Behind the News: Susan Cliffe, Hiqa inspector

The Health Information and Quality Authority is to start monitoring patient nutrition and hydration, plus use of antimicrobial drugs. What will it involve?

Susan Cliffe, a Health Information and Quality Authority inspector, spends her working days checking the standards of hygiene and healthcare at acute hospitals – and that means much more than you might imagine, she says.

“The public perception of Hiqa is that we are looking at infection-control issues like hand-washing and the cleanliness of floors, fixtures and fittings, but this year we are moving on to monitor patient nutrition and hydration and the prescribing and administration of antimicrobial drugs,” she says, referring to antibiotics, antiviral and antifungal medication.

Cliffe says that these two programmes will be added to annual hygiene inspections of Ireland’s 49 acute hospitals. “We know from international studies that patients in hospitals don’t always have adequate nutrition and hydration, and up to now there hasn’t been any programme to monitor that.”

Acute adult hospitals will be asked to assess their own policies on patient nutrition and hydration; this will be followed up by unannounced inspections in the autumn.


The antimicrobial programme aims to improve the treatment of infection and reduce the growth of resistance to antibiotics.

Unsurprisingly, hospital managers find the arrival of Hiqa inspectors stressful. “I know from my previous job as an assistant director of nursing in an acute hospital that the adrenaline is high when Hiqa inspectors are in the hospital, but we don’t go with lead boots and faces like hatchets,” she says.

An unannounced inspection, carried out on two randomly chosen wards, can take between three and four hours. “Issues of high risk are brought to the management team straight away, and we write up our reports within five to 10 working days,” says Cliffe. All Hiqa reports are available online.

Although the initial inspection can reveal hygiene problems, it’s only by talking to patients, staff and cleaners that the full picture emerges, Cliffe says. “The less obvious issues relate to the management and governance structures in the hospital.”

This week Hiqa published national standards for safer, better healthcare, based on the recommendations of seven reports over the past five years. They have three main themes: “effective care and support; leadership, governance and management; and dealing with the workforce”. The aim is to encourage hospitals to avoid unnecessary risk and create a culture of learning from patient-safety incidents.

Does she think the media gives a fair view of Hiqa reports? “There is a tendency to report the bad and ignore the good, and that’s a pity,” she says. We’ve had inspection reports on some hospitals that have been quite good, and only the one or two bad things make it into the newspapers. That shakes the confidence of hospital users.”