Planning for Excellence: Insights from an International Review of Regulators’ Strategic Plans

What constitutes regulatory excellence? Answering this question is an indispensable first step for any public regulatory agency that is measuring, striving towards, and, ultimately, achieving excellence. One useful way to answer this question would be to draw on the broader literature on regulatory design, enforcement, and management. But, perhaps a more authentic way would be to look at how regulators themselves define excellence. However, we actually know remarkably little about how the regulatory officials who are immersed in the task of regulation conceive of their own success. In this Article, we investigate regulators’ definitions of regulatory excellence by drawing on a unique source of data that provides an important window on regulators’ own aspirations: their strategic plans. Strategic plans have been required or voluntarily undertaken for the past decade or longer by regulators around the globe. In these plans, regulators offer mission statements, strategic goals, and measurable and achievable outcomes, all of which indicate what regulators value and are striving to become. Occasionally, they even state explicitly where they have fallen short of “best-in-class” status and how they intend to improve. To date, a voluminous literature exists examining agency practices in strategic planning, but we are aware of no study that tries to glean from the substance of a sizeable number of plans how regulators themselves construe regulatory excellence. The main task of this Article is undertaking this effort. This Article draws on twenty plans from different regulators in nine countries. We found most generally that excellent regulators describe themselves (though not necessarily using exactly these words) as institutions that are more (1) efficient, (2) educative, (3) multiplicative, (4) proportional, (5) vital, (6) just, and (7) honest. In addition to these seven shared attribute categories, our reading of the plans also revealed five other “unusual” attributes that only one or two agencies mentioned. Beyond merely cataloguing the attributes identified by agencies, this Article also discusses commonalities (and differences) between plan structures, emphases, and framings. We found that the plans differed widely in features such as the specificity of their mission statements, the extent to which they emphasized actions over outcomes (or vice versa), and the extent to which commitments were organized along organizational fiefdoms or cut across bureaucratic lines. We urge future scholarship to explore alternative methods of text mining, and to study strategic plans over time within agencies, in order to track how agencies’ notions of regulatory excellence respond to changes in the regulatory context and the larger circumstances within which agencies operate. Looking longitudinally will also shed light on how agencies handle strategic goals that are either met or that prove to be unattainable

Planning for Excellence: Insights from an International Review of Regulators\u27 Strategic Plans

What constitutes regulatory excellence? Answering this question is an indispensable first step for any public regulatory agency that is measuring, striving towards, and, ultimately, achieving excellence. One useful way to answer this question would be to draw on the broader literature on regulatory design, enforcement, and management. But, perhaps a more authentic way would be to look at how regulators themselves define excellence. However, we actually know remarkably little about how the regulatory officials who are immersed in the task of regulation conceive of their own success. In this Article, we investigate regulators’ definitions of regulatory excellence by drawing on a unique source of data that provides an important window on regulators’ own aspirations: their strategic plans. Strategic plans have been required or voluntarily undertaken for the past decade or longer by regulators around the globe. In these plans, regulators offer mission statements, strategic goals, and measurable and achievable outcomes, all of which indicate what regulators value and are striving to become. Occasionally, they even state explicitly where they have fallen short of “best-in-class” status and how they intend to improve. To date, a voluminous literature exists examining agency practices in strategic planning, but we are aware of no study that tries to glean from the substance of a sizeable number of plans how regulators themselves construe regulatory excellence. The main task of this Article is undertaking this effort. This Article draws on twenty plans from different regulators in nine countries. We found most generally that excellent regulators describe themselves (though not necessarily using exactly these words) as institutions that are more (1) efficient, (2) educative, (3) multiplicative, (4) proportional, (5) vital, (6) just, and (7) honest. In addition to these seven shared attribute categories, our reading of the plans also revealed five other “unusual” attributes that only one or two agencies mentioned. Beyond merely cataloguing the attributes identified by agencies, this Article also discusses commonalities (and differences) between plan structures, emphases, and framings. We found that the plans differed widely in features such as the specificity of their mission statements, the extent to which they emphasized actions over outcomes (or vice versa), and the extent to which commitments were organized along organizational fiefdoms or cut across bureaucratic lines. We urge future scholarship to explore alternative methods of text mining, and to study strategic plans over time within agencies, in order to track how agencies’ notions of regulatory excellence respond to changes in the regulatory context and the larger circumstances within which agencies operate. Looking longitudinally will also shed light on how agencies handle strategic goals that are either met or that prove to be unattainable

Planning for Excellence: Insights from an International Review of Regulators’ Strategic Plans

