A clear governance framework and standards that each site understands it is expected to adhere to are key to providing assurance to regulators.
Even with different models of care within a network, standardisation of types of service offered and central monitoring of compliance should ensure quality and safety and provide assurance for regulators.
If the two parties are not clear about who is doing what, the regulator will be unclear too. Our research has frequently highlighted the need for robust agreements between specialty provider and host trust to be in place before the new service starts. SLAs can be very useful to describe the relationship, what each partner is supposed to be doing for the other and to inform regular reviews. However, they do not usually have the legal standing that formal contract documents offer.
In some networked models – for instance one where the host trust continues to count the activity provided by the partner in its performance reports – provider trust staff can sometimes feel more part of the host organisation than their own. In this case enforcing the provider’s standards can be a particular challenge and will rely heavily on strong local leadership.
Because inspectors are less familiar with the networked model, organisations can have difficulties explaining how some aspects work. For example, a manager on one site will be responsible for staff in her area but not for staff in her specialty on another site. Having structures with clear lines of responsibility that staff clearly understand will mitigate this.
Another issue can arise when it is not clear to an inspector where the line is drawn between areas of responsibility for patient care, for instance during surgery and on a post-operative ward. Again, being able to provide evidence of agreed protocols and accountabilities will provide assurance.
“One inspector expected the pharmacist to know about all pharmacy staff’s mandatory training across the network, not just at her site, whereas she knew that was not her responsibility.”
“As the provider we were responsible for the day case procedure but not for the post-operative nursing and when an issue arose about analgesia on the recovery ward, the inspector didn’t understand why we hadn’t administered it.”