Policy Tensions in Regulatory Reform: Changes to Regulation of Health Professions in Australia, the United Kingdom, and Ontario, Canada

Drivers of regulatory reform in Canadian health professions: Institutional isomorphism in a shifting social context

Research has documented how the decline in professional self-regulation in the UK and Australia was led by policy-makers in response to regulatory failures. In Canada, professional self-regulation is currently in decline as well, and while policy-makers have driven some change it is also the case that self-regulating professions have begun to transform themselves from within: altering their structure, make-up, and processes to enhance fairness, public input, and accountability, while reducing professional control. Why would they do so? This paper draws on the concept of institutional isomorphism to understand why professional regulators would invoke changes that, on the surface, might seem to counteract their own interests. Analysing data from 46 interviews with leaders in healthcare profession regulation, this paper examines how coercive, mimetic, and normative processes drive regulatory reform in a changing regulatory field.

Professional regulation, profession-state relations and the pandemic response: Australia, Canada, and the UK compared

The COVID-19 pandemic provoked a surge in demand for health services. To help meet this demand, governments and health profession regulators implemented regulatory policy change to enhance professional availability and flexibility. Some nations may have been better positioned to make such changes due to their systems of healthcare profession regulation. More specifically, countries like Australia and the United Kingdom with their national regulatory structures could be more adaptable than Canada with its provincial system of regulation. To determine if this is the case, and guided by Abbott's (1988, 2005) ecological approach, we conducted a policy analysis. We find few differences in regulatory policy changes in terms of what was done, with the exception of scope of practice changes, which were implemented in Canadian provinces, but were not necessary in Australia and the United Kingdom. Instead, in the latter two countries practitioners were asked to bear responsibility for their own scopes. Additional content analysis of medical journals explored what professionals thought about policy responses, finding that Australian professionals were more positive than others. Moreover, government responses were regarded more favourably when they were perceived to be collaborative. Although there is little evidence that one regulatory system is better than another in facilitating crisis responses, regulatory structures do shape the nature of regulatory policy change.

Stakeholder attitudes to the regulation of traditional and complementary medicine professions: a systematic review

BACKGROUND

There has been a considerable increase in the number of traditional and complementary medicine (T&CM) practitioners over the past 20 years and in some jurisdictions are estimated to outnumber general practitioners. Despite this globally significant role, it is apparent that worldwide not all T&CM professions operate under adequate accountability and regulatory oversight for maintaining public protection. To date there has been no published systematic examination of stakeholder opinions regarding regulated and unregulated T&CM occupations. In response, this review aims to investigate, describe, and analyse attitudes held by a range of stakeholder groups towards the regulation of T&CM professions.

METHODS

A database search of AMED, CINAHL, Embase, Ovid MEDLINE, ProQuest, PsycINFO, PubMed, Scopus, and Google Scholar was conducted for original research published between 2000 and 2020 on stakeholder opinions regarding the regulation of T&CM professions.

RESULTS

Sixty studies across 15 countries reported on the views of six health care stakeholder groups: consumers, T&CM practitioners, conventional medicine practitioners, professional associations, education providers, and policy-makers. Across all stakeholder groups there was between 15% and 95% (median 61%) support for, and 1% to 57% (median 14%) opposition to the regulation of various T&CM professions. The main reasons for supporting regulation included providing greater public protection, raising training and practice standards, establishing title protection, and gaining acceptance from conventional medicine providers. Concerns regarding regulation included potential restrictions to practice, misappropriation of practice, and medical oversight of T&CM practitioners. Few studies canvassed the views of professional associations (n = 6), education providers (n = 2), and policy-makers (n = 2).

CONCLUSIONS

There appears to be broad support for the regulation of T&CM professions, although there was wide variation in attitudes as to how this should be applied. Further research, with a particular focus on policy-makers, education providers, and professional associations, is critical to inform appropriate health policy and practice recommendations relating to T&CM professional regulation across jurisdictions. Systematic review registration: the a priori protocol for this systematic review was registered in PROSPERO and is available at: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42020198767 .

Regulation and accreditation of pre-licensure education of registered nurses: a scoping review protocol

OBJECTIVE

The objective of the scoping review is to examine and map the literature that reports outcomes of the regulation and accreditation of pre-licensure education of registered nurses (RNs).

INTRODUCTION

Pre-licensure nursing education is the basic education that a person must complete before becoming an RN. Regulation and accreditation of nursing education vary by country and may vary within a country. The intended purpose of regulation and accreditation is to protect the public and ensure the quality of education programs; however, there is a gap in published evidence on the outcomes of such regulation and accreditation.

INCLUSION CRITERIA

Published and unpublished studies worldwide of any pre-licensure RN students or any pre-licensure graduates of RN programs will be considered. Concepts of interest for the proposed review are reported outcomes related to regulatory activities or accreditation requirements affecting any pre-licensure education programs preparing students to become RNs. The context is pre-licensure regulation or accreditation of RN education in any country or setting. This review will consider quantitative research designs, qualitative research designs, economic evidence evaluations, and textual evidence/gray literature.

METHODS

Databases to be searched include CINAHL Complete, Cochrane Central Register of Controlled Trials, Directory of Open Access Journals, Education Source, Health Policy Reference Center, MEDLINE Complete, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, and Ovid Nursing. Articles published in English will be included. No date limits will be set. Selected studies will be reviewed and data extracted by two independent reviewers. Extracted data will be placed in a table and synthesized in narrative format.