Regulating doctors: between performance and practice
Lead Research Organisation:
University of Leicester
Department Name: Health Sciences
Abstract
Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.
People |
ORCID iD |
| Mary Dixon-Woods (Principal Investigator / Fellow) |
Publications
Ashcroft R, Dixon-Woods M.
(2011)
Bioethics Around the Globe
Bosk CL
(2009)
Reality check for checklists.
in Lancet (London, England)
Dixon-Woods M
(2010)
Why is patient safety so hard? A selective review of ethnographic studies.
in Journal of health services research & policy
Dixon-Woods M
(2009)
Why do people cooperate with medical research? Findings from three studies.
in Social science & medicine (1982)
Dixon-Woods M
(2011)
Why is U.K. medicine no longer a self-regulating profession? The role of scandals involving "bad apple" doctors.
in Social science & medicine (1982)
Dixon-Woods M
(2011)
Defending Rights or Defending Privileges? Rethinking the ethics of research in public service organizations
in Public Management Review
Mary Dixon-Woods (author)
(2010)
Detecting the dodgy doctor
in Risk and regulation : special issue on close calls, near misses and early warnings
Tarrant C
(2010)
Continuity and trust in primary care: a qualitative study informed by game theory.
in Annals of family medicine
Waring J
(2010)
Modernising medical regulation: where are we now?
in Journal of health organization and management
Yeung K
(2010)
Design-based regulation and patient safety: a regulatory studies perspective.
in Social science & medicine (1982)
| Description | Scandals and the medical profession Scandals are especially undermining of any group that has made its claim to trustworthiness the foundation of its bargain with society. The patient-doctor relationship is in essence a principal-agent relationship; the institution of the medical profession is the basis on which patients are invited to believe that the risks inherent in such relationships will be resolved in their favour. The Medical Act (1858), which established the General Medical Council (GMC) and allowed it to maintain a list or "register" of recognised doctors, gave legal force to this bargain. It also granted the profession self regulatory powers. Three claims underpinned the self regulatory model for medicine: one of expertise, one of virtue, and one of control. Freidson summarises these as follows: First, there is the claim that there is such an unusual degree of skill and knowledge involved in professional work that non professionals are not equipped to evaluate or regulate it. Second, it is claimed that professionals are responsible that they may be trusted to work conscientiously without supervision. Third [..] the profession itself may be trusted to undertake the proper regulatory action on those rare occasions when an individual does not perform his work competently or ethically. (1970:137) Thus, what Hughes terms the "social licence" for medicine went well beyond legal permission to carry out certain types of work, and involved the profession claiming and being granted a broad social, moral and intellectual mandate based on its own trustworthiness. It is questions about the trustworthiness of the profession, and the extent to which self regulation best serves the aim that individual members of the profession will be trustworthy, that have been at the heart of the scandals. The scandals (including those involving Harold Shipman, Bristol Royal Infirmary, Clifford Ayling, William Kerr, Michael Haslam, Richard Neale, Rodney Ledward, and others) appeared to suggest that the profession defaulted on its obligations to patients, the public, the NHS, and the state. The nature of the misconduct involved in the different scandals varied, sometimes involving unacceptable behaviour, and sometimes involving failures of performance (though these were sometimes inextricably linked) but all suggested that the profession could not be trusted to exercise the proper control over doctors who were 'bad apples'. Why did the scandals occur? My analysis suggests that the Inquiry reports tended to locate much of the blame for the scandals in the professional self regulatory model. Some of the reasons for this lay in the rise of an unsympathetic critique of the professions across a variety of disciplines and settings. Historiographical sociology both in the UK and the US presented the professionalisation project as primarily concerned with restriction of entry, and motivated predominantly by economic considerations, including a search for market shelter.3 This view was increasingly shared during the 1980s and 1990s by a range of different commentators and political actors, who now saw the professions as lobbies or pressure groups fighting to preserve and pursue their own interests rather than carrying some special imprimatur. Political scientists from the rational choice school were, for example, highly sceptical of the claims to professionalism that liberated doctors from external control, while neo liberal critiques of the professions similarly saw credentialing and licensing as simply attempts to collect monopoly rents. Alongside these critiques, the compact between the state and the professions came under severe strain during the