Tim Walker Chief Executive GOsC 19 September 2016 What is regulation A rule or directive made and maintained by an authority The control governance or management of a larger system by a smaller ID: 545220
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Slide1
Regulation as a learning community
Tim Walker
Chief Executive, GOsC
19 September 2016Slide2
What is regulation?
‘A
rule or directive made and maintained by an
authority’
‘The
control, governance or management of a larger system by a smaller
system’
‘A framework which allows professionalism to flourish’Slide3
The traditional approach
Regulatory systems for healthcare professionals tend to have a core set of activities:
Approval and quality assurance of educational courses/ programmes
Holding a register of current practitionersSetting standards of competency, conduct and ethicsAssuring continuing competence of practitionersManaging complaints and disciplinary proceedingsSlide4
Avoiding harms
Discipline
Point of Harm
‘Upstream activity’
TimeSlide5
Challenges in avoiding harms
Disciplinary processes – tail that wags the dog
Little systemic analysis of harms:
Why these occurWho is involvedLack of coherence in ‘upstream’ interventions that can reduce harm (or evidence that supports them)How to measure events that don’t happenSlide6
What do we know about ‘harms’?
Analysis of 660 GOsC complaints, indemnity insurance claims and concerns raised with professional association 2013-15 (NCOR 2016):
311 conduct
333 clinical care10 convictions6 adjunctive therapySlide7
Significant concerns
Conduct
Failure to communicate effectively (44)
Failure to obtain valid consent (42)Sexual impropriety (39)Communicating inappropriately (32)Failure to protect patient modesty/dignity (27)Clinical careTreatment causes new of increased pain/injury (118)
Inappropriate treatment/treatment not justified (60)Treatment administered incompetently (34)Slide8
What do we know about people?
Analysis (unpublished) of 131 individuals investigated by the GOsC 2011-16 (
n.b.
not all resulted in an adverse finding) Headline findings:71% male, 29% femaleMedian age 46Peak between 6-15 years after graduationAge at graduation appears to be a factor (>30s more likely to be investigated)Slide9
What do we worry about as a regulator?
Engagement with standards (McGivern et al 2015):
76% ‘familiar with current standards’
44% ‘standards reflect what it means to be a good osteopath’49% ‘I have a clear sense of whether I am complying’Communication and consent – see complaints/ concerns data abovePractitioner isolation – 56% practise on their own more than 90% of the time (KPMG 2011)Slide10
A new approach to CPD
Requirement that CPD covers the breadth of an individual’s practice and the
GOsC’s
standards:Communication and patient partnershipKnowledge, skills and performanceSafety and quality in practiceProfessionalismCompulsory elements on communication/consentRequirement for objective feedback, e.g. patients, colleagues, audit
Peer discussion at end of three-year cycle Key words are: engagement, community and supportSlide11
New tools to support practice
Developing practice-focused guidance underpinning standards, explaining the ‘why’ not just the ‘what’
Exploring patients’ and osteopaths’ values
and what interventions can be used to reduce risk of misunderstandingsWorking with the profession to support the development of local learning communitiesSlide12
Why learning communities?
‘Communities
of practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact
regularly’ (Wenger and Trayner 2015)Continued development of professionalism in practice requires more regular interventions than can possibly be provided by a regulatorSpace is needed for professionals to have supportive, reflective conversationsSlide13
Implications for regulation
The disciplinary element of regulation is unavoidable, but…
A model based on deference and fear is demonstrably ineffective
Shifting the focus ‘upstream’ will require new thinking and regulators carrying out new rolesAn ideal profession needs to be a participative learning community that supports both autonomy and responsibilityRegulators can play a facilitative role to both support and be part of that learning communitySlide14
References
KPMG (2011)
How
do osteopaths practise? http://www.osteopathy.org.uk/news-and-resources/document-library/continuing-fitness-to-practise/kpmg-report-a-how-do-osteopaths-practise-ozone/how-do-osteopaths-practise-kpmg-reporta-ozone.pdf McGivern et al (2015) Dynamics of effective regulation
http://www.osteopathy.org.uk/news-and-resources/document-library/research-and-surveys/dynamics-of-effective-regulation-final-report/dynamics-of-osteopathic-regulation-final-report.pdf
NCOR (2016) Types of concerns raised about osteopaths and osteopathic services in 2013 to 2015 http://www.osteopathy.org.uk/news-and-resources/document-library/about-the-gosc/pac-june-2016-item-6a-annex-a-common-classification-system-data/public-item-6a-annex-common-classification-system-data-report-final.pdf Sparrow (2008)
The Character of Harms: Operational Challenges in Control, Cambridge University Press: Cambridge, UKWenger and Trayner (2015) Introduction to communities of practice http://wenger-trayner.com/introduction-to-communities-of-practice/