title: Revalidation and quality assurance: the application of the MUSIQ framework in independent verification visits to healthcare organisations.
abstract: We present a national evaluation of the impact of independent verification visits (IVVs) performed by National Health Service (NHS) England as part of quality assuring medical revalidation. Organisational visits are central to NHS quality assurance. They are costly, yet little empirical research evidence exists concerning their impact, and what does exist is conflicting.
  
  
  
  The focus was on healthcare providers in the NHS (in secondary care) and private sector across England, who were designated bodies (DBs). DBs are healthcare organisations that have a statutory responsibility, via the lead clinician, the responsible officer (RO), to implement medical revalidation.
  
  
  
  All ROs who had undergone an IVV in England in 2014 and 2015 were invited to participate. 46 ROs were interviewed. Ethnographic data were gathered at 18 observations of the IVVs and 20 IVV post visit reports underwent documentary analysis.
  
  
  
  Primary outcomes were the findings pertaining to the effectiveness of the IVV system in supporting the revalidation processes at the DBs. Secondary outcomes were methodological, relating to the Model for Understanding Success in Quality (MUSIQ) and how its application to the IVV reveals the relevance of contextual factors described in the model.
  
  
  
  The impact of the IVVs varied by DB according to three major themes: the personal context of the RO; the organisational context of the DB; and the visit and its impact. ROs were largely satisfied with visits which raised the status of appraisal within their organisations. Inadequate or untimely feedback was associated with dissatisfaction.
  
  
  
  Influencing teams whose prime responsibility is establishing processes and evaluating progress was crucial for internal quality improvement. Visits acted as a nudge, generating internal quality review, which was reinforced by visit teams with relevant expertise. Diverse team membership, knowledge transfer and timely feedback made visits more impactful.
authors.affiliation: Research Department for Medical Education, UCL Medical School, London, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Griffin
authors.affiliation: Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK.
authors.forename: Alex
authors.identifier: 0000-0003-2582-6493
authors.initials: A
authors.lastname: McKeown
authors.affiliation: Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK.
authors.forename: Rowena
authors.initials: R
authors.lastname: Viney
authors.affiliation: Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK.
authors.forename: Antonia
authors.identifier: 0000-0002-1548-6328
authors.initials: A
authors.lastname: Rich
authors.affiliation: Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK.
authors.forename: Trevor
authors.initials: T
authors.lastname: Welland
authors.affiliation: Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK.
authors.forename: Irene
authors.initials: I
authors.lastname: Gafson
authors.affiliation: Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK.
authors.forename: Katherine
authors.identifier: 0000-0003-4915-0715
authors.initials: K
authors.lastname: Woolf
mesh_terms: D002608:Charities / Q000331:legislation & jurisprudence / Q000592:standards; D003406:Credentialing; D003695:Delivery of Health Care / Q000592:standards*; D004739:England; D005246:Feedback; D058006:General Practice / Q000331:legislation & jurisprudence / Q000592:standards; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D007882:Legislation, Hospital; D009042:Motivation; D019370:Observation; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D011787:Quality of Health Care; D013222:State Medicine
keywords: INSPECTION VISITS; MEDICAL EDUCATION & TRAINING; MEDICAL REVALIDATION; PROFESSIONAL REGULATION; QUALITY IMPROVEMENT