SynthesisBMJ open2020
Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis.
Synthesis in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Hospital accreditation: an umbrella review.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2023Pooled it
- Experiences and Impacts of Working in Organisations Undergoing Regulatory Scrutiny: An Integrative Review.Journal of advanced nursing · 2026Review
- What Gets Measured Gets Counted: Food, Nutrition, and Hydration Non-Compliance in Ontario Long-Term Care Homes and the Role of Proactive Compliance Inspections, 2024.International journal of environmental research and public health · 2025Article
- Association between regulator inspection and ratings on primary care prescribing: an observational study in England 2014 to 2019.BMC health services research · 2024Observational
- Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons' perspectives.BMJ open quality · 2024Article
- External inspection approaches and involvement of stakeholders' views in inspection following serious incidents - a qualitative mixed methods study from the perspectives of regulatory inspectors.BMC health services research · 2024Article
- What GPs do to meet accreditation standards - implementation activities and perceived improvements attributed to general practice accreditation.BMC primary care · 2022Article
- Change Management in Medical Contexts, especially in Medical Education: A Systematized Review.Journal of advances in medical education & professionalism · 2022Review
- Linking resilience and regulation across system levels in healthcare - a multilevel study.BMC health services research · 2022Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesExternal inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections.
methodsWe performed a literature search (1980-January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change.
resultsWe included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation's current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance.
conclusionsExternal inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.