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Cited by 38Occupational and Professional Licensing RegulationHealthcare RegulationGlobal Health Workforce Issues

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Design, delivery and effectiveness of health practitioner regulation systems: an integrative review

Open access
Leslie, Kathleen, Bourgeault, Ivy Lynn, Carlton, Anne-Louise, Balasubramanian, Madhan, Mirshahi, Raha, Short, Stephanie D., Carè, Jenny, Cometto, Giorgio, Lin, Vivian·2023·Human Resources for Health
DOI 10.1186/s12960-023-00848-yPMC PMC10478314

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Abstract

BACKGROUND: Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions. METHODS: We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework. FINDINGS: This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners. CONCLUSION: We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.

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Registry

Crossref · 10.1186/s12960-023-00848-y

Cites

251 of 251 references verified0 citation errors · 0 not checkable

Statistics

Figures

Fig. 1 Modified Donabedian framework of HPR systems
Fig. 1 Modified Donabedian framework of HPR systemsCC BY · PubMed Central
Fig. 2 PRISMA flow diagram for academic literature sources
Fig. 2 PRISMA flow diagram for academic literature sourcesCC BY · PubMed Central
Fig. 3 Distribution of published literature by topic and structures (S), processes (P), and outcomes (O)
Fig. 3 Distribution of published literature by topic and structures (S), processes (P), and outcomes (O)CC BY · PubMed Central
Fig. 4 Most frequent countries and health occupations in the published literature (n = 410)
Fig. 4 Most frequent countries and health occupations in the published literature (n = 410)CC BY · PubMed Central
Fig. 5 Most frequent countries and health occupations in the grey literature (n = 426)
Fig. 5 Most frequent countries and health occupations in the grey literature (n = 426)CC BY · PubMed Central
Fig. 6 Overview of topics and themes categorized by structures, processes, and outcomes
Fig. 6 Overview of topics and themes categorized by structures, processes, and outcomesCC BY · PubMed Central
Fig. 7 Most frequent countries and health occupations in published literature addressing the scope and governance of regulatory systems
Fig. 7 Most frequent countries and health occupations in published literature addressing the scope and governance of regulatory systemsCC BY · PubMed Central
Fig. 8 Most frequent countries and health occupations in the published literature on regulatory institutions
Fig. 8 Most frequent countries and health occupations in the published literature on regulatory institutionsCC BY · PubMed Central
Fig. 9 Most frequent countries and health occupations in the published literature on regulatory system linkages
Fig. 9 Most frequent countries and health occupations in the published literature on regulatory system linkagesCC BY · PubMed Central
Fig. 10 Most frequent countries and health occupations in the published literature on registration and monitoring of continuing competence of practitioners
Fig. 10 Most frequent countries and health occupations in the published literature on registration and monitoring of continuing competence of practitionersCC BY · PubMed Central
Fig. 11 Most frequent countries and health occupations in published literature addressing accreditation of HPE programs
Fig. 11 Most frequent countries and health occupations in published literature addressing accreditation of HPE programsCC BY · PubMed Central
Fig. 12 Most frequent countries and health occupations in published literature addressing regulation of scopes of practice
Fig. 12 Most frequent countries and health occupations in published literature addressing regulation of scopes of practiceCC BY · PubMed Central
Fig. 13 Most frequent countries and health occupations in the published literature on regulation of complaints-handling and discipline
Fig. 13 Most frequent countries and health occupations in the published literature on regulation of complaints-handling and disciplineCC BY · PubMed Central
Fig. 14 Most frequent countries and health occupations in published literature addressing regulation of T&CM practitioners
Fig. 14 Most frequent countries and health occupations in published literature addressing regulation of T&CM practitionersCC BY · PubMed Central
Fig. 15 Most frequent countries and health occupations in published literature addressing impacts of HPR on health workforce and health system outcomes
Fig. 15 Most frequent countries and health occupations in published literature addressing impacts of HPR on health workforce and health system outcomesCC BY · PubMed Central

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Citations

Cites

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Research works printed but not linked: 13

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  12. Ying X, Kannan V, Greener E, Smith JA, Brasch J, Johnson BA, et al. Full scope-of-practice regulation is associated with higher supply of nurse practitioners in rural and primary care health professional shortage counties. J Nurs Regul. 2018;8:5–13. · DOI
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Metadata

Authors
Leslie, K., Bourgeault, I. L., Carlton, A.-L., Balasubramanian, M., Mirshahi, R., Short, S. D., Carè, J., Cometto, G., & Lin, V.
Affiliations
  • Athabasca University (CA)
  • University of Ottawa (CA)
  • RMIT University (AU)
  • The University of Sydney (AU)
  • University of Technology Sydney (AU)
  • World Health Organization (CH)
  • University of Hong Kong (HK)
Corresponding author
Leslie, Kathleen
ORCID
Venue
Human Resources for Health
Publisher
Springer Science and Business Media LLC
Published
2023-09-04
Volume
21
Issue
1
Pages
72-72
ISSN
1478-4491 (ISSN-L)
DOI
10.1186/s12960-023-00848-y
PMC
PMC10478314
OpenAlex
W4386423345
Cited by
38
References
252
Citations by year
2026: 13 · 2025: 13 · 2024: 9 · 2023: 3
FWCI
2.35
Type
journal article
Language
en
Open access
Licence
Locations
  • Human Resources for Health (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • uO Research (University of Ottawa) (submittedVersion, public-domain)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
World Health Organization
Topics
  • Social Sciences › Law › Occupational and Professional Licensing Regulation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Regulation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health Workforce Issues
Keywords
health practitioner regulation, healthcare workers, statutory registration, risk-based regulation, continuing professional development, licensing examinations, mandatory reporting, remedial programme, patient safety, health workforce policy
MeSH terms
Accreditation, Government, Government Programs, Health Education, Humans, Databases, Factual

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