trust and transparency in the regulation of patient safety
DESCRIPTION
Trust and transparency in the regulation of patient safety. Judith Healy Regulatory Institutions Network Australian National University GovNet Health Governance Conference Brisbane, 10-11 December 2007. This talk. Responsive regulation ideas - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/1.jpg)
Trust and transparency in the regulation of patient safety
Judith HealyRegulatory Institutions Network
Australian National UniversityGovNet Health Governance Conference
Brisbane, 10-11 December 2007
![Page 2: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/2.jpg)
This talk
• Responsive regulation ideas
• Constellation of regulatory actors - networked governance
• Regulatory principles: trust and transparency
![Page 3: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/3.jpg)
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.
![Page 4: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/4.jpg)
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
![Page 5: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/5.jpg)
Regulatory pyramid
Market mechanisms
Self-regulation
Meta-regulation
Command and control
Voluntarism
RegNet researchers: John Braithwaite, Neil Gunningham, Peter Grabosky
Co-regulation
![Page 6: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/6.jpg)
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
![Page 7: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/7.jpg)
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 -)
![Page 8: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/8.jpg)
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)
![Page 9: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/9.jpg)
Government
Professions
Community
Market
Institutional constellation of regulatory actors
![Page 10: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/10.jpg)
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
![Page 11: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/11.jpg)
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
![Page 12: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/12.jpg)
![Page 13: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/13.jpg)
Greater transparency
• Hospital performance indicators
• Hospital accreditation reports
• Adverse events public reporting
• Medical register – practitioner profile
• Confidential quality assurance (qualified privilege) versus open disclosure
![Page 14: Trust and transparency in the regulation of patient safety](https://reader036.vdocuments.site/reader036/viewer/2022081508/56814e00550346895dbb6d30/html5/thumbnails/14.jpg)
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