Evidence Points To 'Gaming' At Hospitals Subject To National Health Service Cleanliness Inspections.
Inspections are a key way to monitor and ensure quality of care and maintain high standards in the National Health Service (NHS) in England. Yet there is a perception that inspections can be gamed. This can happen, for example, when staff members know that an inspection will soon take place. Using data for 205 NHS hospitals for the period 2011-14, we tested whether patients' perceptions of cleanliness increased during periods when inspections occurred. Our results show that during the period within two months of an inspection, there was a significant elevation (2.5-11.0 percentage points) in the share of patients who reported "excellent" cleanliness. This association was consistent even after adjustment for secular time trends. The association was concentrated in hospitals that outsourced cleaning services and was not detected in those that used NHS cleaning services.
Veronica Toffolutti (veronica.toffolutti@sociology.ox.ac.uk) is a postdoctoral researcher in health economics at the University of Oxford, in the United Kingdom.
Veronica
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Toffolutti
Martin McKee is a professor of European public health at the London School of Hygiene and Tropical Medicine, in the United Kingdom.
Martin
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McKee
David Stuckler is a professor of political economy and sociology at the University of Oxford.
David
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Stuckler
D004739:England; D006761:Hospitals / Q000592:standards / Q000639:trends*; D006797:Housekeeping, Hospital / Q000379:methods / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000592:standards*; D017063:Outcome Assessment, Health Care / Q000592:standards*; D010361:Patients / Q000523:psychology; D010362:Patients' Rooms / Q000592:standards; D013222:State Medicine; D011795:Surveys and Questionnaires
Gaming; Hospital Cleanliness; Hospital Inspections; Opportunistic behaviour