Regulation of professionals in health and care is comparatively undeveloped as a field of academic study. Government Social Research Service. 2018;213:98105. While our remit was to consider as wide a range of international literature as practicable, the huge number of results meant we had to make the strategic decision to concentrate on those regions and administrations whose healthcare and regulatory systems are most comparable to those of the UK. Exploring risk in professional nursing practice: an analysis of work refusal and professional risk. The study is intended to inform policy thinking for the Department of Health and others in developing the regulation of safety and quality of health and social care in England. 2016 Feb;29(1):5461. The exception to this preoccupation with FtP within the annual reports was the newly established Social Work Englands annual report 2018/19 [85]; this may have been because the main part of the document was devoted to describing the structure of the new regulator. All search menus are included in the appendix to this paper; a list of sources is available from the corresponding author on reasonable request. This finding needs contextualising, however. Regrettably, our ability to realise the full potential of a modern, principles-based system of regulation is hampered by what remains an antiquated legislative framework. 2019. Because of the large number of records retrieved, we used a four-step process of screening. 2013;14(1):160. https://doi.org/10.1186/1471-2296-14-160. Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams. Recent research into healthcare professions regulation: a rapid There may be sanctions and financial incentives that help ensure adherence. Health and social care regulators - The Health and Care Professions Careers, Unable to load your collection due to an error. Exploring the context of fitness to Practise concerns about social Workers in England: explanations beyond individuals. How HCI Can Help HCI works with regulatory bodies to ensure the service offered to direct care providers is in line with international best practice and applicable standards. Where there was significant disagreement between reviewers, these were discussed and rated by the wider team. https://doi.org/10.1016/j.ienj.2012.03.004. Regulation is an important entity in healthcare and healthcare insurance. Jacob SA, Boyter AC. Analysis of the time and workers needed to conduct systematic reviews of medical interventions using data from the PROSPERO registry. In addition, local authorities in the UK provide regulatory functions in a number of areas. 2019;9(7):e028663. 2010;5(1):56. https://doi.org/10.1186/1748-5908-5-56. 2014;22(4):27680. The final in group studied comprised a diverse collection of evaluation and impact studies and other, more general, articles. Several regulatory bodies used their annual reports to express frustration with outdated legislation around fitness to practise. Wier J. Health Information and Quality Authority (HIQA) HIQA is the independent authority established to drive continuous improvement in Ireland's health and social care services. For example, in Australia voluntary regulation and self-regulation play a core role, using frameworks derived from state-led and intergovernmental committees. https://doi.org/10.1111/jep.13279. Moreover, practice standards and rigid protocols imposed without simultaneous clarity around goals and flexibility to respond to dangerous circumstances will push the management of risk on to individuals [17]. J Eval Clin Pract. The countries reviewed provide examples of systems that vary in the way that health and social care services are organised and financed. PDF Support RAND For More Information CPD is now increasingly widespread and mandatory in the health and care professions [48]. Our definition of research in the context of this review was a broad one: we included surveys, consultations, and strategic reviews as well as literature reviews, peer reviewed publications and commissioned research. AB made substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data; and substantially revised the work for publication. These comprise the core literature underpinning the REA. Terms and Conditions, Browne F, Bettles S, Clift S, Walker T. Connecting patients, practitioners, and regulators in supporting positive experiences and processes of shared decision making: a progress report. https://doi.org/10.1016/j.midw.2017.06.001. J Interprof Care. Guillemin M, Archer J, Nunn S, de Bere SR. Revalidation: patients or process? 2018;27(10):81826. https://doi.org/10.1080/13698575.2016.1192585. Care standards are intended to support efforts in maintaining and improving the A 2011 scoping review, exploring the academic literature on the behavioural effects of regulatory activity and interventions on those regulated, concluded that the evidence concerning how professional regulation affects behaviour was both sparse and weak [1]. Knox S, Dunne SS, Hughes M, Cheeseman S, Dunne CP. Thomas LA, Tibble H, Too LS, Hopcraft MS, Bismark MM. The structure and form of these standards vary in terms of their specificity. https://doi.org/10.1016/j.wombi.2015.08.005. Health care stakeholders will face escalating pressure to articulate their . The Canadian national EMS research agenda: impact and feasibility of implementation of previously