Home » Research Projects » The Visible and Invisible Performance Effects of Transparency in Medical Professional Regulation
‘Do it where I can see you’
Can greater transparency in regulation improve the performance of medical professionals?
Bentham’s dictum ‘the more we are watched, the better we behave’ is often asserted as a truism. It is, therefore, no surprise that in a profession where poor decision-making can lead to a patient’s death, calls for greater transparency abound. However, the relationship between transparency and performance is not as simple as this maxim suggests.
Imagine you are a heart surgeon for whom death rates are audited and reported as an indicator of your performance. You’re faced with a patient who is almost certain to die on the operating table, but has a slight chance of survival if you perform a vital life-saving surgery. Do you operate? If you do not operate the patient will certainly die; yet, if you do, the patient will most likely die and that may prove to be a blot on your professional record. In such a scenario the transparent audit of patient death rates creates an apparent disincentive for surgeons to take on difficult cases. Indeed, it is sometimes claimed that that the best surgeons have the worst mortality rates, for only they are willing to take on the most difficult operations.
Traditionally, medical professionals in most countries have been primarily regulated by their professional peers, yet this lack of transparency may hide poor performance. Recently there have been moves toward more standardisation and transparent auditing in medical regulation. As illustrated in the scenario above, greater transparency does not always necessarily lead to better performance. This project explores the visible and invisible effects of transparency in medical regulation, including instances where greater transparency in professional regulation may lead to ‘performance side effects’, such as perverse incentives and gaming, as well as where real gains in clinical performance result.
What the research means for policy makers and the wider community
This study will be useful to a range of stakeholders in medical professional regulation, including:
- Medical regulators in the UK and other countries will benefit from a better understanding of how professionals perceive and respond to regulation, thus helping them to develop more effective regulation.
- Medical professionals and managers, both in the UK and overseas, will gain from a better understanding of regulators’ perspectives, enabling the former to practice, and the latter to run regulatory processes, more effectively.
- Patients will benefit since a better understanding of medical regulation should lead to more effective regulation and, ultimately, to a resulting increase in standards of patient care.
Research Methods
This is a qualitative study based mainly on semi-structured interviews with various stakeholders in medical professional regulation. The interviews will mostly take place in London, with approximately 15 GPs and surgeons as well as a number of NHS managers and regulators. The aim is to extract the different perspectives of each group on how transparency and regulation affect performance, as well as how each group perceives, interacts and possibly games with its counterparts. The researchers will also interview around 10 psychotherapists and counsellors, where a regulatory regime is only newly emerging, in order to compare and contrast with the more established medical profession and discover if there are any lessons that one profession could teach the other.
On conclusion of the fieldwork, the research team will convene a workshop to bring together the various stakeholders in medical regulation to discuss the provisional findings of the study and facilitate a dialogue between them. This will also present an opportunity for further data collection on the interaction amongst the different stakeholders.
