Trust and transparency in the regulation of patient safety Judith Healy Regulatory Institutions...
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Transcript of Trust and transparency in the regulation of patient safety Judith Healy Regulatory Institutions...
Trust and transparency in the regulation of patient safety
Judith HealyRegulatory Institutions Network
Australian National UniversityGovNet Health Governance Conference
Brisbane, 10-11 December 2007
This talk
• Responsive regulation ideas
• Constellation of regulatory actors - networked governance
• Regulatory principles: trust and transparency
A broad definition of regulation
1.Governance: influencing flow of events OR2. State as regulator OR3. Compliance with rules and regulations.
Responsive regulation –governance ranging upwards from soft to hard strategies in a regulatory pyramid.
Braithwaite, Healy & Dwan (2005) The governance of health safety and quality Commonwealth of Australia, Canberra.
Responsive regulation: pyramids of sanctions and supports
Pyramid of supports Pyramid of sanctions
John Braithwaite et al (2007) Regulating Aged Care, Edward Elgar
Softer regulation
Harder regulation
Regulatory pyramid
Market mechanisms
Self-regulation
Meta-regulation
Command and control
Voluntarism
RegNet researchers: John Braithwaite, Neil Gunningham, Peter Grabosky
Co-regulation
Regulatory strategies and mechanisms Examples of mechanismsCriminal or civil penaltyLicense suspensionDoctor re-registration
External clinical auditMandated adverse event reporting Funding agreements
Clinical governanceHospital accreditationPerformance targets
Peer review
Consumer complaints Performance paymentsPublic reporting
Clinical protocols Personal monitoringContinuing education
Market
Self-regulation
Meta-regulation
Command and control
Voluntarism
Co-regulation
Eras in safety and quality governance
• Voluntarism and professional self-regulation (19th onwards)
• Information strategies (1970s -)
• Financial strategies (1980s -)
• Leadership and cultural change (1990s -)
• Co-regulation & meta-regulation (2000s -)
Institutional constellations
“We conceive [institutional constellations] as entire sets of formal institutions and interconnected rules that shape public decision-making in a given regulatory arenas, including shared interpretative structures, affecting the patterns of interaction by decision-makers within that sector” (Jordana & Sancho 2004: 298)
Regulatory principles
• An abstract prescription that guides action
• Usually a high degree of generality
• Serve to mobilise others
• Europe stresses quality, Anglophone countries stress patient safety
• Trust and transparency are key regulatory themes internationally
Restoring public trust • Patient-centred professionalism• More accountability: move from self-regulation
to co-regulation and meta-regulation• Professional registration boards with external
members, separation of powers, re-registration• Hospital accreditation: voluntary to mandatory
standards• Adverse events reporting systems• Health departments held accountable• Performance agreements/contracts
Greater transparency
• Hospital performance indicators
• Hospital accreditation reports
• Adverse events public reporting
• Medical register – practitioner profile
• Confidential quality assurance (qualified privilege) versus open disclosure
In summary• Safety and quality problems in patient care requires
more regulatory attention from the state• There is no single regulatory actor – requires networked
governance• Relevance of ‘responsive regulation’ to the health sector
– being responsive to context, culture and conduct • Stronger external regulation involves co-regulation and
meta-regulation to monitor that quality systems are in place
• Principles of trust and transparency trump professional autonomy