full-time equivalent surveyors are employed to regulate more than 17,000 nursing facilities in the United States. Nursing facility licensing and certification dominates the work of state survey agencies, although they are responsible for regulating many other health care organizations. Spending has risen recently, but resource levels vary greatly across states, and most state agencies report significant funding shortfalls that impact on their ability to perform their regulatory function. On a range of indicators, the performance of state survey agencies varies fivefold. Some of that state variation is explained by differences in resource levels for regulation, but most is not. IMPLICATIONS: State survey agencies probably need more funding to fulfill their responsibilities properly, but other changes are also needed to improve their performance, including more support and oversight by CMS and more effective regulatory design.
Nursing Homes↗
Evangelism of quality.
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Health Care Reform↗
When things go wrong: how health care organizations deal with major failures.
Concern about patient safety, caused in part by high-profile major failures in which many patients have been harmed, is rising worldwide. This paper draws on examples of such failures from several countries to analyze how these events are dealt with and to identify lessons and recommendations for policy. Better systems are needed for reporting and investigating failures and for implementing the lessons learned. The culture of secrecy, professional protectionism, defensiveness, and deference to authority is central to such major failures, and preventing future failures depends on cultural as much as structural change in health care systems and organizations.
Developed Countries↗