Design, delivery and effectiveness of health practitioner regulation systems: an integrative review

Abstract

Background Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions. Methods We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework. Findings This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures–processes–outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners. Conclusion We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.

Exploring the literature on racism and health practitioner regulation: a scoping review protocol

“…Although health practitioner regulation can include occupational rules created and enforced by various bodies such as non-governmental or self-regulatory bodies, our review focuses on regulatory bodies operating under government delegation or recognition. 5 Typical regulatory functions of health practitioner regulators include overseeing education programmes, enforcing licensure requirements and maintaining public registers, developing and enforcing standards of practice and code of ethics, and addressing unprofessional conduct. 5 Any health profession identified in the International Standard Classification of Occupations 21 will be included.…”

“… 5 Typical regulatory functions of health practitioner regulators include overseeing education programmes, enforcing licensure requirements and maintaining public registers, developing and enforcing standards of practice and code of ethics, and addressing unprofessional conduct. 5 Any health profession identified in the International Standard Classification of Occupations 21 will be included. As a result, regulators of medical doctors, nursing and midwifery professionals, traditional and complementary medicine professionals, paramedical practitioners and other health professionals (including dentists, pharmacists, environmental and occupational health and hygiene professionals, physiotherapists, dieticians and nutritionists, audiologists and speech therapists, optometrist and ophthalmic opticians, and health professionals not elsewhere classified) will be included.…”

“…4 Regulatory schemes differ around the world; however, in general, the goal of health practitioner regulation is to protect the public by ensuring practitioners provide high-quality care in accordance with standards and codes of ethics. 5 Professional regulation represents authority over specific knowledge and practices and helps to clearly articulate what is acceptable for healthcare practitioners. 6 …”