Efficient osteopath regulation = improved care

How effective is current regulation of healthcare practitioners, and can it be used to improve the quality of care? 

A new study exploring regulation and its unintended consequences on healthcare practitioners has sounded the alarm bells for Dr Michael Fischer, Senior Research Fellow in Organisational Behaviour and Leadership at the University of Melbourne’s Centre for Workplace Leadership. 

Dr Fischer was one of six academics who led the research project, “Exploring and explaining the dynamics of osteopathic regulation, professionalism and compliance with standards in practice”, and sees a direct link between the studies conducted in the United Kingdom, and how the results can be applied in Australia, particularly in the wake of four sudden deaths in January this year of three young trainee psychiatrists and a medical intern in Victoria. 

The aim of the research into osteopathy regulation was to explore ways to develop regulation that was not only more effective in implementation, but would also positively influence how osteopaths actually practice. 

Being sole practitioners not managed by health organisations, osteopaths made convincing test subjects, representative of the wider healthcare sector. 

Dr Fischer and his team found that although most osteopaths had confidence in the regulation (most felt the regulator was doing a good job, 82 per cent said they would always report concerns of serious misconduct. With 59 per cent actually having previously considered reporting another osteopath), very few osteopaths (only 10 per cent) had actually made a formal complaint to the regulator even when they had serious concerns about a colleague. 

The reasons for these seemingly poor lines of reporting are representative of the fear of the effects of damaging reputations and professional careers should a practitioner be investigated. 

Widespread perception is that once regulators decide to investigate, every aspect of the practice will be placed under scrutiny (not just the specific complaint), and the risk of bringing additional issues before a tribunal, such as the quality of note-keeping, will be significantly increased. 

Osteopaths who had been through a ‘fitness to practice’ tribunal and who had been interviewed by Dr Fischer and his team felt the investigations were not about malpractice, while the experience had led them to practise more defensively. 

In a separate research paper with Dr Gerry McGivern, Dr Fischer discovered that many of the doctors they had interviewed spoke about their own, or close colleagues’, personal experiences of being put through distressing investigations.  Stories emerged of numerous practitioners who had lost their careers, and others who had been left feeling so isolated, devastated and ruined that some had even committed suicide.

Complaints to regulators were particularly threatening to a doctor because, to quote one GP they spoke to:

“A doctors’ sense of self is wrapped up in their career; to have that challenged by a serious medical complaint, you have real doubts about yourself. It’s a real affront to your whole identity, your being, yourself, the way your colleagues see you. You find yourself with absolutely no support.” 

High expectations, external scrutiny and poor peer support are all factors that were cited as leading to poor reporting and less effective regulation. 

“[These are] the unintended effects of regulation,” says Dr Fischer. 

“Doctors and osteopaths have voiced concern about the way that complaints are investigated and the lack of support they receive during the process. They described how anxiety about complaints distracted them, potentially causing them to make further mistakes.”

Dr Fischer and his colleagues hope that further research will lead to regulatory reform that will enable the healthcare sector to practise with more confidence in regulators.

www.workplace leadership.com.au