A current consultation in the UK highlights the complexity of policy choices involved in the regulation of professions. One such choice is whether to take a quality improvement or a transparent inspection approach to enhancing registrant performance in a particular area.
The quality improvement approach focusses on supporting and encouraging registrants to enhance their performance to a high level. Typically, this will involve tools such as self-reflection and peer support to maximize the registrant’s motivation to perform well. (See: Regulators’ Role in Professional Identity Formation.) To foster registrant participation, this approach generally treats the information gathered during the process as confidential and generally precludes its use in the complaints and discipline process. The quality assurance programs for Ontario health regulators adopts this approach.
The transparent inspection approach is more often used for compliance assurance. The regulator will have an inspector attend (usually on-site) using a checklist to determine whether the registrant is complying with specific objective requirements. Usually, this approach focusses on achieving minimum expectations rather than fostering excellence. For example, a regulator for retirement homes might inspect whether the home has updated the care plans for each resident every six months or whether medications are administered on schedule. Typically, the inspection report, or a summary of its findings are posted publicly.
Where the transparent inspection approach is used, a further choice is whether to post a rating summarizing the result for easy public viewing. Residents of Toronto will be familiar with the colour-coded ratings signs (green for pass, yellow for conditional pass, red for closed notice) posted at all eating establishments under the city’s DineSafe program.
The United Kingdom’s Care Quality Commission (CQC) is consulting on changes to its rating system. The CQC inspects health facilities to assess whether the: “services [are] safe, effective, caring, responsive and well-led.” The facilities inspected include the offices of general practitioner physicians, hospitals, and care homes. Current inspection reports indicate whether the indicators for each of these categories are “outstanding, good, require improvement or are inadequate.”
The CQC is considering whether to provide an overall rating for each facility. This is not a simple decision. An inquest into the death by suicide of head teacher Ruth Perry, after receiving an unexpected negative rating of her school, recommended changes to the school inspection process to reduce the stress caused by such blunt public postings.
Right-touch regulation involves careful application of the most effective regulatory tools to each circumstance.
