Sally Lloyd-Bostock

Reforming regulation of the medical profession : The risks of risk-based approaches

Abstract Risk-based regulation is growing in popularity and in the UK has official backing as part of the governments modernization programme. State and non-state regulators alike are under pressure to adopt risk-based approaches. With radical reform of the General Medical Council (GMC) in progress, the rhetoric of risk-based regulation is used by both the Department of Health and the GMC, and is evident in the 2007 White Paper Trust, Assurance and Safety—The Regulation of Health Professionals in the 21st Century. This paper focuses on the dilemmas inherent in risk-based approaches to regulation by the GMC. Two sources of difficulty are examined. First, the evidential demands can be heavy and costly. Databases and information sources related to patient safety and the performance of doctors are proliferating, but have important limitations. Second, decisions about which risk factors to include and how to weight them are riddled with difficulties, both technical and normative. One attraction of risk-based approaches is that they seem to offer objectivity, but it is questionable how far this is possible in practice. Risk information is neither generated nor used against a neutral background. In the medical regulation arena, questions of public trust and confidence are crucial: risk-based regulation does not help deal with these. Furthermore, a focus on individual doctors and a certain amount of blame and sanctioning would seem to be integral to regulatory functions of such bodies as the GMC. The paper poses fundamental questions about how blame-free these systems really can be.

Risk, interest groups and the definition of crisis: the case of volcanic ash†

This paper considers a key aspect of the risk society thesis: the belief that we should be able to manage risks and control the world around us. In particular it focuses on the interface between risk and risk events as socially constructed and the insights that critical situations give us into the routine and mundane, the otherwise taken for granted assumptions underlying risk regulation. It does this with reference to the events precipitated by the April 2010 volcanic eruption in the Eyjafjallajökull area of Iceland. The resulting cloud of volcanic ash spread across Europe and much of Europes airspace was closed to civil aviation for six days, with far reaching consequences including huge financial losses for airlines. The social processes of defining and reacting to risk and crisis both reveal and generate dilemmas and challenges in regulation. This paper examines the role of different interest groups in defining risk expectations and thereby redefining the ash crisis as a regulatory crisis.

The creation of risk-related information: The UK General Medical Council's electronic database.

PURPOSEnThis paper aims to clarify the potential to use data on doctors and fitness to practise (FTP) cases held by the UK General Medical Council (GMC) for wider regulatory purposes, such as identifying risk factors. The paper aims to concentrate on how data are shaped by the GMCs functions and organisational concerns, and by the configuration and use of their electronic database.nnnDESIGN/METHODOLOGY/APPROACHnThe GMC provided samples of their data, access to documentation surrounding the configuration and use of the database, and meetings with staff able to provide background on the database, GMC procedures, and the GMC as an organisation.nnnFINDINGSnThe FTP database is designed to process cases within complex legal rules, and to provide for accountability. The database and its use are adapted to these purposes. Attempts to use it for other purposes are likely to find it difficult to use, the scope and quality of data uneven and some codes unsuitable. The register data are very narrow in scope. While combining register and FTP data to identify risk factors is by itself of limited value, the database can contribute to closer study of risks to patient safety from poorly performing doctors.nnnRESEARCH LIMITATIONS/IMPLICATIONSnThe research was exploratory. It provides initial insights and the basis for further research.nnnPRACTICAL IMPLICATIONSnThe data have potential policy use for the GMC, but it is essential to understand the limitations.nnnORIGINALITY/VALUEnThe paper examines previously unanalysed influences on the GMCs data. It also develops new angles on questions in the regulation literature about organisational risks and the creation of risk data.

Propensity to Sue in England and the United States of America: The Role of Attribution Processes. A Comment on Kritzer

In the mid 1970s, the Oxford Centre for Socio-Legal Studies conducted a large-scale empirical study of systems of compensation for illness and injury in England and Wales the Oxford study referred to by Kritzer.1 As part of the Oxford research team, my interests were close to Kritzers concerns in his paper, namely, accident victims attributions of fault for their accidents; and how their attributions related to their views that they should be compensated and to their decisions to bring a claim. In a chapter that Kritzer cites,2 I argue, amongst other things, that when people attribute fault to the person they claim against, we cannot conclude that their attributions of fault have led to their decision to bring a claim. Instead, I suggest, the prospect or process of claiming may have led to the attributions of fault. In other words, some attributions of fault are justifications rather than reasons for claiming compensation. Kritzers reference to this conclusion might leave the impression that I propose somewhat cynically that attributions of fault are always just a rationalization (p. 408) resulting from desire for compensation (p. 418).3 I appreciate the opportunity to detail a little further my approach and conclusions from the Oxford study, and where I believe Kritzer and I differ.

Regulatory crisis: negotiating the consequences of risk, disasters and crises

Using a new concept - regulatory crisis - this book examines how major crises may or may not affect regulation. The authors provide a detailed analysis of selected well-known disasters, tracing multiple interwoven sources of influence and competing narratives shaping crises and their impact. Their findings challenge currently influential ideas about regulatory failure, risk society and the process of learning from disasters.