What constitutes regulatory excellence? Answering this question is an indispensable first step for any public regulatory agency that is measuring, striving towards, and, ultimately, achieving excellence. One useful way to answer this question would be to draw on the broader literature on regulatory design, enforcement, and management. But, perhaps a more authentic way would be to look at how regulators themselves define excellence. However, we actually know remarkably little about how the regulatory officials who are immersed in the task of regulation conceive of their own success. In this Article, we investigate regulators’ definitions of regulatory excellence by drawing on a unique source of data that provides an important window on regulators’ own aspirations: their strategic plans. Strategic plans have been required or voluntarily undertaken for the past decade or longer by regulators around the globe. In these plans, regulators offer mission statements, strategic goals, and measurable and achievable outcomes, all of which indicate what regulators value and are striving to become. Occasionally, they even state explicitly where they have fallen short of “best-in-class” status and how they intend to improve. To date, a voluminous literature exists examining agency practices in strategic planning, but we are aware of no study that tries to glean from the substance of a sizeable number of plans how regulators themselves construe regulatory excellence. The main task of this Article is undertaking this effort. This Article draws on twenty plans from different regulators in nine countries. We found most generally that excellent regulators describe themselves (though not necessarily using exactly these words) as institutions that are more (1) efficient, (2) educative, (3) multiplicative, (4) proportional, (5) vital, (6) just, and (7) honest. In addition to these seven shared attribute categories, our reading of the plans also revealed five other “unusual” attributes that only one or two agencies mentioned. Beyond merely cataloguing the attributes identified by agencies, this Article also discusses commonalities (and differences) between plan structures, emphases, and framings. We found that the plans differed widely in features such as the specificity of their mission statements, the extent to which they emphasized actions over outcomes (or vice versa), and the extent to which commitments were organized along organizational fiefdoms or cut across bureaucratic lines. We urge future scholarship to explore alternative methods of text mining, and to study strategic plans over time within agencies, in order to track how agencies’ notions of regulatory excellence respond to changes in the regulatory context and the larger circumstances within which agencies operate. Looking longitudinally will also shed light on how agencies handle strategic goals that are either met or that prove to be unattainable

An action research protocol to strengthen system-wide inter-professional learning and practice

Background. Inter-professional learning (IPL) and inter-professional practice (IPP) are thought to be critical determinants of effective care, improved quality and safety and enhanced provider morale, yet few empirical studies have demonstrated this. Whole-of-system research is even less prevalent. We aim to provide a four year, multi-method, multi-collaborator action research program of IPL and IPP in defined, bounded health and education systems located in the Australian Capital Territory (ACT). The project is funded by the Australian Research Council under its industry Linkage Program. Methods/Design. The program of research will examine in four inter-related, prospective studies, progress with IPL and IPP across tertiary education providers, professional education, regulatory and registration bodies, the ACT health system's streams of care activities and teams, units and wards of the provider facilities of the ACT health system. One key focus will be on push-pull mechanisms, ie, how the education sector creates student-enabled IPP and the health sector demands IPL-oriented practitioners. The studies will examine four research aims and meet 20 research project objectives in a comprehensive evaluation of ongoing progress with IPL and IPP. Discussion. IPP and IPL are said to be cornerstones of health system reforms. We will measure progress across an entire health system and the clinical and professional education systems that feed into it. The value of multi-methods, partnership research and a bi-directional push-pull model of IPL and IPP will be tested. Widespread dissemination of results to practitioners, policymakers, managers and researchers will be a key project goal

Strengthening organizational performance through accreditation research - a framework for twelve interrelated studies: the ACCREDIT project study protocol

