Rosemary Smyth Interim Chief Executive Mental Health Commission The Principles of Responsive Regulation and its Contribution to Quality Improvement Rosemary Smyth Interim Chief Executive Mental Health Commission

Who we are & what we do Principles of Responsive Regulation & its Contribution to Quality Improvement.

Purpose of regulation Improve performance Making organisations more accountable Providing information (Walshe & Boyd, 2007) Principles of Responsive Regulation & its Contribution to Quality Improvement.

Responsive regulation - model ‘Responsive’ or ‘Smart’ Regulation Moves away from the two poles of compliance & deterrence Adopts a more flexible pragmatic approach Contingent on the behaviour of the organisation being regulated No one size fits all Organisations performing poorly will be treated more stringently from those performing well (Ayres & Braithwaite 1992) Principles of Responsive Regulation & its Contribution to Quality Improvement.

Principles of regulation (1) Accountability Clearly explain how decisions have been reached Establish clear standards and criteria against which they can be judged Well-publicised complaints/ appeals procedures Proportionality Proportionate to the risk posed Educational rather than a punitive approach where possible. Principles of Responsive Regulation & its Contribution to Quality Improvement.

Principles of regulation (2) Consistency Predictable in order to give stability & certainty Apply regulations consistently Transparency Open and keep regulations simple Aware of their obligations Given the time and support to comply The consequences of noncompliance should be made clear Principles of Responsive Regulation & its Contribution to Quality Improvement.

Principles of regulation (3) Targeting Focus on the problem Guidance and support should be adapted to the needs of different groups Focus primarily on those whose activities give rise to the most serious risks Regulations should be systematically reviewed to test whether they are still necessary and effective Better Regulation Task Force (UK 1997) Principles of Responsive Regulation & its Contribution to Quality Improvement.

Improving performance Efficiency Effectiveness Raising standards Principles of Responsive Regulation & its Contribution to Quality Improvement.

Making organisations more accountable Changing relationships between regulated organisations & interest groups to enhance accountability to users & wider society Regulators may both depend on some of these groups to promote regulatory compliance Principles of Responsive Regulation & its Contribution to Quality Improvement.

Effects of Regulation Positive Negative Sustain improvements in organisational performance and quality Encourage critical self-analysis of performance in relation to similar organisations and or standards Codify policies and procedures Provide impetus for change (Sutherland and Leatherman, 2006) Negative Temporary improvements timed to coincide with inspections or targets Reinforcement to strive for minimally accepted performance rather than aspire towards excellence Foster gaming Resource intensive/significant opportunity costs Focus on centrally defined priorities rather than local needs Principles of Responsive Regulation & its Contribution to Quality Improvement.

Detecting/Measurement Regulatory tools Direction Detecting/Measurement Enforcement (Leatherman & Sutherland, 2006) Principles of Responsive Regulation & its Contribution to Quality Improvement.

A hierarchy of regulatory interventions Closure removal of licence Detailed ongoing supervision inspection; penalties; limitations to activities or areas of work Formal requirement to remedy problems; repeat or follow-up inspections; disclosure of findings to others; referral to support or other agencies Informal intervention to deal with minor problems; limited follow-up inspection; positive feedback on achievements and strengths Granting of greater autonomy; relaxing of regulatory regime; rewards for good performance; public recognition of achievements; leading role in transferring good practice to other organisations (Walshe, 2009)

Regulating for improvement Information high quality and timely data to make responsive regulatory decisions Regulatory staff content knowledge and credibility process skills in interaction and professional judgement Regulatory process design discretion and flexibility allowed in its implementation balanced with need for accountability and fairness (Walshe, 2009) Principles of Responsive Regulation & its Contribution to Quality Improvement.

Conclusions Regulation strategies are not “evidence-based” Some evidence that regulation: Can drive change in healthcare organisations Can have negative as well as positive impacts Responsive regulatory strategies provide opportunities to make more effective use of regulation so as to contribute to quality improvement efforts More research is needed to develop and evaluate effective regulatory strategies Principles of Responsive Regulation & its Contribution to Quality Improvement.

Thank you for your attention! rosemary.smyth@mhcirl.ie Principles of Responsive Regulation & its Contribution to Quality Improvement.