ORCID

Abstract

Background: The raison d’etre of healthcare profession regulators across the globe is to protect patients and the public from the risk of harm. In cases of serious misconduct, remediation is deemed to be an important factor when considering the risk of harm from a practitioner under investigation. Yet, we know very little about how regulators account for remediation in their decision-making, and whether it is consistent with the aim of risk reduction. This paper explores the role of remediation in decision-making in cases of serious misconduct before UK healthcare regulators. Methods: We conducted interviews with 21 participants from across eight of the nine UK healthcare profession regulators, covering a range of roles in the decision-making process in misconduct cases. Interviews were conducted remotely by video call and digitally transcribed. Data were analysed using the framework analysis method. The initial framework was developed from existing literature and guidance documents from the regulators, and was subsequently refined through the various rounds of coding. Results: Remediation influenced decision-making in three ways: (1) Some types of misconduct were deemed more inherently remediable than others. In cases involving dishonesty or sexual misconduct, remediation was less likely to serve as a mitigating factor. (2) Decision-makers often view remediation as a proxy indicator of practitioner insight. (3) Whether a practitioner had demonstrated their commitment to change through undergoing remediation was more likely to feed into decision-making at the point where current impairment was under consideration. Conclusions: Remediation plays a key role in decision-makers’ judgements in cases of misconduct, particularly when these cases relate to clinical misconduct. In such cases, remediation informs judgements on the levels of practitioner insight and the risk of such misconduct being repeated. Our results suggest a need to develop remediation interventions that are explicitly geared towards the regulatory function of developing practitioner insight. Regulators should also consider the structure of their fitness to practise processes and whether there are appropriate opportunities for judgements on remediation to feed into decisions and to facilitate balanced and proportionate outcomes.

Publication Date

2024-08-06

Publication Title

BMJ Quality and Safety

ISSN

2044-5415

Acceptance Date

2024-07-16

Deposit Date

2024-09-27

Funding

This paper is derived from a larger project that was jointly funded by the General Dental Council (GDC) and the Nursing and Midwifery Council. TO'B, coauthor and coapplicant, has previously received payments (\u00A3124 675) from the GDC as an educational advisor and an assessor for specialist list applications. TO'B has also previously received payments from the GDC for acting as an expert witness in regulatory proceedings. MEB, TO'B and TG have previously received funding from the GMC: Bryce M, Gale T, Hanks S, O\u2019Brien T, Zahra D. \u2018Unlocking the potential of fitness to practise data\u2019. August 2020 to January 2022, General Dental Council, \u00A3151 711. This study was funded by the General Dental Council (GDC2019-007) and the Nursing and Midwifery Council (GDC2019-007).

Keywords

Decision making, Governance, Qualitative research, Risk management

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