Kind, Firm, and Fair Medical Regulation: A Systems Approach and Six Ethical Principles.

Background: Regulatory processes can be stressful, anxiety provoking, and complicated for the health professional involved, the institutions they work for, and for the regulators. Methods: This paper uses a case study to describe a systems approach to comprehensively identify the agents (ie: the complainant, the health professional concerned, the regulator dedicated to the case, the institution, the healthcare profession, the public, and the regulatory authority) and 6 ethical issues that emerge during the regulatory process: potential to cause harm, not in the best interest of a person, affects autonomy, unjust, not truthful, and loss of trust. Results: A systems approach lends to a mental model in which there are dynamic interactions across these elements accompanied by positive and negative feedback loops that maintain overall stability of the whole system. Conclusions: The process can be further refined and kinder to those concerned by developing a sensitive approach to improve assessment of risks, using feedback to improve the regulatory process, adapting transparent procedures, not causing undue delays to the process, embedding regulatory activities in a patient safety system, minimizing individual blame, using non-legalistic, non-threatening and respectful communications, and directing the different actors to a support network for guidance and advice. [ABSTRACT FROM AUTHOR]