Audit is also a Social Process. When I got a job with the District Audit Service about 20 years ago my Father in Law (one of the wisest people I’ve ever known, just like his daughter) told me a joke.

QUESTION: How do you know you’ve met an extrovert Auditor?

ANSWER: When they were talking to you, they looked down at YOUR shoes, not their own.

I don’t think he was actually telling me a joke, it was more of an ‘observation’. At the time I was stood there in my new grey suit, neutral shirt, purple tie and black shoes. It’s one of those moments that has stuck with me. Did I have the ‘right’ interpersonal skills to be a good Auditor?

Relationships and Interpersonal Skills Matter. Recently I wrote about the negative effect that Regulation, Inspection and Audit (Regulation) can have on people, in this post; Regulation, Inspection and Audit Really, Really Shouldn’t Hurt.

In the post I mention the Kings Fund / Manchester University Business School report, Impact of the Care Quality Commission on provider performance: room for improvement? The title might not suggest it, but it’s actually a great weekend read (particularly with Storm Dennis lashing down outside).

In the Discussion Chapter, there’s a specific section that talks about the ‘Importance of relationships and social processes’ (pg 41-44). I’m sure you’ll understand the point that ‘behaviour begets behaviour’ and ‘tough, adversarial’ approaches to regulation aren’t helpful or effective – which was covered in the earlier post (link). The report emphasises the point that relationships and how people behave really does matter. Here’s a powerful quote from the report – relevant to situations beyond just CQC Inspections.

“Regulation is clearly seen as a social process. For both the regulator and providers, it is not just what you do, it is who does it and how it is done that matters fundamentally to the way regulation works, and to the impact. That does not mean that regulatory standards and procedures do not matter, but that the human interactions and social dimensions of inspection and rating are very important indeed.“

Pathological to Generative Regulation. This phrase doesn’t actually feature in the Kings Fund Report, but I think it is definitely implied. It does however get an explicit mention by former CQC Director of Quality Improvement, Jeremy Cox in the video I linked to in the last post, and his own post he wrote for Easier Inc, The Box that Ticked Itself.

As far as I can work out the origins of the phrase ‘Pathological to Generative’ comes from work done around the evolution of the health and safety culture in the Oil and Gas Industry. If you’ve got the inclination, have a look at this 2001 paper ‘Safety Management and Safety Culture. The Long, Hard and Winding Road’ by Prof. Patrick Hudson from Leiden University in The Netherlands.

Alternatively you can have the ‘Hollywood’ version I wrote; Pathological to Generative. Moving up the Regulation Ladder with Bruce Willis. The most useful thing I can point you towards quickly is the graphic that illustrates the difference between Pathological and Generative approaches.

Making the move from Pathological to Generative. I did mention that the Kings Fund report identifies a number of things that help the relationship move from Pathological to Generative (they use Purposeful – but I’m sticking to Generative). This is focussed around something they call ‘Regulatory Impact Mechanisms’. I’ll try to explain the basic gist of how I think it works:

• A pathological relationship features a tough, adversarial approach and a number of behaviours that reinforce this – on both sides (and it doesn’t actually have the desired impact – improved services).
• A generative approach is much more supportive, featuring mutual trust, respect, openness and the sharing of knowledge (to help people and organisations improve what they do).
• Sitting between these ‘states’ are eight ‘Regulatory Impact Mechanisms’ (RIMS for short).
• The general idea is that you can use these RIMS in ways that can have different impacts on the relationship between Regulated and Regulator.
• Depending on what you both do it can be a Pathological Relationship (BAD) or a Generative Relationship (GOOD).
• But, you’ve both got to want the same thing.
• It’s as easy as that!
• Just to help you a bit more I’ve tried to describe the RIMS in the drawing above. Its also worth looking at pages 14-15 of the Kings Fund Report (link here). I’ve also posted images of the pages at the end of the post.

Yeah, but the Regulators will go ‘soft’. The worry that Regulators, Inspectors and Auditors will ‘go soft’ and ‘return to the wild’ is valid. A bit ‘over-played’ but valid. Nobody really wants a ‘cosy regulator’ like nobody wants a ‘bent copper’.

There are plenty of ways to overcome this concern though (it’s all just good risk management). The Kings Fund report talks about the training process for Inspectors. If you want to look further afield – try the United States Nuclear Regulatory Commission, Resident Inspectors Programme. Basically the Inspectors become ‘resident’ at the nuclear facility and really get to know what’s going on. To avoid them getting ‘too cosy’ there are all sorts of things in place, and they move on after 7 years. You can have a read about it and find some links in this post I wrote: The Hawthorn Effect and ‘Cleaning the House’ before important visitors arrive.

A Framework for…? The report identifies that RIM activities 1 & 2 are the most commonly used. For the rest, their application is less frequent and widely spread, but they do actually happen (I’d confirm that from my own experience).

So, if it’s already happening in some places… I’m tempted to ask what’s stopping the rest of us also doing it? Probably only our own behaviours and some (misplaced) fear of failure. To quote William Gibson, ‘The future is already here, It’s just unevenly distributed’… and it might well be already happening under your nose.

Finally, It all boils down to people and the relationships we have. I ditched the grey suit and purple tie ages ago, now I’ve got a Tweed waistcoat and I’ve grown a ‘hipster’ moustache, its much more ‘me’.

So, What’s the PONT?

1. Regulation, Inspection and Audit is a Contact Sport. It’s a social practice that requires good interpersonal relationships based upon trust and mutual respect.
2. To move from Pathological to Generative relationships the Regulatory Impact Mechanisms detailed in the Kings Fund Report offer a ‘Framework’.
3. The future (of Regulation, Inspection and Audit) is already here, its just unevenly distributed and probably happening under your nose.