Accounting for failure: risk-based regulation and the problems of ensuring healthcare quality in the NHS.
Accounting for failure: risk-based regulation and the problems of ensuring healthcare quality in the NHS.
复制标题
计算失败：基于风险的监管以及确保NHS医疗保健质量的问题。
DOI：
10.1080/13698575.2016.1192585
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发表时间：
2016-05-18
期刊：
影响因子：
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通讯作者：
Rothstein H
中科院分区：
文献类型：
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作者：
Beaussier AL;Demeritt D;Griffiths A;Rothstein H
在本文中，我们研究了为什么基于风险的政策工具未能提高英国国民医疗服务体系 (NHS) 医疗质量监管的比例性、有效性和合法性。基于风险的方法不是试图防止所有可能的危害，而是承诺通过将监管标准制定和执行活动集中在最高优先级的风险上，合理化和管理监管希望实现的不可避免的限制，这些风险是通过对其概率和后果的正式评估而确定的。因此，过去十年来，医疗质量监管机构积极采用基于风险的方法。然而，通过对2013-2015年历史政策分析和对15位英国高层知情人的深入访谈，我们发现了使用基于风险的政策工具来定义、评估和确保遵守医疗质量标准时存在的一系列实际问题。根据我们的分析，我们继续思考为什么尽管经历了一系列失败，医疗保健监管机构仍然致力于开发和使用基于风险的方法。最后，我们确定了基于风险的监管成功的几个先决条件：目标必须明确，目标之间的权衡必须能够达成一致；监管机构必须能够可靠地评估不良结果的可能性和后果；监管机构必须拥有一系列可以根据风险比例部署的执法工具；必须对不利结果有政治容忍度。
In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013–2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes.