Regulating reliably: building high-reliability regulators in healthcare

Macrae, Carl

Abstract

Regulation and regulators play a critical role in assuring the quality and safety of care, and undertake a range of influential activities. This includes setting appropriate standards of care; assessing and monitoring care actually being delivered within healthcare systems, often through intensive data collection and inspection; intervening when standards of care are suboptimal, with options ranging from supportive guidance to legal sanction; and, perhaps most fundamentally , determining whether organisations and practitioners can provide care in the first place, through licensing and registration. Healthcare organisations and practitioners are heavily scrutinised by an array of these external regulatory actors and activities. In the English National Health Service, for instance, around 126 different oversight bodies have some role in assessing, monitoring and regulating patient safety. 1 Despite this-and indeed, likely in part due to this supervisory complexity 2-disastrous care failures still happen with distressing regularity, 3,4 with healthcare regulators often identified as having missed or misunderstood the emerging signs of impending failure. 5 Moreover, regulators themselves can struggle to establish regulatory strategies, practices and cultures that enable effective regulation of increasingly complex and pressured health services, 6,7 leading to regulatory crises that threaten the legitimacy of, and trust in, the regulatory system itself. 8,9

Citation

Macrae, C. (2025). Regulating reliably: building high-reliability regulators in healthcare. Journal of the Royal Society of Medicine, 118(1), 11-15. https://doi.org/10.1177/01410768241309191

• Journal Article Type: Article
• Acceptance Date: Dec 8, 2024
• Online Publication Date: Jan 24, 2025
• Publication Date: 2025-01
• Deposit Date: Jan 28, 2025
• Publicly Available Date: Mar 6, 2025
• Journal: Journal of the Royal Society of Medicine
• Print ISSN: 0141-0768
• Electronic ISSN: 1758-1095
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 118
• Issue: 1
• Pages: 11-15
• DOI: https://doi.org/10.1177/01410768241309191
• Public URL: https://nottingham-repository.worktribe.com/output/44687383
• Publisher URL: https://journals.sagepub.com/doi/full/10.1177/01410768241309191