Developing scaled tools for residential and nursing home inspection: feasibility study

Purpose: This study explored the feasibility of developing scaled inspection tools for use during external inspection of health and social care facilities to give improved accuracy in identifying facilities “at risk”, a tool for risk-adjusted frequency of inspection, and greater consistency of judgements. Design/methodology/approach: This paper summarises the development through working groups and workshops involving 20 experienced inspectors (nurses and social workers) of the Regulation and Quality Improvement Authority who inspect the 206 nursing and 182 residential care homes in Northern Ireland. A brief evaluation survey, including response to a case vignette, gathered inspectors' views after using the tools for six months. Findings: Eight two-dimensional Scaled Inspection Tools were created, each embodying a scale of performance (seriousness of risk issue) and a scale of the ability of the facility to manage that issue, each axis comprising four points. The Scaled Inspection Tools were used for on-site inspections during 2017–18. Evaluative comments were generally positive. The case vignette seemed to highlight greater risk aversion amongst newer inspectors. Research limitations/implications: The creation of scaled inspection tools adds credibility to the potential for developing risk-based governance in service regulation. Further testing of domains and their scope is required. Practical implications: Prompts for each domain were found essential to guide inspectors. Despite the challenge of change, inspectors became enthusiastic about use for evaluating risks, and managers about improvements in consistency of inspection. Social implications: Knowledge derived from statistical approaches needs to be incorporated into inspection and regulation, just as in other aspects of professional practice. Originality/value: Scaled inspection tools, with two orthogonal axes corresponding to seriousness of risk and ability to manage the risk (inverse of likelihood of harm), proved acceptable and intuitive in use. The study gives credibility to the possibility of developing screening and surveillance approaches to risk-based governance in service regulation.