The Special Measures for Quality and Challenged Provider Regimes in the English NHS: A Rapid Evaluation of a National Improvement Initiative for Failing Healthcare Organisations

Document Type : Original Article

Authors

1 Department of Applied Health Research, University College London, London, UK

2 Department of Targeted Intervention, University College London, London, UK

3 NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK

4 Nuffield Trust, London, UK

Abstract

Background 
There is limited knowledge about interventions used for the improvement of low-performing healthcare organisations and their unintended consequences. Our evaluation sought to understand how healthcare organisations in the National Health Service (NHS) in England responded to a national improvement initiative (the Special Measures for Quality [SMQ] and challenged provider [CP] regimes) and its perceived impact on achieving quality improvements (QIs).

Methods 
Our evaluation included national-level interviews with key stakeholders involved in the delivery of SMQ (n=6); documentary analysis (n = 20); and a qualitative study based on interviews (n = 60), observations (n = 8) and documentary analysis (n = 291) in eight NHS case study sites. The analysis was informed by literature on failure, turnaround and QI in organisations in the public sector.

Results 
At the policy level, SMQ/CP regimes were intended to be “support” programmes, but perceptions of the interventions at hospital level were mixed. The SMQ/CP regimes tended to consider failure at an organisational level and turnaround was visualised as a linear process. There was a negative emotional impact reported by staff, especially in the short-term. Key drivers of change included: engaged senior leadership teams, strong clinical input and supportive external partnerships within local health systems. Trusts focused efforts to improve across multiple domains with particular investment in improving overall staff engagement, developing an open, listening organisational culture and better governance to ensure clinical safety and reporting.

Conclusion 
Organisational improvement in healthcare requires substantial time to embed and requires investment in staff to drive change and cultivate QI capabilities at different tiers. The time this takes may be underestimated by external ‘turn-around’ interventions and performance regimes designed to improve quality in the short-term and which come at an emotional cost for staff. Shifting an improvement focus to the health system or regional level may promote sustainable improvement across multiple organisations over the long-term.

Keywords


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Articles in Press, Corrected Proof
Available Online from 11 April 2022
  • Receive Date: 13 July 2021
  • Revise Date: 07 November 2021
  • Accept Date: 10 April 2022
  • First Publish Date: 11 April 2022