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Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory

OBJECTIVES: The introduction of medical revalidation in 2012 has been a controversial and radical change to medical regulation in the UK. It involved changes to the way organizations manage medical performance, and to the relationships between doctors, their employers and the professional regulatory...

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Autores principales: Tazzyman, Abigail, Ferguson, Jane, Boyd, Alan, Bryce, Marie, Tredinnick-Rowe, John, Price, Tristan, Walshe, Kieran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307413/
https://www.ncbi.nlm.nih.gov/pubmed/31112432
http://dx.doi.org/10.1177/1355819619848017
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author Tazzyman, Abigail
Ferguson, Jane
Boyd, Alan
Bryce, Marie
Tredinnick-Rowe, John
Price, Tristan
Walshe, Kieran
author_facet Tazzyman, Abigail
Ferguson, Jane
Boyd, Alan
Bryce, Marie
Tredinnick-Rowe, John
Price, Tristan
Walshe, Kieran
author_sort Tazzyman, Abigail
collection PubMed
description OBJECTIVES: The introduction of medical revalidation in 2012 has been a controversial and radical change to medical regulation in the UK. It involved changes to the way organizations manage medical performance, and to the relationships between doctors, their employers and the professional regulatory body. In this paper, we explore the implementation of medical revalidation, analysing the change process and its consequences for doctors and organizations. METHODS: We conducted a qualitative investigation of the implementation of revalidation in 15 case study organizations in 2016–2017, collecting documents and undertaking a total of 80 interviews with medical and non-medical staff. We used Normalization Process Theory to frame and structure the analysis. RESULTS: Revalidation reforms were largely implemented successfully within and across our case study organizations, with evidence of growing acceptance of the purpose and processes of revalidation. There was an emergent shift from securing doctors’ compliance towards the use of revalidation to strengthen clinical governance, and towards evaluating revalidation processes and seeking to make them more effective. However, there was substantial variation in the implementation and impact of revalidation; it was still not fully understood by many doctors, and revalidation processes were highly reliant on a few key individuals in each organization. The changes brought about by revalidation have had consequences for the way in which doctors construct their identity and the way they relate to the organizations in which they work. CONCLUSION: Despite considerable early scepticism and overt opposition in the medical profession, revalidation has become gradually accepted, embedded and even valued over time. Its impact and effectiveness are still questioned by many stakeholders, and the focus of attention has now shifted towards revising and improving the way revalidation works in practice.
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spelling pubmed-73074132020-07-06 Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory Tazzyman, Abigail Ferguson, Jane Boyd, Alan Bryce, Marie Tredinnick-Rowe, John Price, Tristan Walshe, Kieran J Health Serv Res Policy Original Research OBJECTIVES: The introduction of medical revalidation in 2012 has been a controversial and radical change to medical regulation in the UK. It involved changes to the way organizations manage medical performance, and to the relationships between doctors, their employers and the professional regulatory body. In this paper, we explore the implementation of medical revalidation, analysing the change process and its consequences for doctors and organizations. METHODS: We conducted a qualitative investigation of the implementation of revalidation in 15 case study organizations in 2016–2017, collecting documents and undertaking a total of 80 interviews with medical and non-medical staff. We used Normalization Process Theory to frame and structure the analysis. RESULTS: Revalidation reforms were largely implemented successfully within and across our case study organizations, with evidence of growing acceptance of the purpose and processes of revalidation. There was an emergent shift from securing doctors’ compliance towards the use of revalidation to strengthen clinical governance, and towards evaluating revalidation processes and seeking to make them more effective. However, there was substantial variation in the implementation and impact of revalidation; it was still not fully understood by many doctors, and revalidation processes were highly reliant on a few key individuals in each organization. The changes brought about by revalidation have had consequences for the way in which doctors construct their identity and the way they relate to the organizations in which they work. CONCLUSION: Despite considerable early scepticism and overt opposition in the medical profession, revalidation has become gradually accepted, embedded and even valued over time. Its impact and effectiveness are still questioned by many stakeholders, and the focus of attention has now shifted towards revising and improving the way revalidation works in practice. SAGE Publications 2019-05-21 2020-01 /pmc/articles/PMC7307413/ /pubmed/31112432 http://dx.doi.org/10.1177/1355819619848017 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc/4.0/ Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Tazzyman, Abigail
Ferguson, Jane
Boyd, Alan
Bryce, Marie
Tredinnick-Rowe, John
Price, Tristan
Walshe, Kieran
Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory
title Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory
title_full Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory
title_fullStr Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory
title_full_unstemmed Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory
title_short Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory
title_sort reforming medical regulation: a qualitative study of the implementation of medical revalidation in england, using normalization process theory
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307413/
https://www.ncbi.nlm.nih.gov/pubmed/31112432
http://dx.doi.org/10.1177/1355819619848017
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