De inspecteur over de effecten van het toezicht

Inleiding. In de afgelopen decennia is bij de rijksinspecties de bewustwording over het belang van het meten van de effecten van toezicht sterk toegenomen. Rijksinspecties kregen steeds vaker te maken met de wens vanuit de politiek en het publiek om zich te verantwoorden over hun meerwaarde. Evidence based inzicht in de effecten van het toezicht maken het voor inspecties makkelijker om zich extern, maar ook intern, te verantwoorden. Rijksinspecties zijn zelf verantwoordelijk voor het aantonen van hun effect. Sinds 2009 heeft de Inspectieraad, het samenwerkingverband van tien rijksinspecties, het meerjarenprogramma ‘Effecten van toezicht’ in uitvoering. Het meerjarenprogramma stimuleert en ondersteunt inspecties bij het aantonen van hun effect...

Symmetry reduction due to gallium substitution in the garnet Li6.43(2)Ga0.52(3)La2.67(4)Zr2O12

Single-crystal structure refinements on lithium lanthanum zirconate (LLZO; Li7La3Zr2O12) substituted with gallium were successfully carried out in the cubic symmetry space group I [Formula: see text]3d. Gallium was found on two lithium sites as well as on the lanthanum position. Due to the structural distortion of the resulting Li6.43(2)Ga0.52(3)La2.67(4)Zr2O12 (Ga-LLZO) single crystals, a reduction of the LLZO cubic garnet symmetry from Ia[Formula: see text] d to I [Formula: see text]3d was necessary, which could hardly be analysed from X-ray powder diffraction data.DFG/TMG/GE1981/31DFG/TMG/GE1981/32Niedersächsisches Ministerium für Wissenschaft und Kultur (MWK)/PH/74ZN99

Overheidstoezicht door de Inspectie voor de Gezondheidszorg

Het rijksoverheidstoezicht door de Inspectie voor de Gezondheidszorg (IGZ) zoals we dat nu kennen heeft zijn wortels in de eerste helft van de negentiende eeuw. In deze bijdrage gaat het over het verleden en de toekomst van het overheidstoezicht door de IGZ als een van de actoren binnen de complexe sturingsrelaties in de gezondheidszorg. De sectorschets is geschreven in opdracht van de Wetenschappelijke Raad voor het Regeringsbeleid (WRR). Tijdens het schrijfproces heeft de WRR een expertbijeenkomst georganiseerd met de auteurs en deskundigen uit het toezicht, de zorg en de wetenschap. De tijdens deze bijeenkomst gemaakte opmerkingen zijn verwerkt in de tekst. De auteurs zijn verantwoordelijk voor de inhoud van de sectorschets

Experimental studies to improve the reliability and validity of regulatory judgments on health care in the Netherlands: a randomized controlled trial and before and after case study

Rationale, aims and objectives We examined the effect of two interventions on both the reliability and validity of regulatory judgments: adjusting the regulatory instrument and attending a consensus meeting. Method We adjusted the regulatory instrument. With a randomized controlled trial (RCT) we examined the effect of the adjustments we made to the instrument. In the consensus meeting inspectors discussed cases and had to reach consensus about the order of the cases. We used a before and after case study to assess the effect of the consensus meeting. We compared the judgments assigned in the RCT with the unadjusted instrument with the judgments assigned with the unadjusted instrument after the consensus meeting. Moreover we explored the effect of increasing the number of inspectors per regulatory visit based on the estimates of the two interventions. Results The consensus meeting improved the agreement between inspectors; the variance between inspectors was smallest (0.03) and the reliability coefficient was highest (0.59). Validity is assessed by examining the relation between the assigned judgments and the corporate standard and expressed by a correlation coefficient. This coefficient was highest after the consensus meeting (0.48). Adjustment of the instrument did not increase reliability and validity coefficients. Conclusions Participating in a consensus meeting improved reliability and validity. Increasing the number of inspectors resulted in both higher reliability and validity values. Organizing consensus meetings and increasing the number of inspectors per regulatory visit seem to be valuable interventions for improving regulatory judgment

Het ene oordeel is het andere niet: Kwantitatieve analyse van de variatie bij IGZ-Inspecteurs

DOEL\ud Onderzoek naar de variatie in oordelen tussen inspecteurs van de Inspectie voor de Gezondheidszorg (IGZ) in het systeem van gefaseerd toezicht op de verpleeghuiszorg en naar de relatie tussen het type oordeel en de aan- of afwezigheid van onderbouwing daarbij.\ud \ud OPZET \ud Descriptief, kwantitatief, retrospectief.\ud \ud METHODE\ud In totaal werden 4914 oordelen met bijbehorende onderbouwingen van 26 inspecteurs uit 182 toezichtrapporten geanalyseerd. De oordelen waren in 2005 en 2006 gegeven op 25 criteria voor verantwoorde zorg in verpleeghuizen. Om de inspecteurs en hun oordelen over verschillende instellingen te kunnen vergelijken, werd met covariantieanalyse statistisch gecorrigeerd voor instellingskenmerken.\ud \ud RESULTATEN\ud Er waren statistisch significante verschillen in beoordeling tussen de inspecteurs. Na correctie voor instellingskenmerken bleven voor 14 van de 25 criteria significante verschillen bestaan. Tevens bleek de aanwezigheid van een onderbouwing bij een oordeel zowel afhankelijk te zijn van de inspecteur als van het gegeven oordeel.\ud \ud CONCLUSIE \ud Beoordelaarsverschillen tussen inspecteurs spelen een rol in de tweede fase van het gefaseerd toezicht op de verpleeghuizen. De IGZ zal resultaten van dit onderzoek gebruiken om haar toezicht verder te ontwikkelen

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

Inspectors' responses to adolescents' assessment of quality of care: A case study on involving adolescents in inspections

Background: Users of care services are increasingly participating in inspections of the quality of care. In practice, incorporating service users' views is difficult, as users may have other views on good care than inspectors and thus give information that does not fit the inspectors' assessment criteria. This study compared the views on good care of young care users (adolescents) and inspectors, seeking to understand what the differences and similarities mean to incorporating the users' views in inspections. Methods: We conducted a single-case study combining document analysis with a meeting with inspectors. The selected case came from a Dutch inspectorate and involved a thematic inspection of care for children growing up poor. Results: Inspectors and adolescents agree on the importance of timely care, creating opportunities for personal development, and a respectful relationship. The views on quality of care differ with regard to sharing information, creating solutions, and the right moment to offer help. We identified three ways inspectors deal with the differences: 1) prioritize their own views, 2) pass the problem onto others to solve, and 3) separate the differing perspectives. With similar viewpoints, inspectors use the adolescents' views to support their assessments. When viewpoints conflict, information from adolescents does not affect the inspectors' judgments. Explanations are related to the vulnerability of the adolescents involved, the inspectorate's organizational rules and routines and the external regulatory context. Conclusions: Service user involvement in inspections potentially impacts the quality of care. Yet, conflicts between the views of service users and inspectors are not easily overcome in the regulatory context