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Healthcare regulation is one means to address quality challenges in healthcare systems and is carried out using compliance, deterrence and/or improvement approaches. The four countries of the UK provide an opportunity to explore and compare different regulatory architecture and models. The purpose of this paper is to understand emerging regulatory models and associated tensions.

This paper uses qualitative methods to compare the regulatory architecture and models. Data were collected from documents, including board papers, inspection guidelines and from 48 interviewees representing a cross-section of roles from six organisational regulatory agencies. The data were analysed thematically using an a priori coding framework developed from the literature.

The findings show that regulatory agencies in the four countries of the UK have different approaches and methods of delivering their missions. This study finds that new hybrid regulatory models are developing which use improvement support interventions in parallel with deterrence and compliance approaches. The analysis highlights that effective regulatory oversight of quality is contingent on the ability of regulatory agencies to balance their requirements to assure and improve care. Nevertheless, they face common tensions in sustaining the balance in their requirements connected to their roles, relationships and resources.

The paper shows through its comparison of UK regulatory agencies that the development and implementation of hybrid models is complex. The paper contributes to research by identifying three tensions related to hybrid regulatory models; roles, resources and relationships which need to be managed to sustain hybrid regulatory models.

The purpose of this paper is to understand how inspection team members work together to conduct surveys of hospitals, the challenges teams may face and how these might be addressed.

Data were gathered through an evaluation of a new regulatory model for acute hospitals in England, implemented by the Care Quality Commission (CQC) during 2013-2014. The authors interviewed key stakeholders, observed inspections and surveyed and interviewed inspection team members and hospital staff. Common characteristics of temporary teams provided an analytical framework.

The temporary nature of the inspection teams hindered the conduct of some inspection activities, despite the presence of organisational citizenship behaviours. In a minority of sub-teams, there were tensions between CQC employed inspectors, healthcare professionals, lay people and CQC data analysts. Membership changes were infrequent and did not appear to inhibit team functioning, with members displaying high commitment. Although there were leadership authority ambiguities, these were not problematic. Existing processes of recruitment and selection, training and preparation and to some extent leadership, did not particularly lend themselves to addressing the challenges arising from the temporary nature of the teams.

Conducting the research during the piloting of the new regulatory approach may have accentuated some challenges. There is scope for further research on inspection team leadership.

Issues may arise if inspection and accreditation agencies deploy temporary, heterogeneous survey teams.

This research is the first to illuminate the functioning of inspection survey teams by applying a temporary teams perspective.

Organisations within healthcare increasingly operate in rapidly changing environments and present wide variation in performance. It can be argued that this variation is influenced by the capability of an organisation to improve: its improvement capability. However, there is little theoretical research on improvement capability. The purpose of this paper is to set out the current diverse body of research on improvement capability and develop a theoretically informed conceptual framework.

This paper conceptualises improvement capability as a dynamic capability. This suggests that improvement capability is comprised of organisational routines that are bundled together, and adapt and react to organisational circumstances. Existing research conceptualises these bundles as three elements (microfoundations): sensing, seizing and reconfiguring. This conceptualisation is used to explore how improvement capability can be understood, by inductively categorising eight dimensions of improvement capability to develop a theoretically informed conceptual framework.

This paper shows that the three microfoundations which make up a dynamic capability are present in the identified improvement capability dimensions. This theoretically based conceptual framework provides a rich explanation of how improvement capability can be configured.

Identifying the component parts of improvement capability helps to explain why some organisations are less successful in improvement than others. This theoretically informed framework can support managers and policy makers to identify improvement capability dimensions in need of development. Further empirical research, particularly in non-market settings, such as publicly funded healthcare is required to enhance understanding of improvement capability and its configuration.

The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat strategizing as a practical coping mechanism which begins in response to a problem and unfolds over time into an episode. This approach enables the authors to explore strategizing pathways and the ways they can mobilise accounting to advance from practical coping to explicit strategic intent.

The authors conducted semi-structured interviews with Clinical Directors, Business Managers and Finance personnel at three NHS hospitals. Documents were also collected, such as business cases and financial reports. The authors employed theories on strategizing agency, episodes and practical coping to select examples of strategizing and indicate how strategizing is constructed and performed. The authors present the results of this qualitative analysis in three strategizing narratives.

The analysis highlights how Clinical Directors’ strategizing with accounting, in response to their financial problems, can take on contesting, conforming and circumventing modes. As the strategizing pathway unfolds, accounting acts as an obligatory passage point through which Clinical Directors pursue their strategic intent. Along each pathway the authors identify, first, where practical coping takes on a clear strategic intent and, second, whether this emergent strategy proves efficacious.

