Peter Carter Chief Executive Officer International Society for
Quality in Health Care Physician Heal Thyself
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Agenda Definitions Introduction Why Regulate (Self or Imposed)
Scale of Challenges Case Studies The Beauty and the Beast of Self
Regulation Big Brother (Imposed Regulation) Questions for you
2
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Definitions 3
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Choice Self Regulation OR Imposed Regulation OR WHAT???
Hybrid?? 4
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Why Regulate 5 Market Failure Public Interest Private
Interest
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Market Failure(Asymmetry of Information) Consumer less informed
about nature & quality of service Relies on expertise of the
professional Potential for supply induced demand So need 6
Protection of consumer through regulation
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Public Interest Cartel like behaviour Control of supply to
prices 7
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Private Interest 8 Improve market equilibrium through efforts
to promote greater and evenly distributed social welfare
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9 The scale of the challenges 140,000+ different ways the human
body can go wrong ICD10 codes 6000+ medicines for treating diseases
BNF and we wonder why things go wrong.
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The scale of the challenges 1 in 10 patients admitted
experience an adverse event Half of adverse events are judged to be
preventable 5% of deaths in English acute hospitals had at least a
50% chance of being prevented Principal problems associated with
preventable deaths poor clinical monitoring (31.3%), diagnostic
errors (29.7%), and inadequate drug or fluid management (21.1%)
Most preventable deaths (60%) occurred in elderly patients with
multiple comorbidities and less than 1 year of life left 72% of all
patient safety incidents are from the acute sector, 13% from Mental
Health, 11% from Community, 2% from Learning Disability, 0.6% from
Community Pharmacy and 0.4% from General Practice. 10
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Case Study 1 Jayant Patel Who is Dr Patel Nature of his
appointment Under the Radar Problems Emerge Inquiries Criminal
Charges What went wrong Is there a bright side? ( Lessons learned)
Questions 11
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Case Study 1(Continued) 1. Would Self Regulation have prevented
this (or similar episodes)? 2. Did the existence of a self
regulation regime prevent more effective regulatory practices being
invoked? 3. 12 Is imposed regulation alone sufficient or is it
likely to marginalise the profession?
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Case Study 2 The Beautiful Hospital Chelsmford HospitalHarry
Bailey 13
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Chelmsford Private Hospital Facts Conducted Deep Sleep Therapy
in the 1960s and 1970 Many patients died directly or indirectly as
a result over many years Failures of Self Regulation and Imposed
Regulation allowed this 14
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Why? Self Regulation Unresponsive Lacked sanctions Influenced
by peer colleagues intimidation Feared being sued Imposed
Regulation Unresponsive Poor mechanisms Was also intimidated And
Confusion between the professional body & the government
regulator in connection to responsibilities 15
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Statutory Protection PProtection for quality assurance
activities to encourage their use DDisclosure of morbidity &
mortality IInformation and the disclosure of information
DDisclosure in peer review meetings cannot result in legal action
against health professionals TThis has the effect of making Self
Regulation more effective & responsive 16
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Key arguments for imposed regulation Information Asymmetry The
professional services consumers gaps in knowledge Obligation to
fill the consumers knowledge gaps 17
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Hybrid The DoH(1997) stresses that in order to achieve the aims
of clinical governance: i.e. control, responsibility, regulation,
it expects individual health professionals to be more responsible
for the own clinical practice and professional self regulation(
individual and organisational).It must remain an essential element
in the delivery of quality patient services 18
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The Last Word goes to.. Professor Avedis Donabedian Systems
awareness and systems design are important for health
professionals, but they are not enough. They are enabling
mechanisms only. It is the ethical dimensions of individuals that
are essential to a systems success. Ultimately, the secret of
quality is love 19
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Questions Would self regulation alone have presented the deaths
& injuries in the two case studies? Would imposed regulation
have done so? Both were present in both case studies - what went
wrong? Is there a system/process that can ensure the public they
will not be injured or killed by those in whom they put their
trust? All you need in Love is Donabedian right? 20