early 1980s, as the new public management ideology, with its scepticism about professional motives, was embraced. Such an account tends to leave unexplained the motives of the state in granting the largesse of professional status and self regulation in the first instance. The historian Irvine Loudon argues that it is not incompatible to understand the 1858 Act as aspiring to serve the interests of the profession and those of the public, a view also supported by Roberts' recent analysis, 5 and understandable within a climate of mid nineteenth century opinion that saw professional self interest as the best guarantee of a good public service. Over 100 years after the Act was passed, the Merrison Inquiry, set up in the 1970s to investigate the regulation of doctors, was to describe the relationship between the profession and the public as one of 'mutual advantage'. The interest of the state, I propose, was in securing safety: the social contract in which the profession was granted the privileges of self regulation was in return for its fulfilment of fiduciary responsibilities, and can at least in part be understood as an early example of consumer protection, providing an apparently neat solution to the principal agent problem. The reasons why self regulation failed to control the behaviour of 'bad apples' had, I argue, much less to do with purposeful, interest driven efforts at occupational enhancement than with the weakness of social control inherent in the model adopted by the medical profession. This model assumed that the profession would be populated only by good people. It further assumed that each fully qualified member was equal in authority, self directing and self disciplined, and would be sufficiently conditioned by the norms acquired from her peers, socialisation into the profession and her own conscience to conduct herself well and competently. The consequences of this were far reaching, manifesting at GMC level in guidance on the standards of proper behaviour that was only vaguely formulated, and preoccupied with how doctors should treat each other rather than with their conduct towards patients. In keeping with the subject positioning of doctors as by definition and inclination 'good', there was no active system of monitoring doctors' performance or conduct, and no inspectorate either by the GMC or the NHS. The idealised public character offered to every person admitted to the medical register functioned as a veil under which 'bad' doctors could perform or behave very poorly. The institutionalised claim of goodness powerfully shaped social relations, such that even raising questions about the technical competence or the moral character of individual doctors was enough to risk the character of the complainer - whether doctor, patient, or manager. It was often dangerous, or at the very least extremely uncomfortable, to raise concerns about a doctor, especially for colleagues of that doctor. Thus, a striking finding of the Inquiries was the extent to which particular individuals knew, or had strong reasons to suspect, that their colleagues were engaged in misconduct, but were fearful of acting. This operation of the 'rule of anticipated reaction' to raising concerns was strengthened by the official standard for misconduct, which was, as the scandal Inquiries indentified, set unreasonably high. For much of its lifetime, the GMC confined its remit to cases of serious professional misconduct (SPM); formal procedures were therefore activated only for dealing with the most extreme end of misconduct. What counted as misconduct also, until recently (1995), reflected a belief that no doctor's clinical performance could be called into question. Further, determining that a doctor was guilty of misconduct required a criminal standard of proof, but many of the suspicions that people had about bad apples were difficult to turn into hard evidence. Even when there was good evidence a doctor's conduct was unacceptable, the Inquiries repeatedly highlighted the GMC's failures to take meaningful action. The perception that interests of the GMC had become misaligned with those of patients and the public did much to damage its legitimacy as a regulator. But any account of the phenomenon of bad apples in medicine needs to recognise the broader institutional context. What Rudolf Klein describes as the 'politics of the double bed' meant the NHS was itself in a principal agent relationship with the profession. All of the reports found weak NHS systems that tolerated misconduct and poor practice. There was no systematic mechanism for monitoring the clinical performance of healthcare professionals. Patients' complaints were often ineffectively dealt with, and concerns were not investigated or properly addressed. Managers lacked clarity about who was in charge and on what authority, were often unsure what to do about problem doctors, and felt unable to act unless they received a complaint from a patient. They also recognised that any disciplinary efforts would be arduous, time consuming, uncomfortable, and prone to failure. It is, however, important to recognise also that there is little that is specific to the medical profession or the NHS about the tendency for organisational