Exploring & explaining the dynamics of osteopathic regulation, professionalism, &

compliance with standards in practice

Prof Gerry McGivern (Warwick Business School, University of Warwick; gerry.mcgivern@wbs.ac.uk),

Dr Michael Fischer (Oxford University), Zoey Spendlove, Prof Justin Waring (Nottingham University)

& Dr Oliver Thomson (British School of Osteopathy)

Background research on clinical regulation

• Previous ESRC/ GMC funded research on regulatory transparency in medicine and psychological therapies

• McGivern, G. & Fischer, M.D. 2012. ‘Reactivity & reactions to regulatory transparency in medicine, psychotherapy & counselling. Social Science & Medicine, 74 (3) p286-296)– Regulators had little understanding of the effects of regulation in

practice– Importance of ‘formative spaces’ within regulatory processes– Non-rational narratives & anxieties shaping professionals’ defensive

attitudes towards regulation in a perceived ‘inquisition’ like wider environment

– Echoed earlier study on consultant appraisal: McGivern, G. & Ferlie, E. 2007. Playing Tick Box Games: Interrelating Defences in Professional Appraisal. Human Relations, 60 (9) p1361-1385

The Francis Inquiry

• Mid-Staffs/Francis-report: – Focus on superficial compliance with standards/numbers– Professional disengagement; ‘kept their heads down’– ‘There is a tendency when a disaster strikes to try to seek out

someone who can be blamed… we have still not managed to move successfully away from the culture of blame which … Donaldson, in Organisation with a Memory and.. the Bristol Inquiry, were so keen to banish… blame will perpetuate the cycle of defensiveness, concealment, lessons not being identified and further harm.’ (Francis, 2013: 35)

– Call for culture change: Professionalism & internalisation of standards

The GOsC-funded research

• Current General Osteopathy Council (GOsC) funded research• Exploring osteopaths’ & other regulatory stakeholders’

perceptions & experience of regulation in practice • Explaining factors that encourage or inhibit compliance with

osteopathic standards & regulation • Links to osteopathic professionalism• Aim to help GOsC understand how it can encourage

compliance with osteopathic standards & thus support safe & high quality osteopathic practice.

Why is osteopathy interesting?

• Protected professional title (4800 UK osteopaths) • No agreed definition of osteopathy• Limited evidence-based• Communication/professionalism important• Independent professionals (sole; private practice)• GOsC revalidation pilot: reflective discussion part

of GOsC fitness to practice regulatory process (following PSA ‘right-touch’ regulation, 2012)

What are we doing?

• Literature review: (1) osteopathy & (2) clinical regulation• Qualitative semi-structured interviews (n=50; on-going)

– Representative range of osteopaths; – Representatives of the osteopathic educational institutions;– Public/patient representatives; – Regulators (e.g. HCPC, GOsC, General Chiropractic Council); – Other stakeholders affecting the wider regulatory climate (e.g.

lawyers, journalists, policy-makers, politicians)• Online survey of 4800 GOsC-registered Osteopaths (June) • Stakeholder validation and feedback workshop

Where have we got to?

• Still early in the project – Literature reviews: (1) osteopathy and (2)

regulation/revalidation/FTP; – Preliminary review of public FTP information and GOsC

revalidation pilot findings– Ethical approval – Sampling framework– Interview questions 2 pilot interviews done; – More interviews arranged

• No results to report yet (available end of 2014)