1. 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

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

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

5. 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.

6. 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.

7. 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.

8. 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.

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

10. 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.

11. 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.

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

13. 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)

14. 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.

15. 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.

16. Thank you for your attention!
Principles of Responsive Regulation & its Contribution to Quality Improvement.