Imagine a situation where you can measure the psychological and physiological effects of a visit from the Regulator.

That’s what this fuzzy image shows. It’s actually heart beats per minute of the registered manager of a care provider, and the impact of a notice to visit from the Regulator. The ‘spike’ happens when the ‘regulatory visit’ was announced (October) and declines towards to actual visit in the following January. “I lived with a bit of anxiety tucked under my rib cage at all times” was how it was described, surely that’s not good for anyone?

Creating stress and anxiety can not be right… I’m really troubled by the idea that a ‘visit from the Regulators’ is a major source of stress and anxiety. Along with that, it also influences the behaviour of the people being regulated – and not generally in a good way either.

Have a look at this video Radical Models of Regulation by Jeremy Cox, former Director of Quality Improvement at the Care Quality Commission (CQC). Jeremy tells the whole story, offers some ideas for a better approach to regulation and there’s even a happy ending for the Registered Manager, Helen.

Who do your Values and Behaviours apply to…? I bet that lots of the organisations that do ‘regulation’ will have values and behaviours written down. They will talk about; ‘valuing people’, ‘treating people with respect’ and ‘building trust’. I’m guessing that this applies to how the people working for regulators treat each other, but I’m left wondering how this applies to the people who they regulate. I do know a few teachers who can describe experiences like those explained in the video. It feels like a common experience – but that doesn’t make it right, or even useful.

Behavior begets behaviour. There’s an important point Jeremy Cox makes in the video that Regulators often complain of ‘dysfunctional behaviour’ in organisations. However the Regulators don’t stop to think about what part they play in creating that behaviour.

If your behaviour is all about mistrust, sniffing out problems and punishing the guilty it’s hardly surprising that people behave defensively. I wrote about this in ‘How to beat the Inspectors’ . It was prompted by my surprise that there was an ‘industry’ of people advising organisations on how they should prepare for regulation , inspection and audit. Basically, how to ‘pull the wool’ over the regulators eyes. What a waste of money and resources.

The second point that’s nagging at me around behaviour is about how a negative approach to regulation can contribute to the fear of failure. We all recognise that an ‘overactive’ fear of failure in organisations can lead to behaviours that involve hiding the evidence and looking for someone to blame when things inevitably go wrong.

This lovely flowchart was developed by Professor Keith Grint paints the picture. The details are explained in this post about moving from Pathological to Generative Regulation.

The Spanish Inquisition Approach to Regulation. The ‘terrorise and torture’ or ‘cruel but fair’ approach to regulation, inspection and audit isn’t something we should be using in the 21st Century. Apart from the fact that it doesn’t really work as a means of ‘driving’ improvement, it actually builds some negative and counter-productive behaviours.

It really, really shouldn’t hurt. The idea that Regulation is also causing people stress and anxiety is not right. I’d hope the people designing the regulation approach would want to avoid that as an impact (I hope…). Nobody wants to see people doing their best, often in difficult circumstances, suffering because they are being inspected.

There is hope, and a happy ending. I do recommend you watch the video. Jeremy Cox puts forward some ideas on how you might do regulation differently which includes things like:

• Developing a relationship based on mutual trust and respect;
• Sharing information on good practice; and
• Linking stakeholders and peers to share learning.

All interesting ideas which I’ll expand on from my own experiences in a follow on post. The one thing I would add and emphasis though is context. It’s massively important to understand the context of where you both are. If either organisation (regulated or regulator) are in different places on the spectrum of Pathological to Generative, it’s going to be difficult to see things through the ‘same lens’, and ‘speak the same language’. Interestingly Jeremy Cox used the Cynefin Framework as a means of looking at context… more of that in the next post.

So, Whats the PONT?

1. A bit of stress can be useful in certain circumstances. But prolonged anxiety ‘tucked under your rib cage’ can not be good for you. Regulators need to think about the impact of their actions on those they regulate.
2. Behaviour does beget behaviour. If you don’t trust people, look for problems and punish the guilty, don’t be surprised if people are defensive and hide things.
3. A generative approach is a great aspiration, but not everyone plays nice and by the rules. Just be aware of context.

Thanks to Sam Spencer (@rethinkingserv) for sharing the Jeremy Cox video and prompting this post