The authors contribute to the nascent body of accounting and strategizing studies through seeing strategizing with accounting, not as the formulation of explicit organisational strategy as “done” in board rooms and strategy meetings, but as an impromptu response to a critical financial problem within a localised organisational setting. In response to a problem, actors may realise their immanent strategizing through their engagement with accounting practices.

Clinical governance is the linchpin of the UK government's quality improvement strategy for the country's National Health Service. Extending quality accreditation programmes from hospitals into the primary care sector — local general practice surgeries — presents a critical set of challenges. In this extract from Accreditation in Primary Care, Nicola Walsh and Kieran Walshe explore how to evaluate accreditation initiatives to assure the quality of primary care.

CASPE Research and Brighton Health Authority have been working together to test a series of approaches to quality assurance in healthcare. In this paper, they give an account of the results of the quality assurance techniques used; discuss the key requirements for successful quality assurance in the NHS environment; and consider the need for systematic evaluation of quality assurance programmes.

The aim of this study was to develop a multi‐professionally agreed list of adverse events, which may act as a prompt for clinical incident reporting in trauma and orthopaedics and to determine what healthcare professionals understand by the term adverse event. A modified Delphi process with healthcare professionals working in trauma and orthopaedics (242) in three NHS trusts was performed. The process involved initial brainstorming sessions, a two‐round Likert‐style postal questionnaire and final focus group discussion. The initial brainstorming sessions generated a list of 224 adverse events to be included in the first round of the postal questionnaire. They included 83 causes of adverse events, 36 health and safety related adverse events and 105 clinical adverse events. Following the second round questionnaire and focus group discussion, a final list of 20 adverse events was produced. There were variations between professional groups in terms of validity scoring of individual adverse events. Overall, medical staff gave a lower rating to the adverse events than the other two professional groups. There were also variations between professional groups in terms of response rates. The modified Delphi process proved to be a successful tool for generating a multi‐professionally agreed list of adverse events and for understanding what healthcare professionals understand by the term adverse event.

The first phase of this study developed a multi‐professionally agreed list of adverse events for clinical incident reporting in Trauma and Orthopaedics. This follow‐up study aims to evaluate the effectiveness of the adverse event list.

Two follow‐up questionnaires were sent to healthcare professionals working in Trauma and Orthopaedics in two of the participating National Health Service (NHS) Trusts (n=247 for the first questionnaire and n=240 for the second questionnaire). Trends in routine incident reporting data were also monitored over a two‐year period to determine the impact of the adverse event list on levels of adverse event reporting.

The questionnaires indicated that awareness about the adverse event list was good and improved between questionnaires. However usage of the adverse event list appeared to be poor. Multiple regression analysis with the dependent variable count of orthopaedic incidents suggested that the adverse event list had little, if any impact on levels of reporting in Trauma and Orthopaedics.

The results of this study suggest that a practical tool, such as the adverse event list has little impact on incident reporting levels.

To examine the introduction of role‐redesign in the NHS and highlight implications for employment relations.

A 12‐month independent evaluation (2003‐2004) of a role redesign initiative in the NHS is reported. The study followed a developmental, case‐study design and included secondary data analysis, semi‐structured interviews and observations at five case‐study sites.

The role redesign process involved four types of change to job content: skill‐mix changes; job widening; job deepening; and development of new roles. Each of these changes had implications for employment relations in terms of remuneration, management and accountability, and education and training.

The research involves one initiative in the NHS and was evaluating a developing programme. Whilst implications are suggested for efforts at role redesign generally the research specifically relates to NHS organisations.

Three aspects of employment relations are identified as important when attempting role redesign: remuneration, management and accountability, and education and training.

This paper offers the first account of this national NHS role redesign initiative.

Adverse event monitoring is a problem‐oriented approach to clinical audit and health‐care quality improvement, which was developed and has been widely used in the USA. Briefly explores the technique itself and its evolution. Presents experience gained from the widespread use of the approach in a British acute hospital, and results from one specialty – ophthalmology. Suggests that the study of adverse events in patient care can produce significant improvements in patients’ care, that it is particularly suited to some specialties, and that it should be used alongside other techniques in hospital clinical audit programmes. Concludes that, as the demand for quality‐monitoring information from purchasers and within providers grows, adverse event monitoring may become one of the key techniques for quality assessment and improvement.