Striving for Balance

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Illustration of a see-saw with "regulatory force" at one end and "target risk" at the other

College adopts Right Touch Regulation approach

‘Right-touch regulation is based on a proper evaluation of risk, is proportionate and outcome focused; it creates a framework in which professionalism can flourish and organisations can be excellent’

The Professional Standards Authority

It’s another busy night at a hospital emergency department, and two physicians end up exchanging fiery words with each other in front of patients and other colleagues.

While the behaviour is not professional and certainly does not reflect well on either physician, it could be argued that this is not a matter in which the College needs to be directly involved. In fact, it may be the type of matter that is most effectively managed at the hospital level.

If the antagonism between the two physicians is ongoing and escalates to the point where patients are placed in harm’s way and the hospital is unable to manage the situation, then a solid argument could be made for regulatory intervention.

This approach is an example of right touch regulation, which has been adopted by a number of regulatory bodies across the world. Because the regulator is usually furthest removed from the harm it is trying to prevent, proponents of the framework suggest it is a very dull instrument for promoting behaviour change. Right touch regulation should see regulators only intervene when necessary and remedies should be appropriate to the risk posed.

“We can’t target everything with the same amount of energy. The matters with the greatest urgency in terms of public safety must be our biggest priority.”

Dr. Nancy Whitmore, Registrar/CEO

It is an evidence-based framework that has found favour with this College.

“We need to change our mindset and work to identify how much regulatory force is actually needed to achieve a desired effect,” said Dr. Nancy Whitmore, College Registrar and CEO.

“We can’t target everything with the same amount of energy. The matters with the greatest urgency in terms of public safety must be our biggest priority,” she said.

Originating with the Professional Standards Authority (PSA) in the United Kingdom, right touch regulation ensures that the level of regulation is proportionate to the level of risk to the public. A frequently used analogy is finding the right balance on a set of scales. “When weighing something on balancing scales, nothing happens until you reach the desired weight, at which point the scales tip over,” states a paper authored by the PSA. “Once they have tipped any further, weight added to the other side is ineffectual. So the right amount of regulation is exactly that which is needed for the desired effect,” stated the paper. Too little is ineffective; too much is a waste of effort.

6 Principles of Right Touch Regulation
1. Proportionate. Regulators should only intervene when necessary. Remedies should be appropriate to the risk posed.
2. Consistent. Rules and standards must be joined up and implemented fairly.
3. Targeted. Regulation should be focused on the problem, and minimize side effects.
4. Transparent. Regulators should be open, and keep regulations simple and user friendly.
5. Accountable. Regulators must be able to justify decisions, and be subject to public scrutiny.
6. Agile. Regulation must look forward and be able to adapt to anticipate change.

Source: Professional Standards Authority

It is a concept that underlies our new approach to investigations, which is to triage complaints on the basis of risk of harm to the public and to consider managing lower risk complaints through an alternative dispute resolution process.

The framework recognizes that there is no such thing as “zero risk” and that all decisions about what and how to regulate will involve a trade-off between different risks and competing benefits.

Dr. Whitmore says that a key role for regulators in right touch regulation is to provide clinicians who may be vulnerable to potentially harmful situations with the knowledge to contribute to their prevention.

In a recent presentation to hospital presidents and chiefs of staff, Dr. Whitmore said the College is developing new tools that will increase our proactive engagement with physicians at all stages of their careers and help create conditions most favorable to ensuring their success.

A right touch regulation framework that includes accessible tools to help physicians self-manage the course of their careers is fundamental to modernizing medical regulation. It also allows us to be more transparent about our expectations, said Dr. Whitmore.

“Applying the right touch principles sets the stage for what medical regulation should be in the 21st century,” said Dr. Whitmore.

Elements at the core of Right Touch Regulation
Identify the problem before the solution
The problem must be properly described and fully understood before a solution is found.
Quantify and qualify risks
Quantifying risks means gauging the likelihood of harm occurring and its severity. Qualifying risks means looking closely at the nature of the harm, and understanding how and why it occurs.
Get as close to the problem as possible
Understand the context in which the problem arises and the tools available to address the harm.
Focus on the outcome
The outcome should be both tangible and measurable, and it must be directed towards the reduction of harm
Use regulation only when necessary
Once a problem has been fully considered, serious thought must be given as to whether regulation is the best tool to address it.
Keep it simple
If one cannot explain the purpose of a particular regulation, it will not work.
Check for unintended consequences
Regulating to remove one risk without a proper analysis of the consequences may create new risks.
Review and respond to change
Regulation strategy needs to be flexible enough to respond to new evidence that calls for change.

Source: Professional Standards Authority