Responding to regulatory reform: National Care Forum

HammondCare Chief Executive Dr Stephen Judd has told the National Care Forum in the United Kingdom that members should pursue innovation, differentiation and ‘life to the full’ for clients in the face of new regulatory frameworks.

To do this, Dr Judd said, would require knowing regulations better than the regulators, having an organisational approach to quality, engaging consumer groups and turning to evidence-based research.

Dr Judd was speaking at the annual conference of the National Care Forum which represents the interests of not-for-profit health and social care providers in the United Kingdom. The conference had a particular focus on implementing The Care Act 2014 and the implications for care providers.

I am certainly not an expert on your regulations but in the past 20 years in Australia we have had two significant periods of regulatory reform and today I am going to talk about what responses have worked – and what haven’t!” Dr Judd told the audience which consisted mainly of CEOs.

How not to respond to regulatory reform

Dr Judd said there were several responses to avoid in an environment of regulatory reform. These are:

  • Defeatism and ritualism
  • The folly of documentation
  • A protective disciplinary culture.

“The most common response is defeatism and ritualism. It is easy to adopt the attitude ‘please tell us what hoops we must jump through and we will jump’,” Dr Judd said. “Sometimes such compliance is not externally-driven but internalised… waving the white flag and, at the expense of the residents’ quality of life… blindly conforming to rules that may or may not exist.

“A related response of resigned compliance is an all-consuming focus on documentation. An obsessive focus on the documents in a regulatory process can, if we are not careful, drive an ‘if it ain’t written, it didn’t happen’ view of the world.

“We cannot allow regulators, assessors and care staff to focus purely on the documentation. It means that they are less likely to get a ‘feel’ for the service. Walking around, observing interactions between residents, relatives and staff and meeting clients gives everyone a far better appreciation for what the service looks like.”

Dr Judd said the third approach to avoid was a protective disciplinary culture.

“Where the threat of litigation becomes the driver, it means that care services risk becoming highly disciplined institutions in which people are under surveillance and all their actions are constantly charted, so that the company cannot be accused of acting negligently.

“Far too many older people lose those rights when they enter care services. Instead they are in a controlled environment in which they are protectively disciplined.”

Positive ways to approach regulatory reform

Instead, Dr Judd urged care providers to not forget the outcome they should be seeking, “…for residents to feel at home and to enjoy, as far as possible, the same quality of life that those living in the community have.”

He referred to Frederick Buechner, an American writer, who says in his book, The Longing for Home, that home is a place “where you feel you belong and which in some sense belongs to you”.

“That’s because human beings function well in space that they can control and in which there are things of meaning,” Dr Judd said.

To this end, health and aged car providers were urged to face the challenge of regulation by:

  • Taking it up to the regulators
  • Developing a strong organisational approach to risk and quality
  • Advocating as a sector by turning to regulatory researchers
  • Working with consumers to ensure effective regulatory change.

“Every innovative, differentiated service provider who wants to control their own business rather than be externally controlled has to be willing to challenge the assessor who walks through the door.” Dr Judd said.

“In order to do that, you have to know the codes and the actual letter of the regulations better than the assessors. Don’t take their word for it. Don’t adopt the ritualistic, tick-a-box approach to regulation.”

In regard to an organisational approach to risk and quality, Dr Judd said, “I believe organisations that want to be innovative, highly competitive in the market place and, in addition, know the regulations better than the regulator, need a structuring of quality whereby a dedicated team of people is focussed on quality, risk and safety. It is a team that ‘lives locally but reports centrally’.”

He cited HammondCare’s example of having a team of 21 people focused on this area, working in the field in local services, but reporting centrally.

“It won’t prevent stuff-ups happening but it does mean that we are able to identify what went wrong and why and what is the corrective action before any external party tells us. It is also this team who can know the regulations better than the assessors.”

Regulatory research should also be part of the mix and Dr Judd quoted the work of John Braithwaite and his co-authors who advocate for broad-based outcomes rather than ever narrower reforms.

“Good regulatory research can help with showing consumers and bureaucrats and industry groups the paths from ritualism to innovation,” Dr Judd said.

And in relation to consumers, Dr Judd it was true in some situations consumers called for more and more layers of documentation and compliance but more broadly it was vital to engage with consumers.

“I believe that the care sector would be well served to work more closely with consumer groups to agitate for innovation and for regulations that improve the lives of older people. Consumer groups can lead the charge to advocate for processes that are less focussed on checklists and documentation and more on the experience of the person.”