generated recommendations. Mechanisms to secure standard adherence include criminal or civil penalty; licence revocation or suspension; physician revalidation. All papers reported a number of conceptual and practical issues concerning how quality of care is assessed and measured. Bourne T, Vanderhaegen J, Vranken R, Wynants L, De Cock B, Peters M, et al. Negative attitudes can be exacerbated by evidence of inconsistent practice across regulators, regions or countries. Midwifery. CJEM. This may cause individual practitioners some concerns about how to make personal choices regarding their own training and registration. Int J Nurs Stud. official website and that any information you provide is encrypted https://doi.org/10.1016/j.ijnurstu.2013.07.005. A relatively simple institutional search for nursing and professional regulation produced over 200,000 results. BMC Med. London: Professional Standards Authority for Health and Social Care. These seem to support the notion that regulatory systems need to strike a balance between the use of formal, interventionist instruments and more informal, softer approaches to ensure standard adherence and quality improvement more broadly. 2018;63(3):28593. We were able to focus our searches more effectively thanks to a rigorous specialist-designed search strategy involving lengthy and comprehensive search strings. Most work presents relatively weak data of low relevance to regulators, mainly reporting or describing the current position. Jensen JL, Blanchard IE, Bigham BL, Carter A, Brown R, Socha D, et al. 2018;32(2):20623. However, the continued presence of traditional hierarchies in healthcare continues to threaten the development of more common approaches to regulation [78,79,80]. Antecedents and processes of professional misconduct in UK Health and Social Care: Insights into sexual misconduct and dishonesty. This is also the case in Australia. CAS We also reviewed ten UK regulators websites, analysing the most recent annual reports to identify issues of current concern and details of future strategic priorities to gain insights into whether, and if so, how far, the published research literature informed the regulators agendas and vice versa. Disability & Society. One mechanism that may encourage the adoption of new quality improvement measures is competition [62]. Acad Med. What are the functions of regulatory bodies? Responses to the Francis Inquiry demonstrate the need for an interprofessional response. BMC Medical Education. An example is the General Dental Councils 2018 annual report which stated ([84] p9). The site is secure. Sociol Health Illn. The same authors, in a subsequent study [71], found that many midwives had opted to maintain dual nursing and midwife registrations, making the revalidation process more complicated. Command and control: implies direct enforcement by government (eg licensing professionals and facilities, enforcing performance standards). Guidelines and standards how regulatory guidance is modified, interpreted and applied, the impact of standards on practice and training, the impact of government and employer regulations on regulatory guidance (e.g. Retrieved from: https://www.nmc.org.uk/globalassets/sitedocuments/other-publications/bme-nurses%2D%2Dmidwives-ftp-research-report.pdf. https://doi.org/10.1136/bmjopen-2016-012545. https://doi.org/10.1016/j.socscimed.2018.07.042. 2011;26(1):1932. Conversely, Germany and the USA have established quasi-legislator bodies with wide competences in standard setting. The out group was retained in case future work is needed. https://doi.org/10.1111/adj.12625. our largest regulator the Therapeutic Goods Administration looks at prescription medicines, vaccines, sunscreens, vitamins and minerals, medical devices, blood and blood products the Aged Care Quality and Safety Commissioner looks into the quality of care or services being delivered to people receiving aged care services Article The USA has a framework for creating national standards, but the considerable power of state governments and the tendency to rely on private markets to purchase and provide care creates challenges to a unified national quality standard. Your privacy choices/Manage cookies we use in the preference centre. The regulator for the health and social care sector in England is the Care Quality Commission (CQC). Professional regulation | NHS Employers However, there is little empirical evidence by which to assess the effectiveness of regulatory strategies for ensuring care quality and safety at system level. Patient safety regulation in the NHS: mapping the regulatory landscape Our work around the UK. Review full papers. A perspective on councils on chiropractic education accreditation standards and processes from the inside: a narrative description of expert opinion, part 2: analyses of particular responses to research findings. Some specifically explored the implementation process. Our work was commissioned by the PSA, which was particularly interested in research relating to its own regulators in UK. Project Report. These were analysed in detail by all members of the research team. Spyridonidis D, Calnan M. Are new forms of professionalism emerging in medicine? These organisations have been set . This finding needs contextualising, however. Professional Standards Authority for Health and Social Care Right-Touch Reform: A new framework for assurance of professions. Concerns about damage to reputations and loss of business may also affect incident reporting [35] and there is significant anxiety regarding vexatious complaints [32] . Butcher DL, MacKinnon K, Bruce A, Gordon C, Koning C. Experiences of pre-licensure or pre-registration health professional students and their educators in working with intra-professional teams: a qualitative systematic review. Henshaw AM, Clarke D, Long AF. PubMedGoogle Scholar. BMJ Qual Saf. https://doi.org/10.1093/intqhc/mzu036. In Finland, administrative and political responsibility is largely devolved to local authorities, while in the Netherlands responsibility for the health and social care systems is shared by central government and corporatist actors. 