Background: Service accreditation is a structured process of recognising and promoting performance and adherence to standards. Typically, accreditation agencies either receive standards from an authorized body or develop new and upgrade existing standards through research and expert views. They then apply standards, criteria and performance indicators, testing their effects, and monitoring compliance with them. The accreditation process has been widely adopted. The international investments in accreditation are considerable. However, reliable evidence of its efficiency or effectiveness in achieving organizational improvements is sparse and the value of accreditation in cost-benefit terms has yet to be demonstrated. Although some evidence suggests that accreditation promotes the improvement and standardization of care, there have been calls to strengthen its research base. In response, the ACCREDIT (Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork) project has been established to evaluate the effectiveness of Australian accreditation in achieving its goals. ACCREDIT is a partnership of key researchers, policymakers and agencies.FindingsWe present the framework for our studies in accreditation. Four specific aims of the ACCREDIT project, which will direct our findings, are to: (i) evaluate current accreditation processes; (ii) analyse the costs and benefits of accreditation; (iii) improve future accreditation via evidence; and (iv) develop and apply new standards of consumer involvement in accreditation. These will be addressed through 12 interrelated studies designed to examine specific issues identified as a high priority. Novel techniques, a mix of qualitative and quantitative methods, and randomized designs relevant for health-care research have been developed. These methods allow us to circumvent the fragmented and incommensurate findings that can be generated in small-scale, project-based studies. The overall approach for our research is a multi-level, multi-study design.DiscussionThe ACCREDIT project will examine the utility, reliability, relevance and cost effectiveness of differing forms of accreditation, focused on general practice, aged care and acute care settings in Australia. Empirically, there are potential research gains to be made by understanding accreditation and extending existing knowledge; theoretically, this design will facilitate a systems view of accreditation of benefit to the partnership, international research communities, and future accreditation designers

Alcohol risk environments, vulnerability and social inequalities in alcohol consumption

Alcohol and alcohol-related harm are key public health challenges. Research has shown that individual-level factors, such as age and sex, are important predictors of alcohol consumption, but such factors provide only a partial account of the drivers of consumption. In this article, we argue that individual-level factors interact with features of the risk environment to increase the vulnerability of individuals to such environments. Features of the alcohol risk environment include the density of alcohol premises in a neighborhood. Previous research has shown that neighborhoods with a higher density of alcohol outlets have higher levels of both alcohol consumption and alcohol-related harm. There has, however, been a distinct lack of attention paid to the differential ways in which particular sociodemographic groups might be more vulnerable to such risk environments. In this article, we address the risk environment through a primary focus on the local supply and availability of alcohol products (captured using a measure of outlet density) and the relationship with the harmful use of alcohol. Using responses to the Scottish Health Survey (2008–2011), we explore vulnerability through the interaction between individual-level socioeconomic position, measured using household income, and environmental risk to assess differential social vulnerability to such environments. We report findings showing that those in the lowest income groups might be disproportionately affected by outlet density. This evidence suggests that risk environments might not affect us all equally and that there could be socially differentiated vulnerability to such environments

Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study

ABSTRACT Background Despite the widespread use of accreditation in many countries, and prevailing beliefs that accreditation is associated with variables contributing to clinical care and organisational outcomes, little systematic research has been conducted to examine its validity as a predictor of healthcare performance. Objective To determine whether accreditation performance is associated with self-reported clinical performance and independent ratings of four aspects of organisational performance. Design Independent blinded assessment of these variables in a random, stratified sample of health service organisations. Settings Acute care: large, medium and small healthservice organisations in Australia. Study participants Nineteen health service organisations employing 16 448 staff treating 321 289 inpatients and 1 971 087 non-inpatient services annually, representing approximately 5% of the Australian acute care health system. Main measures Correlations of accreditation performance with organisational culture, organisational climate, consumer involvement, leadership and clinical performance. Results Accreditation performance was significantly positively correlated with organisational culture (rho¼0.618, p¼0.005) and leadership (rho¼0.616, p¼0.005). There was a trend between accreditation and clinical performance (rho¼0.450, p¼0.080). Accreditation was unrelated to organisational climate (rho¼0.378, p¼0.110) and consumer involvement (rho¼0.215, p¼0.377). Conclusions Accreditation results predict leadership behaviours and cultural characteristics of healthcare organisations but not organisational climate or consumer participation, and a positive trend between accreditation and clinical performance is noted

Tragicomic presentations of self : starring Phil Silvers as Bilko : the incomplete comic human

When a performer becomes over-associated with a particular, celebrated comic character can this lead to problems, not merely in terms of type-casting, but in creating confusions for the actor’s own perception of self? In instances where a comic creation is perceived to be an extension of the performer’s actual ‘self’, what dissonances in self construct may arise between the comic actor’s created persona and his/her own presentation of self? This article considers the nature of tensions created through the permeation of persona and person which can beset comedians who become closely identified with their particular mediated role. Can, indeed, over-association with their successful ‘signature’ comic role be seen to prove psychologically destabilising for certain performers whose own fragile, sense of identity becomes further compromised by presentation of their own most familiar and definitive, comic creations? Drawing specifically upon the career and comedy of Phil Silvers (aka ‘Sergeant ‘Bilko’), this article attempts to evaluate the forms of crises of identity that can arise between presentations of public and private selves for those performers who become, in effect, ‘public comic property’