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The Dutch Healthcare Inspectorate has recently tried out a new form of inspection: System-Based Regulation (SBR). This article explores how SBR was situated in the healthcare context through a process of 'experimentalist governance'. A qualitative formative evaluation was undertaken involving two years of participative observation, numerous iterations between data gathering and feedback in order to orient the next steps of the process. The evaluation found that SBR could fit into the existing supervisory regime, but notwithstanding positive outcomes SBR was controversial and further implementation was delayed. The process of 'experimentalist governance' was strengthened by qualitative formative evaluation that documented and reflected on the process as it progressed. The evaluation also helped to translate and communicate learning so as to better understand regulation and to reform and reconceptualize SBR in today's healthcare context.

AbstractDiscretion used to be considered a feature of individuals, but growing literature shows that it has collective features as well. To develop an understanding of the individual and cooperative work of inspectors in using discretion and the discretionary room granted to them, we compared two inspectorates: the Care Quality Commission (CQC) in England and the Joint Inspectorate for Youth (JIY) in the Netherlands. Our analysis reveals that inspectors engage with colleagues, managers, and stakeholders to include other perspectives, gain mandate, and broaden their repertoire. At the CQC, inspectors use their discretion collectively; on their own initiative, they involve others in balancing and interpreting rules to reach judgments. At the JIY, teamwork is central and regulatory teams are granted collective discretionary room. We argue that collective work permits both responsiveness and consistency. In studying the judgments of inspectors and other street‐level bureaucrats, it is vital to look at collective work and how it combines consistency and responsiveness.

Many working hours of healthcare professionals are spent on administrative tasks. Administrative burden is caused by political choices, legislation, the requirements of health insurers and supervisors. Coordination between the parties involved, is lacking. Therefore, we studied to what extent sharing internal audit results of hospitals with external supervisors is possible and the necessary preconditions. We interviewed 42 individuals from six hospitals and the Dutch Health and Youth Care Inspectorate. The interviewees expressed that there is no coordination in timing and content between internal audits and external supervision. They were in favour of sharing internal audit results with external supervisors to reduce the supervisory burden. They stated that internal audits give insight into quality problems and improvements, how hospital directors govern quality and safety, and the culture of improvement within healthcare provider teams. With this information, the inspectorate can judge to what extent hospitals are learning organisations. The interviewees mentioned the following preconditions for sharing audit results: reliable and risk-based information about quality and safety, collected by expert, trained auditors, and careful use of this information by the inspectorate in order to maintain openness among audited healthcare professionals. In conclusion, internal audit results can be shared conditionally with external supervisors. When internal audit results show that hospitals are open, learning and self-reflecting organisations, the healthcare inspectorate can reduce their supervisory burden.

Abstract 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.

AbstractInspectorates have been criticized for assessing compliance with the rules rather than outcomes for children. In the Netherlands, inspectorates have developed a 'journey tool' to reconstruct children's travels through all the organizations providing care. Using document analysis and semi‐structured interviews, we evaluated how inspectors use this tool in practice. We applied an ontological theoretical framework to the coordination of care to analyse 24 journeys through care organizations, including a selection of six journeys in further detail. Our analysis shows that up until now, inspectors used only one form of coordination, the creation of a hierarchy, resulting in one problem definition. However, in complex care practices, children have multiple and often incompatible problems so that one coherent problem definition cannot be made. We show that 'patchwork', a form of coordination that allows discrepancies enables inspectors to reflect on complex care practices and evaluate options to improve outcomes for children.