actors to discount signals of incipient disaster; it has been found across many organisations in many settings, from railways to space. Responding to the scandals The scandals seriously undermined the medical profession's own claims to respect from the public, self regulation, and autonomy. But they also had very adverse effects for the profession's partner in the regulative bargain: the state, or more specifically, the government, for whom the scandals were a huge and ongoing political embarrassment. It was evident that the 'bargain' had failed. I propose that a useful way of understanding the scandals is to see them as provoking a new recognition of professionals as a source of risk, rather than an assurance of safety. Doctors became recognised as a source of risk in three ways. First, the work they do is inherently risky, and has a natural inclination towards catastrophe. The scandals destabilised the claim that the system of professional regulation was sufficient to ensure that all doctors would have the proper level of expertise to defend against the risks of clinical work. Second, professionals can be 'bad people' who purposely cause harm to occur. The moral claim - that doctors will reliably put their patient's interests first - was thus challenged. Third, they are a source of reputational risk, capable of causing embarrassment to the institutions that employ them and to political institutions. The politically embarrassing nature of the scandal, and the ways in which they exposed the government to suggestions that it was not in control of the services it provided, made reform an imperative. The reforms targeted the self regulatory model for a number of reasons. First, the historical evidence (e.g. responses to scandals in the 1960s involving medical research) may have suggested that simply re emphasising the duties and ethical responsibilities of doctors would be ineffectual. Second, the GMC appeared to be in a state of institutional sclerosis by the early 2000s, and was judged not to have responded effectively to the level of concern being expressed (evidenced, for example, in its proposals for revalidation, which were rejected). Third, removal of privileges helped in enacting a narrative of breach, fall, and punishment of an elite group. Fourth, strong pressures of institutional isomorphism were coming to bear. The model of a self regulating profession, with a huge governing council mostly elected by the profession itself and with little external accountability, was looking increasingly old fashioned and not fit for purpose. The effort to make the profession more governable has focused on challenging the traditional agent based model of professional practice, and on moving to a more highly contractualised regulatory model where powers of setting standards, monitoring of practice, and management of defaults from standards are largely relocated from inside to outside the profession. This new emphasis on seeing quality of clinical care and aspects of professional conduct as requiring external regulation, and as not being solely the dominion of the profession, was evident in the early proposals for clinical governance and subsequent establishment of regulators and quasi regulators including the Care Quality Commission, NICE, the National Patient Safety Agency, and others. The introduction of referral and remediation services for doctors, including the National Clinical Assessment Service, for instance, involved colonising a role the profession might previously considered its own. Recent reforms have accelerated this trend, and taken together, have resulted in the end of the self regulatory model. The GMC now has parity of lay and registrant members, and all are now selected by the Appointments Commission;the standard of proof is now civil rather than criminal; the GMC's functioning is overseen by the Council for Healthcare Regulatory Excellence; new procedures and policies for acting on concerns about doctors and responding to complaints have been introduced; and all doctors who wish to remain on the register will now have to be 'revalidated'. Trust and regulation Questions now arise about how effective these reforms will be, both in promoting good behaviour by doctors; in preventing, detecting, and dealing with poor behaviour and practice where it occurs; and in restoring trust. In addressing these questions, it is important to emphasise the apparent paradox that, though one of the central legitimising tropes of the reform programme has been a crisis of public trust in the medical profession, in fact the evidence for erosion of public trust is very thin. Survey data suggests that trust in the medical profession has consistently remained very high - the highest of all professions - and has remained so throughout the scandal filled era. Indeed, our analysis of why people cooperate with medical research indicates that doctors act as guarantors of the propriety of medical research, because doctors are seen as trustworthy. The rather counter intuitive finding of trust in the profession - despite the scandals needs to be explained. My work suggests that there may be important distinctions that are not always well recognised between the ways in