2016;6(7):e011711. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/399020/Response_Cm_8995.pdf. Google Scholar. Google Scholar, Roerig M, Farmer J, Abdulrahman G, Gomaa N, Dempster L, Evans K, et al. The https:// ensures that you are connecting to the Complaints about dental practitioners: an analysis of 6 years of complaints about dentists, dental prosthetists, oral health therapists, dental therapists and dental hygienists in Australia. https://doi.org/10.1080/13691451003706670. https://doi.org/10.1017/S1460396916000054. PubMed Aged Care COVID-19 infection control training HHS Guidance Portal is a searchable database for HHS guidance documents currently in effect. Journal of Interprofessional Care. Gray M, Rowe J, Barnes M. Midwifery professionalisation and practice: influences of the changed registration standards in Australia. Flow diagram detailing the search process. Bryce M, Luscombe K, Boyd A, Tazzyman A, Tredinnick-Rowe J, Walshe K, et al. J Adv Nurs. PubMed The School of Social Sciences Research Ethics Committee at Cardiff University gave ethical approval for this study. Regulators distinctive cultures around patient safety present a potential barrier to curricular integration [38, 39]. The Government Social Research Services Rapid Evidence Assessment toolkit was used as the basis for the methods we used [10]. Provided by the Springer Nature SharedIt content-sharing initiative. Kennedy C, O'Reilly P, Fealy G, Casey M, Brady AM, McNamara M, et al. 2013;4(3):625. In the USA, regulation has traditionally relied heavily on professional self-regulation through board certification and peer review. In Finland, the standards can be traced back to central government and its constitution, but they operate primarily through self-regulation. Lgar F, Freitas A, Thompson-Leduc P, Borduas F, Luconi F, Boucher A, et al. Inclusion in an NLM database does not imply endorsement of, or agreement with, PDF Overseeing the regulators health and social care professionals? An official website of the United States government. In discussing these results, we identify several significant challenges for the study of health and care professions regulation that, if addressed, could improve regulators access to high quality research evidence. Contemp Nurse. BMC Nurs. 2014;51(1):1506. This research has focused primarily on collecting information on existing regulatory mechanisms and actors responsible for ensuring quality of care, rather than comparing levels of patient safety and incidents across the countries examined. volume21, Articlenumber:934 (2021) Moreover, there is a collective move towards greater transparency in the sector through making information available on quality and safety as a means of informing service users and funders. Regan S, Orchard C, Khalili H, Brunton L, Leslie K. Legislating interprofessional collaboration: a policy analysis of health professions regulatory legislation in Ontario, Canada. We undertook a rapid evidence assessment (REA) of the international literature on health and care professions regulation, including reviewing ten UK regulators websites to identify issues of concern and strategic priorities. The majority of accredited continuing professional development activities do not target clinical behavior change. In an attempt to decrease the risks, the research team devised a novel four-stage process to select the most relevant and highest quality papers for review. A shift in health care regulatory priorities has been underway for more than a decade under both Democratic and Republican administrations. Fundamentally, the goal of health professional regulatory regimes is to ensure the highest quality of care to the public. Additionally, we set to one side a large number of lower quality, or less relevant papers that we deemed to be beyond the scope of the study but that might have some potential relevance to future research. Since publication of the Quick report, there have been significant changes in how the public and the professions view the function, purpose and effectiveness regulation within the health and care sectors. 