looking ahead
A
s a medical regulator, we exist to protect
patients from harm. Malcolm Sparrow,
author of The Character of Harms and a
recognized guru of regulation, describes
our central task as identifying the “bads” (risks, threats,
hazards, problems or harms) and then controlling them
effectively.
Focusing on a specific bad thing, says Sparrow,
offers regulators the opportunity to think and act
like a saboteur: to study the harm’s structure, find a
vulnerability of the harm itself, and then devise a tailormade intervention.
Key to this success is possessing the agility and
flexibility to use the right regulatory tool for the task
and acknowledging that different problems require
different solutions. Questions about whether a regulator
should adopt a harsh or soft approach, whether we
should use enforcement or education, or whether
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we should be reactive or preventive or proactive
are all tactical, risk-specific choices, says Sparrow.
Determining the right mix of tools for the specific risk
is the essence of regulatory craftsmanship.
A risk-based approach would change how we
measure and report the success of our interventions.
A risk mitigation tool would look at the time between
when we identified a risk and when it was addressed,
as opposed to the duration of time that the matter
made its way through the completion of our processes.
For example, assume we get information about poor
infection control practices in a particular clinic. The
risk is mitigated when we get into the office and either
stop the doctor from doing the concerning procedure
or require him or her to change their practices. This all
could happen much earlier than the ultimate resolution
of the case. Our performance then becomes focused on
risk, rather than case management, with the implicit
COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
photo: D.W.Dorken
Dr. Rocco Gerace,
Registrar