This report is a literature review commissioned by the PSA to look at scoping a study to examine the effects of health professional regulation on practitioner behaviour and identifying gaps in current research.
Find out more in the summary below or download the full report below.
Limited empirical evidence on regulation’s impact
- Few studies directly examine how regulation influences health professionals' behaviour.
- Most existing research focuses on organisational outcomes or perceptions rather than individual conduct.
Challenges in measuring regulation effects
- Difficult to isolate regulation’s impact due to multiple influencing factors.
- Complex, multi-layered healthcare regulation makes assessing individual behavioural change challenging.
Theoretical Frameworks and Motivations
- Few studies utilise behavioural theories; goal framing theory highlights hedonic, gain, and normative signals.
- Signals from regulation influence behaviour differently, but parameters are context-dependent and under-researched.
Influence of professional certification and disciplinary actions
- Certification linked to higher safety and better care; evidence suggests positive effects on quality.
- Disciplinary processes impact practitioners’ conduct and self-esteem, but evidence is limited and often based on small samples.
Tensions between professional autonomy and regulation
- Professionals often rationalise non-compliance through clinical judgement.
- Regulation is seen as a social defence, sometimes leading to defensive practices like defensive medicine.
Role of technology and design in regulation
- Design-based regulation, such as safety-engineered devices, can prevent errors before they occur.
- Technology’s effectiveness depends on aligning with professional values and discretion.
Impact of external regulation on healthcare organisations
- External pressures and accreditation are associated with improved organisational quality systems.
- Regulatory reviews can positively influence organisational performance but may not directly improve patient outcomes.
Gaps and future directions
- Significant gaps exist in understanding how regulation affects individual professional behaviour.
- More empirical research is needed to clarify mechanisms and develop effective regulatory practices.
Compliance with open disclosure guidance
- Evidence shows that disclosure of adverse events remains uncommon, with only 24% of English hospital trusts routinely informing patients in 2005.
- Doctors are less likely to disclose errors that are less obvious or when serious adverse events occur, often due to fears of litigation and external accountability.
Factors influencing pfrofessional disclosure behaviour
- Doubts about legal safety, resource constraints, paternalism, and trust issues hinder open disclosure.
- Professionals often view regulation negatively, associating it mainly with disciplinary actions, which affects their willingness to engage openly.
Impact of regulation and training on practice
- Empirical evidence suggests regulation has limited influence on changing practitioner behaviour.
- Most influence comes from professional norms, peer behaviour, leadership, and clinical judgement rather than formal regulation or guidelines.
Role of clinical guidelines and Judgement
- Healthcare professionals tend to prioritise their own clinical judgement over external rules and guidelines.
- Disapproval of violations varies by profession, with doctors generally more tolerant than midwives or nurses.
Legal and criminal law effects
- Tort law and litigation are intended to deter unsafe practices but lack conclusive evidence of effectiveness.
- Criminal prosecutions for gross negligence are rare and may foster secrecy and shame rather than safety improvements.
Influence of professional attitudes and culture
- Surveys show doctors report changing practices due to guidelines but are less supportive of peer review and reporting colleagues.
- Fear of retribution discourages whistleblowing, especially in the UK, where only about half of doctors report impaired colleagues.
Challenges in implementing effective regulation
- Regulation often operates alongside multiple influences, making its direct impact difficult to measure.
- Practitioners tend to trust their own judgement and colleagues more than external regulation, which faces legitimacy issues.
Future research directions
- More interviews and focus groups with practitioners could shed light on regulation’s influence.
- Case studies of hospitals under regulatory intervention and applying behaviour theories could improve understanding of regulation’s role.
Summary of key barriers and opportunities
- Practitioners perceive regulation mainly as a compliance burden, not as a helpful resource.
- Building trust, leadership, and integrating regulation with professional norms may enhance its effectiveness.