There’s much talk about the need for regulating NHS managers as the principal influence over the prevention of events at Staffordshire and elsewhere. In the wider context of most professionals being de-professionalised by the intense desire to short cut the thoroughness of training, development and experience needed to make professionals truly professional in most situations, and the intense desire to find causes for adverse behaviour, regulation of most professions is now in place.
Has regulation really made any positive difference?
On the negative side, regulation is a stressor. This is because the regulations are quite frequently the brain child of people whose own abilities in the field are not super human, and so they tend to be averages, or the lowest common denominator that a group of people can agree on, rather than something to aim at. Quite often, regulation compliance is required to keep one’s job. Professional discretion, the ability to respond according to the issue or problem, is the essence of professionalism, but may be very poorly constrained by regulation.
On the positive side, regulation protects the professional from accusations of being implicated in a disaster, so long as the regulations are followed. This is, often, most dissatisfying for us, the consumer, and for the professional, hiding behind a regulation when he/she knows full well that a more professional approach to the mess would not have resulted in the disaster. Hiding behind fig leaves of regulation.
The more we regulate the more we reinforce the movement away from personal responsibility, the worse the motivation, enthusiasm, risk taking and spontaneity becomes. Is this what is required for growth, development and expansion? Absolutely not.
It is, I believe, more important to raise the professional standards of the professional, and to have some kind of benchmark to judge the professional on a daily basis, which when breeched badly, results in the professional losing the right to be a professional as well as compensating for the breech.
The most effective regulation process is that relating to the driving license. The ingredients of this include a Code upon which the granting of the license is made. Individuals have complete freedom of how they can be trained to the standard of the test, that tests their understanding and practical ability to drive. Other ingredients include the level of insurance premiums that go down the better the driver you become; there are advanced tests that influence the insurance premiums from certain insurers. You are completely free to increase your expertise in driving in order to ensure you both enjoy driving and avoid the consequences of other people’s errors, and the consequences of breeching the code and the regulations.
The regulations and law are few in number, obvious, make good sense in the main, and reinforce the code. They are enabling regulations, enabling us to drive safely, and in the main we do.
Other ingredients in this cake are also important and essential for the whole cake to be a success. They are the design of the roads that facilitate good driving and safety (accident black spots being poorly designed for example) and the design of cars and other vehicles, increasingly sophisticated and designed to support the driver’s ability to drive successfully and with high levels of concentration leading to high performance.
The people who observe how well or poorly we drive have the power to start the process that can lead to us losing our license to drive. There are, however, many stages to go through before that happens, including re-training, and the giving of points on a license that are time limited, thereby demonstrating that improvements in driving occur, with out the need for further examination.
All of these ingredients of this cake are focused on the individual driver – the professional if you like. The system works in that the number of drivers driving successfully compared to the number of people who have tragically suffered as a result of poor driving is very small. The driving process for the majority seamlessly slips into daily life, but makes us conscious of our responsibilities each time we drive. The system is built to encourage us to become brilliant drivers as the enforcers are themselves subjected to a higher level test and must achieve higher criteria, and this enables them to judge more effectively the abilities of those with routine level abilities.
Using this as a model for regulating managers, we can identify the type and nature of the ingredients of the cake. For a start, drivers come in all shapes and sizes, as do managers. A code is the basis of the whole system, so we could use the Manager’s Code I’ve developed. Then there is the training to pass a test. There is a test. Then there is the license; there could be a license to practice. Then there is the ability to practice in different environments – different cultures, but the regulations apply to all cultures (the law). There are the initiatives to improve the overall cultures (the roads), and the individual organisations have initiatives to improve their own working environments (the cars). Those who inspect (the police) could be part of the NHS regulatory industry. If the whole attitude is to create, grow and reinforce the most spectacular manager professionals on earth, we could design a process that helps to achieve that, using this model.
Who grants the license, you ask? An independent DVLC type place, contributed to by all the professional organisations that serve the NHS.