which people orient towards medicine as an institution, and the ways in which they orient towards individual members of the profession. The analysis we conducted of the evolutionary dynamics of trust in primary care suggests that what we term 'initial trust' in doctors is institutionally structured, deriving from strongly reinforced social roles and identities ascribed to doctors and patients. Initial trust is a pragmatic position from which to begin, but is not blind or naïve; rather, it is a handy heuristic that provides a necessary starting point for a relationship, and is provisional and contingent. Everyday direct experiences may be most relevant to patients' judgements of the trustworthiness of any individual doctor, while surveys of attitudes may be little more than descriptions of the social norms attached to the professional role. Reports of 'trust in the profession' should therefore not be interpreted as evidence that patients find all doctors trustworthy. Our analysis, drawing on game theory, also found that that it is direct experiences and the opportunity for repeated interactions that allow the role of the doctor as the trusted agent to be validated, not the detail of contractual or regulatory arrangements. However, my work on regulation of medical research also indicates that people demonstrate a generalised reliance on regulation as a feature of everyday life, and the assumed existence of regulatory structures and systems provides important forms of reassurance. The detail of these systems may not matter very much to patients until something goes wrong. Regulation and its consequences I argue that the troubles of the medical profession can be more appropriately understood as a crisis of legitimation rather than a crisis of trust. The relationship between specific regulatory forms and the extent to which people see the profession as trustworthy, or trust individual doctors, is likely to be tenuous at best. What is clear is that the scandals left both the government and the profession unable to demonstrate that the practical functioning of the regulatory system for doctors fulfilled the aims for which it was instituted. The self regulatory approach may have had a number of advantages. In particular, this kind of trust based model involved relatively low transaction costs and a minimum of regulatory overhead, and the high expectations of members may have been powerfully motivating to many, perhaps even most, doctors. But it was remarkably ill suited to dealing with defaulters - those who were unable, unwilling or indifferent to delivering on the commitments to high standards of performance and conduct. The reforms can be seen both as a response to this empirical problem, but also as an attempt to manage the associated institutional risks. The turn towards a contractual form of regulating the profession requires empirical evaluation outside the scope of my fellowship. However, my work has identified several key themes that will need to be addressed in regulating doctors in the UK. First, there is a need for far more attention to the organisational context in which medical work takes place. There is a need for recognition of the complexities of the networks in which doctors are embedded, and of how alternative conceptions of what is 'safe' or 'good practice' may prevail, conditioned by coping with competing priorities, clinical uncertainties, organisational pressures, resource inadequacies, and perceptions of professional role. My analysis of ethnographic studies of patient safety suggests that at least some apparent violations of safety practices occur because of organisational stress (such as insufficient capacity). It is important not to mistake adaptive practices adopted by groups to deal with these strains for the dispositional traits of individuals. It is also important to understand the strongly norming effects of the environments in which doctors work, and to think about how more cooperative and participative forms of regulation can promote desired behaviour, rather than relying too heavily on rule based, surveillance or command and control type regimes. Second, there is a need to think very carefully about how to manage clinician behaviours where there is deemed to be a need to modify them. A common response to the discovery of problems in medical workplaces is to propose the introduction of formal rules (such as checklists and protocols) to render practice more orderly and accountable. But while it may be relatively easy to identify normative aspirations for safety at the level of broad principle, converting them into formal standards in such a way as to deliver on the desired objectives is very hard. My work on checklists shows that efforts to improve safety therefore need to be designed to take account of the realities of practice, and based on an understanding of the logics people are using to inform their practices. Interventions also need to enjoy broad organisational support; checklists are likely to be properly effective only when organisational fitness is addressed at the same time. Using checklists as standards of accountability against which doctors' performance will be assessed may prove problematic. Third, the exercise of