2017;24(4):392407. The 2011 call for stronger evidence on the effectiveness of professional regulation in ensuring high quality care has been taken up more widely following a number of high-profile systematic failings [2, 3]. Healthcare regulation: deciding when statutory regulation is - GOV.UK https://doi.org/10.12968/bjom.2014.22.4.276. Policing the profession? This is a particular issue where new, hybrid or specialist roles are developed that are not adequately covered by current regulatory guidance [58, 59] and where scope of practice and the associated decision-making frameworks, particularly with respect to care for patients, are not clearly conceptualised [60, 61]. A key concern of five of the papers in this group was the statutory supervision of midwives. First among these is that our broad search of the academic literature on regulation confirms the 2011 reports view that the majority of papers report small, uni-professional projects that are local in scope and often appear to be driven by particular agendas. Who regulates health and social care - HSE 2014;23(3):25764. These results are unsurprising in view of the predominance of methods aimed to establish the perceptions of practitioners; while practitioners perspectives are vitally important to the success of improvement initiatives, there was far less multi-methods research aimed at reliably exploring more generalisable causal linkages between professional regulation and professional behaviour. https://doi.org/10.1136/bmjopen-2018-028663. Ryan AT, Too LS, Bismark MM. This study is concerned with "standards of quality and safety" within health and social care systems. Harm prevention and patient safety evidence concerning regulatory activity that aims to reduce the number of patient-safety incidents and to identify and prevent adverse events before they occur. Chiropractic & Manual Therapies. A regulatory body is a public organization or government agency that is responsible for legally regulating aspects of human activity. Role of selected healthcare regulatory agencies in Nigeria Care standards are intended to support efforts in maintaining and improving the quality of care; they have been developed across countries, although the ways in which they are implemented and applied differs between nations. Taking a range of six countries, we review the regulatory mechanisms that have been implemented to ensure that essential standards of care are applied and are being adhered to, and consider the range of policy instruments used to encourage and ensure continuous quality improvement. Cite this article. The full search strategy complete with Boolean strings is reported in Appendix 1. Tiffin PA, Paton LW, Mwandigha LM, McLachlan JC, Illing J. PubMed Analysis of routine hospital data in the English NHS following the introduction of medical revalidation. Article BMJ Open. Many professions have increased the academic content of their education and training, and there are mixed reports on the effects of this depending on the profession concerned. Regulatory Changes in the Future of Health | Deloitte US government site. https://doi.org/10.12968/jpar.2018.10.5.205. Help HHS Review Existing Regulations Through them we build and maintain relationships with relevant organisations and politicians. The other regulators outlined the various measures they were introducing to reduce the number, complexity and burden of FtP procedures including new threshold criteria, increased recruitment of specialist staff, and new measures to close down cases early where this was indicated. BMC Med. The setting of standards typically applies to particular sectors or settings (eg nursing homes), rather than an overarching essential set that is applied across sectors. Regulators have taken significant steps towards tackling perceptions that their regulatory systems are complicated, and that their overriding culture is punitive and overly concerned with fitness to practise (FtP) by developing more collaborative approaches to regulation based on partnership, open consultation and dialogue [4, 5]. https://doi.org/10.1097/ACM.0000000000000464. Gallagher A, Banks S, Jago R, Zasada M, Austin Z, van der Gaag A. 2020;14(2):187203. iii Preface This report is concerned with 'standards of quality and safety' within health and social care systems. van der Gaag A, Jago R, Zasada M, Banks S, Gallagher A, Lucas G, et al. https://doi.org/10.1111/j.1365-2702.2012.04262.x. They also stress that more data are needed to gain a more complete picture. https://doi.org/10.1080/09687599.2011.529663. 2017;52:5763. https://doi.org/10.1002/jpoc.21117. research departments and even specialist journals, health and social care regulation is still developing its own place as an evidence-based field of study and practice . These studies mainly related to relationships between the regulator and registrants. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. The role of the regulatory body is to establish and strengthen standards and ensure consistent compliance with them. Harrison R, Walton M, Healy J, Smith-Merry J, Hobbs C. Patient complaints about hospital services: applying a complaint taxonomy to analyse and respond to complaints. Relations with regulatory bodies research and reports commissioned by regulatory bodies; practitioners attitudes to and reception of regulatory guidance. 2018;10(5):20510. 2012;24(1):8894. What is the definition of a regulatory body? https://doi.org/10.1017/cem.2015.29. Studies reported the views of registrants and other stakeholders who perceived regulators as remote, mistrusted, punitive and unsupportive. Google Scholar. Almost all studies indicate support for clearer guidance, greater harmonisation and standardisation of FtP processes both within and between professions, more support for professionals subject to FtP procedures and a quicker and more streamlined approach to complaint resolution. https://doi.org/10.1111/hsc.12221. Quick O. This presents a unique opportunity both for regulators and academics. Accountability: the challenge for medical and nursing regulators. ethical practice, working hours, workforce planning etc.). 