Design, operation and strengthening of health practitioner regulation systems: A rapid integrative review

Abstract

Abstract Background: In addition to promoting patient safety, health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability. This review aimed to identify the evidence on the design, delivery and effectiveness of HPR systems to inform policy decisions by policymakers and regulators. Methods: A rapid review approach was adopted to conduct an integrative analysis of literature published between 2010 and 2021. Fourteen databases were searched according to a standardized strategy. Data were extracted and synthesized through an integrative approach and categorized according to a modified Donabedian framework. Results We identified 410 academic and 426 grey literature sources. Key themes included HPR structures (regulatory governance systems, regulatory institutions, and system linkages), processes (registration and monitoring of continuing competence of practitioners, accreditation of entry-to-practice education programs, regulating scopes of practice, managing complaints and discipline, and regulating traditional and complementary medicine) and outcomes (impact of HPR structures and processes on health system and workforce outcomes). More evidence was found on HPR structures and processes than outcomes, though over 99% of studies were descriptive (and evidence, accordingly, of very low certainty). Synthesis was constrained by the lack of common terminology. Discussion: Trends on regulatory structures and processes emerged from this analysis. The evidence base limitations, particularly on HPR outcomes, warrant caution in the interpretation, generalizability, and applicability of these findings. Standardized terminology and more evidence on regulatory outcomes (on both workforce and health systems) could inform decisions on regulatory design and implementation.