clinical judgement presents significant dilemmas. On the one hand, clinical expertise and discretion are clearly needed to do the job of doctoring well, and to avoid stupidities and risks associated with rigid rule adherence and other unwanted consequences. On the other hand, claims of special knowledge and immunity from standardisation and conformity with rules can be self interested. Generalised non conformity may be a way of performing a particular kind of professional identity and reinforcing occupational boundaries. Doctors may seek to display their autonomy and seniority by demonstrating that they are not docile, but rather are creative, intuitive, and individual. A view that 'rules do not apply to us' may, however, easily become dysfunctional, extending to all kinds of areas where variations in professional judgement are irrelevant to the matter at hand, and used to legitimate or obscure poor practices. A highly sophisticated approach, based on a thorough understanding of clinical and organisational realities, is needed to inform work in this area. Fourth, there is a need to recognise the enormous number of regulatory forces now at work on doctors. Technology as a regulatory modality is just one of these, and a careful comparison with the theoretical literature on the use of technology as a way of controlling criminal behaviour reveals the need for caution and reflection before accepting what appear to be straightforward and commonsense solutions. A range of other regulatory agencies and regulatory tools have also been directed at increasing control over aspects of quality, professional decision making, and surveillance of professional activity and performance. Targets and their measurement have proliferated. Market like incentives, including the Quality and Outcomes Framework, have been introduced in several areas, while the courts are involved through their adjudication on negligence claims. There is a need to be sensitive to the number and variety of these regulatory forces, to identify how they interact and where they may conflict, and to explore which are perceived as most influential and why. Fifth, many of the new regulatory measures aim to detect (and potentially expel) renegades who fail to cooperate with the norms and standards expected of members of the profession on the basis of 'warning signs' (such as complaints from patients or colleagues or evidence of substandard performance). However, warning signs may be understood as an essentially contested concept: one where securing agreement on the broad principle (e.g. 'doctors should be good') is easy, but how to determine whether any particular instance meets the criteria, and who should own the definition of the situation, is very hard. The problem of how to ensure that concerns are indeed raised by colleagues and others is not yet well understood, and it is by no means clear that the sense of danger, threat, and discomfort associated with raising concerns has been diminished by recent reforms. The use of warning signs or other measures to control problematic doctors may also be subverted by tactics neutralising formal authority, including recourse to employment law, while individuals intent on malice may be especially skilful at evading detection. It is thus important to recognise that efforts to codify and formalise surveillance of doctors may interfere with informal peer based sanctioning, which, notwithstanding its weaknesses as a sole regulatory tool, may have highly productive and functional effects. There are also significant risks that the new revalidation processes may provoke ritualised displays of compliance, and have many unwanted and unnecessarily stifling effects on practice and performance, but persist in dealing ineffectively with the bad apple problem. There is a need for a substantial programme of empirical research in this area. This work, reported only briefly here, has raised many important questions. It is clear that there are inescapable tensions in designing a system to detect and suppress 'bad apples' at the same time as creating an environment in which 'good apples' are likely to flourish with a minimum of regulatory overhead. In addition to questions about optimal choice of regulatory strategy, it is also clear that a major rethinking of traditional sociological analyses of the professions (and the medical profession in particular) will be required. |
| Exploitation Route | Inform policy and practice e.g. at the level of the General Medical Council and other regulators. |
| Sectors | Healthcare |
| Description | Wellcome Trust Senior Investigator award |
| Amount | £890,000 (GBP) |
| Funding ID | WT097899 |
| Organisation | Wellcome Trust |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 09/2012 |
| End | 09/2017 |
| Description | 2. Dixon-Woods M, Bosk CL. Ethics of research in public service organisations. International Research Society for Public Management Conference Berne, Switzerland, April 2010 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussion Led to paper in peer-reviewed journal |
| Year(s) Of Engagement Activity | 2010 |
