How Open Standards for Person-Centered Care Become Checklists Again in Regulatory Practice: Underlying Mechanisms Explained

In health care regulation, open outcome-oriented standards are used to provide flexibility for care organizations to determine how to deal with complex issues. What remains understudied is how this works out in practice. This paper studies how inspectors use open standards to regulate the complex issue of person-centered care. An exploratory qualitative multiple-method design was used to study the work of inspectors who assess the quality of nursing homes within the Dutch Health and Youth Care Inspectorate. Five mechanisms were found that hamper the assessment of open outcome-oriented standards for person-centered care: difficulties in triangulating information, estimating the reliability of the information, deviating from the schedule of the inspection program, judging direct care provision negatively, and indicating a clear boundary between sufficient and insufficient. When using open outcome-oriented standards, it is important to reflect on these mechanisms and evaluate whether outcomes still align with the societal values they attempt to regulate.