1362 papers rated 3 or less were excluded at this stage. We were assisted in our definition of relevance throughout the screening process by the PSAs own definition of the four roles of the regulator [6]. Complement Ther Med. What we do provide, however, is a detailed account of the situation in each country, illustrated where available through case studies, about how these regulatory mechanisms are implemented in practice. Healy JM. We used a systematic desk-based search using a variety of sources to identify the total number of organisations with regulatory influence in the NHS; we researched publicly available documents listing external inspection agencies, participated in advisory consultations with NHS regulatory compliance teams and reviewed the websites of all regulat. Rethinking Regulation. As a library, NLM provides access to scientific literature. Intra-professional learning depends on positive attitudes among faculty, but evidence is lacking concerning patients and carers participation, especially in clinical assessments. The International Journal of Pharmacy practice. We report key findings from our content analysis within each of our final six thematic groupings plus the website review. "no one has yet properly articulated what we are trying to achieve": a discourse analysis of interviews with revalidation policy leaders in the United Kingdom. Regulators, working more closely together, are in a position to set a research agenda for this emergent field by making more effective use of the research literature, refocusing the work of their policy and research departments to ensure that the benefit of engaging with academics and scholarly practice are fully realised, and by ensuring that their research budgets are used more effectively to commission only the highest-quality and most relevant evidence to support their regulatory work, along with targeted dissemination strategies. We also undertook a review of the websites of the ten regulatory bodies overseen by the PSA Because of the enormous scale and scope of these websites, we focused in particular on the regulators annual reports that were current in early 2020. Failure to disclose disability or ill health may affect FtP; while disclosure may benefit practitioners if it leads to appropriate workplace adaptations, many were reluctant to reveal special needs because of fears around stigmatisation [34]. How many health and social care regulating agencies are there? 2011;67(11):247887. Harvey C, Driscoll A, Keyzer D. The discursive practices of nurse practitioner legislation in Australia. Many of these papers conclusions were anticipated in Promoting Professionalism, Reforming Regulation [36] which concluded that if these things were to be achieved in the UK, then current legislation would need to be changed to give more autonomy to professional regulatory bodies. Analyzing complaints made by the public to the Royal College of dental surgeons of Ontario. 2018;65(1):1323. Internal politics may influence which curricula or programmes are chosen and implemented. Background: Healthcare regulatory agencies are responsible for regulating the training and practice of professionals and accreditation of the premises where professional activities take place . What is the Role of Regulatory Bodies in Healthcare? Several regulators also committed to measures to reduce the distress caused by lengthy proceedings and providing extra support for registrants. Based on each country's approaches to quality regulation in health and social care reviewed, we distinguish three categories of regulatory competencies: supervisory and standard enforcement competencies; monitoring and/or standard setting competencies; and quasi-legislator competencies. Rapid evidence assessment toolkit. BMJ Open. Recent research into healthcare professions regulation: a rapid The complexity and scale of the task was increased because of the relatively open research questions, the nine-year timespan, the dozens of professional groups involved, and the international scope of the work. We added a further 134 publications from a search of key authors known to be active in the field, removing 59 duplicates. Knox S, Cullen W, Dunne C. Continuous Professional Competence (CPC) for Irish paramedics and advanced paramedics: A national study. https://doi.org/10.1111/j.1365-2648.2011.05650.x. https://doi.org/10.1007/s10459-017-9802-1. PubMed Central Why do paramedics have a high rate of self-referral? Accessibility 2017;26(2):12030. Beaussier et al. This is not only a challenge when it comes to locating a body of evidence in the field, but it represents challenges for sustained, programmatic research and also hampers regulators efforts to locate and collaborate with experienced academic research teams to explore solutions that would be useful to them. and transmitted securely. Health Policy. https://doi.org/10.1111/inr.12367. 2013;21(1):210. After careful consideration we added these as additional themes. 2013 Jan;29(1):7585. https://doi.org/10.1136/bmjopen-2016-011711.
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