| Description | 3. Dixon-Woods M, Waring J. Detecting the dodgy doctor: 'warning signs' as an essentially contested concept. Close Calls conference, London School of Economics, March 2009 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | SParked questions and discussion Led to publications |
| Year(s) Of Engagement Activity | 2009 |
| Description | 4. Dixon-Woods M, Yeung K. 'Regulating health risks through technology: what are the implications for professional discretion, and should we worry?' at 3rd Annual Cambridge Conference on Regulation, Inspection and Improvement, Cambridge. November 2008 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | sparked questions and discussion N/A |
| Year(s) Of Engagement Activity | 2008 |
| Description | 42. Invited speaker, Lent Lecture, King's College London. Governance in an age of technology: design-based regulation and patient safety. 15 March 2012 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussion N/A |
| Year(s) Of Engagement Activity | 2012 |
| Description | 46. Invited keynote speaker, Changing forms of Professional Responsibility ESRC Seminar Series. University of Leeds, 19 September 2011 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussion Requests for collaboration |
| Year(s) Of Engagement Activity | 2011 |
| Description | 5. Dixon-Woods M., Technoregulation of safety in healthcare: what does it mean for the medical profession?' BSA Medical Sociology Annual Conference 2008 September 2008 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussion N/A |
| Year(s) Of Engagement Activity | 2008 |
| Description | 52. Invited speaker. Bad apples and the end of self-regulation of medicine. Department of Sociology, University of Pennsylvania, April 2011. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussion Consolidated international collaboration |
| Year(s) Of Engagement Activity | 2011 |
| Description | 53. Invited speaker. Medical sociology and patient safety. Quality and Safety Research Group, Johns Hopkins University, US. April 2011 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussion Helped to establish international collaboration network |
| Year(s) Of Engagement Activity | 2011 |
| Description | 54. Invited speaker. Ethnography in patient safety. Imperial College Centre for Patient Safety and Service Quality, London. Sept 2010 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussion Requests for collaboration |
| Year(s) Of Engagement Activity | 2010 |
| Description | 55. Invited speaker. Accountability and design-based regulation in patient safety. Society for Risk Analysis - Europe. King's College London, June 2010 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions anad discussion Requests for collaboration |
| Year(s) Of Engagement Activity | 2010 |
| Description | 58. Invited speaker. What can sociology do for the epistemology of improving quality in healthcare? Health Foundation International colloquium on the epistemology of improving quality. Cliveden, Berskshire, April 2010. |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions Establishment of international network |
| Year(s) Of Engagement Activity | 2010 |
| Description | Changing forms of Professional Responsibility ESRC Seminar Series - Keynote speaker |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | Yes |
| Geographic Reach | National |
| Primary Audience | Participants in your research and patient groups |
| Results and Impact | Seminar provoked considerable discussion and requests for collaboration. Notable impacts are hard to evaluate. |
| Year(s) Of Engagement Activity | 2011 |
| Description | Presentation on: Can we regulate our way to better medical performance? ESRC Public Services Programme workshop with the General Medical Council. London, February 2010 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Sparked questions and discussion Follow-up by GMC |
| Year(s) Of Engagement Activity | 2010 |
| Description | Regulating doctors and the custody of virtue. Seminar at CARR London School of Economics seminar series |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussiona afterwards After my talk, I was approached about further collaborations. |
| Year(s) Of Engagement Activity | 2009 |
| URL | http://www.lse.ac.uk/researchAndExpertise/units/CARR/pdf/annualReports/AnnualReport2008.pdf |
| Description | Seminar on Design-Based Approaches to Patient Safety |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussion afterwards Increase in interest in design-based regulation |
| Year(s) Of Engagement Activity | 2009 |
| URL | http://www.oii.ox.ac.uk/events/?id=231 |
| Description | Trust and the regulation of doctors: ESRC Public Services Programme Workshop, London. 13 January 2009 , 9.30am - 5.30pm |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Sparked questions and discussion Led to formation of international collaborations |
| Year(s) Of Engagement Activity | 2009 |
| URL | http://www.publicservices.ac.uk/index.php/pastevents/regulating-doctors-workshop-2 |
| Description | Using ethnographic methods to study efforts to improve quality and safety in health care: Practical, ethical and communicative challenges. BSA Medical Sociology conference. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Sparked questions and discussion N/A |
| Year(s) Of Engagement Activity | 2012 |