External inspection of compliance with standards for improved healthcare outcomes

Background Inspection systems are used in healthcare to promote quality improvements (i.e. to achieve changes in organisational structures or processes, healthcare provider behaviour and patient outcomes). These systems are based on the assumption that externally promoted adherence to evidence‐based standards (through inspection/assessment) will result in higher quality of healthcare. However, the benefits of external inspection in terms of organisational‐, provider‐ and patient‐level outcomes are not clear. This is the first update of the original Cochrane review, published in 2011. Objectives To evaluate the effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour and patient outcomes. Search methods We searched the following electronic databases for studies up to 1 June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Database of s of Reviews of Effectiveness, HMIC, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. There was no language restriction and we included studies regardless of publication status. We also searched the reference lists of included studies and contacted authors of relevant papers, accreditation bodies and the International Organization for Standardization (ISO), regarding any further published or unpublished work. We also searched an online database of systematic reviews (PDQ‐evidence.org). Selection criteria We included randomised controlled trials (RCTs), non‐randomised trials (NRCTs), interrupted time series (ITSs) and controlled before‐after studies (CBAs) evaluating the effect of external inspection against external standards on healthcare organisation change, healthcare professional behaviour or patient outcomes in hospitals, primary healthcare organisations and other community‐based healthcare organisations. Data collection and analysis Two review authors independently applied eligibility criteria, extracted data and assessed the risk of bias of each included study. Since meta‐analysis was not possible, we produced a narrative results summary. We used the GRADE tool to assess the certainty of the evidence. Main results We did not identify any new eligible studies in this update. One cluster RCT involving 20 South African public hospitals and one ITS involving all acute hospital trusts in England, met the inclusion criteria. A trust is a National Hea