What Might Be Required for Inspections to Be Considered Fair? Comment on "What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya's Health Facility Inspection Reforms".

Tama et al offer us an interesting analysis of a piloted regulatory reform that introduced a Joint Health Inspections (JHIs) system in three Kenyan counties. The study highlights key factors facilitating or hindering the implementation of the reform. In this commentary we reflect on the concept of fairness, which is one of the topics that is discussed in the study.

Can systematic implementation support improve programme fidelity by improving care providers' perceptions of implementation factors? A cluster randomized trial.

Background: Investigations of implementation factors (e.g., collegial support and sense of coherence) are recommended to better understand and address inadequate implementation outcomes.

Learning team-based quality improvement in a virtual setting: a qualitative study.

Objective: The objective was to explore students' perceptions of learning quality improvement (QI) in a virtual setting and identify factors that promote or inhibit virtual learning.

Design: We used an exploratory case study design with focus group interviews. The data were analysed using a thematic analysis approach, with an analytical framework derived from activity theory and Bloom's revised taxonomy of six categories of cognitive processes of learning.

Contextual factors of external inspections and mechanisms for improvement in healthcare organizations: A realist evaluation.

External inspections constitute a key element of healthcare regulation. Improved quality of care is one of the important goals of inspections but the mechanisms of how inspections might contribute to quality improvement are poorly understood. Drawing on interviews with healthcare professionals and managers and health record data from inspected organizations, we used a realist evaluation approach to explore how twelve inspections of healthcare providers in x= Norway influenced quality improvement.

Correction: Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study.

[This corrects the article DOI: 10.1371/journal.pone.

Promoting leadership and quality improvement through external inspections of management of sepsis in Norwegian hospitals: a focus group study.

Objective: Inspections and other forms of external assessment may contribute to positive changes in the health services, but the mechanisms of such change remain unclear. We did a study to explore how external inspections may foster clinical improvement in hospitals.

Design: Focus group study.

Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation.

Objective: To evaluate the effects of external inspections on (1) hospital emergency departments' clinical processes for detecting and treating sepsis and (2) length of hospital stay and 30-day mortality.

Design: Incomplete cluster-randomised stepped-wedge design using data from patient records and patient registries. We compared care processes and patient outcomes before and after the intervention using regression analysis.

Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis.

Objectives: External 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.

Inspecting teams' and organisations' expectations regarding external inspections in health care: a qualitative study.

Background: There is a gap in the literature regarding what takes place between the announcement of a regulatory intervention, such as an external inspection of a health care organisation, and the inspecting body's site visit. This study aimed to explore inspecting bodies' expectations of how inspected organisations should prepare before an external inspection and to elucidate how inspected health care organisations prepare before site visits.

Methods: This qualitative study was based on data from 17 group interviews with a total of 75 participants representing inspection teams, organisation leaders and clinicians in inspected health care organisations.

Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study.

Background: Early recognition of sepsis is critical for timely initiation of treatment. The first objective of this study was to assess the timeliness of diagnostic procedures for recognizing sepsis in emergency departments. We define diagnostic procedures as tests used to help diagnose the condition of patients.

Effects of external inspection on sepsis detection and treatment: a study protocol for a quasiexperimental study with a stepped-wedge design.

Introduction: Inspections are widely used in health care as a means to improve the health services delivered to patients. Despite their widespread use, there is little evidence of their effect. The mechanisms for how inspections can promote change are poorly understood.

A retrospective review of how nonconformities are expressed and finalized in external inspections of health-care facilities.

Background: External inspections are widely used in health care as a means of improving the quality of care. However, the way external inspections affect the involved organization is poorly understood. A better understanding of these processes is important to improve our understanding of the varying effects of external inspections in different organizations.

A qualitative study of contextual factors' impact on measures to reduce surgery cancellations.

Background: Contextual factors influence quality improvement outcomes. Understanding this influence is important when adapting and implementing interventions and translating improvements into new settings. To date, there is limited knowledge about how contextual factors influence quality improvement processes.

Patient experiences with interventions to reduce surgery cancellations: a qualitative study.

Background: The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency, and reduced post-operative complications. In our case a hospital had experienced high cancellation rates and therefore redesigned their pathway for elective surgery to reduce cancelations.

Sustainability of healthcare improvement: what can we learn from learning theory?

Background: Changes that improve the quality of health care should be sustained. Falling back to old, unsatisfactory ways of working is a waste of resources and can in the worst case increase resistance to later initiatives to improve care. Quality improvement relies on changing the clinical system yet factors that influence the sustainability of quality improvements are poorly understood.

A new pathway for elective surgery to reduce cancellation rates.

Background: The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. To reduce high cancellation rates in a Norwegian general hospital, the pathway for elective surgery was redesigned. The changes included earlier clinical assessment of patients, better planning and documentation systems, and increased involvement of patients in the scheduling of surgeries.

[Networks for improving quality in general medicine].

Background: Quality networks are more common in hospitals than in general practice. This study investigates the feasibility of quality networks in general practice, with attention to key factors that may enhance results from continuous quality improvement, such as team leadership, multidisciplinary involvement and optimalising resources.

Material And Methods: Multidisciplinary teams from six general practices in a Norwegian county met five times during one year for instructions and mutual learning.