Should Health Managers Be Regulated

Of course, health services managers should be as accountable as other professionals working in our health services. Having said that, what would a fully developed accountability system look like?

Denis Doherty
Denis Doherty

The modern approach to the regulation of the professions tends to be based on the protection of the public. That underpinning aim is particularly relevant in healthcare. The aim of regulation is to set standards for individual professionals that enable members of the public to have confidence in their profession. That requirement enables members of the profession to attain and retain the standards of professional practice expected of them. The vast majority of regulated professionals never come to public notice for the wrong reasons.

Over many years now, the Institute has facilitated dialogue on the topic of whether or not healthcare managers ought to be regulated and, if they should, what form should regulation take.

Regulated professions need to structured and resourced in ways that enable the requirements of regulation to be met. A number of features are common to most regulated professions. They include:

  • A body of knowledge
  • Entry criteria (usually specified qualifications or examination and proven experience under the eyes of a professional)
  • A Code of Ethics
  • Continuous Learning/CPD
  • A Regulatory Body

Complaints against regulated professionals can be initiated by the regulator of the profession or as a result of complaints against registered professionals.

Regulated professionals in Ireland are protected by our Constitution, by our laws and by human rights entitlements. Serious complaints are dealt with at a public inquiry, usually held in public. Generally speaking, a finding of poor professional performance or professional misconduct must satisfy the criminal standard of ‘beyond reasonable doubt’. The most severe sanction is erasure from the professional register, which in practice tends to be applied in only the most severe cases. Sanctions involving censure or admonishment, often accompanied by undertakings to practice to high professional standards in future, are more common.

Readers of this publication are aware that HMI is the membership organisation of healthcare managers in Ireland. Over many years now, the Institute has facilitated dialogue on the topic of whether or not healthcare managers ought to be regulated and, if they should, what form should regulation take.

For example:

  • The Institute responded positively to the recommendations in the Madden Report and offered to actively assist in managing their implementation.
  • The Institute was represented on and took an active part in the work of the Steering Group that drew up ‘A Code of Conduct for Health Service Providers’, which has the potential to address comprehensively the issues relating to the accountability of managers in healthcare.
  • More recently, the institute participated in the work of the International Hospital Federation in developing a competency framework for healthcare managers.

There has been very little interest, almost everywhere, in engagement, of any kind, on the issues involved except for questions about which heads should roll when public controversies arise.

In considering the issue of regulating health care managers, or making us more accountable, regard should be had to the fact that we are subject to the criminal and civil laws of the State in our working lives as well as in our private lives. We are subject to employment law and we are obliged to honour our contracts of employment and the job descriptions that accompany them. We have constitutional and legal protections similar to professionals who are regulated and our employers have many remedies available to them if we underperform or fail to meet the terms under which we are employed.

It is necessary to have regard to the question of all that is involved and the length of time it takes in Ireland to introduce or even modernise arrangements for the regulation of healthcare professionals here. The older professions, such as medicine, pharmacy and nursing were prioritised and are covered by legislation that is relatively recent. Eventually, the legislation that provides for the regulation of the newer professions was passed and a start has been made on regulating the first of these professions. The task involved is a daunting one and it will take a long time to complete.

The cost involved and the expected benefits will have to weighed up in arriving at a decision one way or the other.

One of the advantages members of regulated professions enjoy is that they can refer prospective employers, at home and abroad, to an independent, regulated repository for evidence of professional good standing.

I am not aware of any healthcare system anywhere that regulates the managers who work in it. That’s not sufficient reason for not proceeding with a system of regulation for managers here, if regulation is considered sufficiently worthwhile. It is likely though to be a time consuming exercise. The cost involved and the expected benefits will have to weighed up in arriving at a decision one way or the other. That said, there is still a very long way to go before the plans to regulate the newer health professions in Ireland are fully implemented. There isn’t any reason though why dialogue on the question of whether or not healthcare managers in Ireland ought to be regulated cannot be stepped up.