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means of identifying and recording how proposed themes have been
developed; it is also an approach that incorporates established methods and
principles of qualitative research which form part of the very research it is
attempting to synthesise. The emerging themes were as follows:
Data and quality measurement: The literature highlighted a significant
degree of complexity which confronts regulators as they attempt to choose
what type of data should be focused upon when making decisions about
quality; the significance of understanding and interpreting administrative data
within the context from which it is gathered is a key consideration - in other
words, a fair representation of one service cannot be applied indiscriminately
across other settings. Measuring meaningful improvement performance
outcomes is also contingent upon collecting data that is both comprehensive
and context specific; while there is inherent potential in using routine data to
improve quality outcomes, this potential is heavily caveated by the type and
relevance of the data itself.
The patient's voice: A review of the literature highlighted that patient
feedback can be seen as potentially presenting a rich and nuanced source of
information as it pertains to quality assessment and risk management;
nevertheless, there is a risk of bias creeping in if no discernment is exercised
as to the influence of patient demographics.
There is clear value in gathering and using a broad range of both quantitative
and qualitative data when making a determination as to the quality of a
service, including that of the patient's own perspective as a consumer of that
service.
Data and predictive decision making: The ability to predict quality is viewed
by some as representing the ideal for targeted and risk-based regulation as it
allows for clearly prescribed and differentiated thresholds of inspection activity.
The potential to use routinely collected data in the context of scheduling
regulatory activity does exist: however, it must be recognised that there are
strengths and limitations of such an approach. Predictive decision making like
this appears to have its greatest use when occupying a clearly circumscribed
role within the full scope of regulatory intelligence which can be used to watch
for failing services. It may be more prudent to develop a monitoring system
which focuses on a service which is failing rather than achieving. A key
characteristic of effective regulation is the capacity to effectively predict where
such failures or successes may occur; the literature suggests that a change in
regulatory mind-set may be required with a greater focus being needed on