Improving the quality of residential care for people with disabilities — What is the experience of inspectors when implementing care quality regulations in Ireland?

Abstract

Background

Regulation by an independent state authority is a common means by which governments seek to safeguard service users and ensure good quality health and social care services. Inspectors play a key role in this process as they work at the interface between regulator and regulatee. Our aim was to investigate the role played by inspectors in the implementation of care regulations in residential disability services in Ireland.

Methods

We conducted focus groups with inspectors of residential disability services in Ireland. Participant recruitment was facilitated with the permission of the regulator. Twenty-two people participated over five online focus groups. Thematic analysis was carried out on the interview data.

Results

Four parent themes were identified: overall views on the regulatory system; the importance of skill and strategy for the role of inspector; impediments to effective regulation and inspection; and, positive effects of regulation. While not directly responsible for implementing regulations in services, inspectors played a role by calling attention to poor practices, apportioning accountability at the appropriate level in regulated organisations, and behaving in a consultant-like fashion in support of managers. There were barriers that complicated and inhibited their work such as resource constraints and bureaucracy. Their observation of improvements in service quality led them to conclude that regulation was an effective intervention, despite some flaws.

Conclusion

Inspectors had a clear sense of the part they played in terms of aiding the implementation effort in services. They shared the goals of managers: trying to improve the quality of services and the lives of those that use services. While there were barriers that impacted on the effectiveness of their work, most inspectors regarded regulation as a positive intervention and had first-hand experience of its impact.