Design, operation and strengthening of health practitioner regulation systems: A rapid integrative review

Abstract

Background: In addition to promoting patient safety, health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability. This review aimed to identify the evidence on the design, delivery and effectiveness of HPR systems to inform policy decisions by policymakers and regulators. Methods: A rapid review approach was adopted to conduct an integrative analysis of literature published between 2010 and 2021. Fourteen databases were searched according to a standardized strategy. Data were extracted and synthesized through an integrative approach and categorized according to a modified Donabedian framework. Results We identified 410 academic and 426 grey literature sources. Key themes included HPR structures (regulatory governance systems, regulatory institutions, and system linkages), processes (registration and monitoring of continuing competence of practitioners, accreditation of entry-to-practice education programs, regulating scopes of practice, managing complaints and discipline, and regulating traditional and complementary medicine) and outcomes (impact of HPR structures and processes on health system and workforce outcomes). More evidence was found on HPR structures and processes than outcomes, though over 99% of studies were descriptive (and evidence, accordingly, of very low certainty). Synthesis was constrained by the lack of common terminology. Discussion: Trends on regulatory structures and processes emerged from this analysis. The evidence base limitations, particularly on HPR outcomes, warrant caution in the interpretation, generalizability, and applicability of these findings. Standardized terminology and more evidence on regulatory outcomes (on both workforce and health systems) could inform decisions on regulatory design and implementation.

Protecting the public interest while regulating health professionals providing virtual care: A scoping review

“…Professional regulators typically aim to meet this public protection mandate by setting entry-to-practice standards, maintaining a register of licensed practitioners, and monitoring and enforcing conduct, competency, and capacity in practice [6]. Typically, this involves some form of title protection (referred to as registration in some jurisdictions) or reservation of practice (referred to as licensing in some jurisdictions) [7]. While there are other frameworks for assuring the safety and quality of the services provided by health practitioners, including voluntary certification by professional associations, negative licensing, and accredited registers [7], we focused in this review on those practitioner groups regulated by a body with a statutory mandate to protect the public.…”

“…Typically, this involves some form of title protection (referred to as registration in some jurisdictions) or reservation of practice (referred to as licensing in some jurisdictions) [7]. While there are other frameworks for assuring the safety and quality of the services provided by health practitioners, including voluntary certification by professional associations, negative licensing, and accredited registers [7], we focused in this review on those practitioner groups regulated by a body with a statutory mandate to protect the public. While this type of regulation is most prominent in high-income Anglophone jurisdictions with a common law history, many low-and middle-income nations also regulate in the public interest, though with resource constraints that may limit the full spectrum of regulatory functions and activities [8,9].…”

Associations, unions and everything in between: contextualising the role of representative health worker organisations in policy

“…Diverse regulatory mechanisms for the health workforce exist across the world, involving combinations of self-regulation, coregulation, direct government regulation or voluntary regulation and variously engaging with RHWOs in these models 28. The role of regulatory bodies, such as professional councils, and RHWOs are conceptually distinct and governed by different institutional frameworks 13 29 30. That said, in practice, the membership of regulatory organisations and representative organisations might overlap and result in considerable collaboration between the two, for example, by working together to establish professional regulation and standards31 as well in the form of regulatory capture 32…”