What do highway chevrons, email marketing, and online trolls have to do with occupational regulation?

A lot, it seems, if viewed with both the wide lens and surgical detail on display at CLEAR’s recent International Congress in Dublin, Ireland. The event drew 30 speakers and hundreds of attendees from around the world for three days, 18 talks, and multiple discussion roundtables on an array of topics tackling challenges and opportunities facing the wildly varied world of this thing we call regulation.

There was no definitive theme connecting all the presentations, and it would be impossible to contain their many revealing details and critical insights in a meager column. But a post-mortem analysis of the presentations shared reveals certain common currents running through the various talks, namely creativity, innovation, and knowledge – three words abundantly employed in values statements wherever they’re found, granted, but especially poignant in the context of contemporary regulation, where a multitude of challenges reside.

What challenges? Where to start? If we look to the contents of the conference talks, regulation’s Hydra rears some of its heads: Pandemic burnout among health care practitioners. The varying prevalence of substance abuse across disciplines. Misinformation’s dastardly capacity to cripple a regulator’s right to regulate. The propensity of a minority of licensed professionals to cause the majority of harms. That failures of regulation forever and always overshadow its successes. And the growing tendency of professionals to flee their practices, to name a few.

These are challenges, however, that sharpen the relevance of the implicit call for creativity and innovation woven across the talks of the conference’s many seasoned speakers and researchers, and how the application of creative innovation begins with good research.

Knowledge, professional development, and the value of healthy working conditions

Take the conference’s leading presentation, entitled “Filling in the Gaps: Research Supporting Innovative Ways to Target Lifelong Learning”. It explored how we ensure practitioners maintain a dedication to lifelong learning and stay current as they move through their career. While recertification and revalidation schemes are in place across many health care fields, regulators still struggle to ensure they remain useful. According to speaker Tom Granatir, VP of policy and external relations at the American Board of Medical Specialties, that means figuring out how to personalize assessments and how to get and give feedback that is meaningful to individual practitioners. In essence, it also means confronting the nuance of the people “who are people who are sometimes physicians,” as Granatir relayed, channeling noted quality leader Dr. Paul Batalden, emeritus professor at Dartmouth Medical School. Nuance isn’t easy and personalization is hard, but in these principles regulators may find greater efficacy in continuing education efforts, Granatir suggested.

He was joined by co-presenters Blake Dobson, assistant director for revalidation, licensing and specialist applications at Britain’s General Medical Council, and Grady Barnhill, a retired testing and credentialing expert, and much of their talk focused on the world of health care. But when asked to share what, of their research, the speakers found applicable across professions, Barnhill pointed to two prevalences that ought to cause alarm: the presence of the Dunning-Kruger effect – “that’s kind of universal,” Barnhill noted – and the general decline of knowledge and skills.

Knowledge resided at the very heart of another presentation by Marian O’Rourke, director of regulation and standards for the Northern Ireland Social Care Council, and Paula McFadden, senior fellow of the Higher Education Academy at Ulster University. They discussed how academia and regulators have worked together to reveal the vital link between workforce well-being and safe practice, a relationship especially highlighted by a brutal global pandemic. One standout statistic from their research collaboration? Over a third of social workers across the British Isles considered leaving the profession due to well-being, burnout, and quality-of-life issues. Again, the need to understand the nuance of the individual makes itself plain. Professionals, particularly in health care and all the fields it contains, need to be understood as humans first if their performance as professionals is to flourish.

It was, after all, the flourishing performance of the nurses at Denis Murphy’s bedside that compelled him to dedicate his career to serving their profession in any way he could. The CAO of the Association for Dental Education in Europe delivered a presentation whose title – “collaboratively creating a life-cycle approach to professional regulatory board member onboarding” – effectively undersold the conference’s most compelling, human story: how an unfortunate strain of pneumonia resulted in multi-organ failure and Murphy’s own near-death experience. The patience and dedication of the nurses that saw him through the traumatic episode left a mark on him. Though doctors get much of the attention in such crises, he relayed, “the people that actually make the difference to the patient in the bed tend to be the nurses.”

With his health restored, he translated the experience into giving back to the profession. Today that means profiling boards to better understand how they can better serve the professions they represent. Favoring domain representation on governing bodies, he rejects the notion boards can be populated by individuals more familiar with governance generally than the nuance of professions governed.

“It’s not just about being a board member, because a professional regulatory board is just not any board, and don’t let anybody tell you otherwise,” he implored. “Yes, governance, finance, and all that stuff goes on. But the other elements that you as regulators do, that is unique and that does not fit into the standard record governance box.” He closed by reiterating the importance of “making sure everybody understands the purpose of the regulation.”

If the uniqueness of individual professionals and professions broadly is to be addressed by regulators, then creative solutions and out-of-the-box thinking will lead the way, later talks suggested.

The case for regulatory ingenuity

Invoking precepts popularized in Richard H. Thaler and Cass R. Sunstein’s ‘Nudge,’ Cynthia Abel, deputy registrar of Ontario’s College of Early Childhood Educators, illustrated how concepts from urban design and marketing can inspire new tactics in regulation.

She and co-presenter Daniel Roukema, CEO of MDR Strategy Group Ltd., explained how painting chevrons along the bend of an accident-prone stretch of Chicago’s waterfront highway gave drivers the illusion of driving faster, compelling them to slow down and, in the process, reduce traffic incidents by 36%. Or how Toronto’s PATH system added piano sounds to a subterranean staircase in a bid to get commuters to choose stairs over escalators, an effort that netted a 66% increase in stair use.

Such nudges, Abel and Roukema suggested, reduce friction by gently encouraging people to do something differently instead of taking away personal choice. Further, this kind of creative solutioneering can improve a regulator’s capacity to improve outcomes in the world.

In her own experience, Abel borrowed tools from a marketer’s toolkit to solve the problem of suspension rates. Likening the process of license renewal to the process of going to the gym, with all its attendant activities – packing the gym bag, getting dressed, driving to the gym, etc. – she underlined the importance of considering all the steps an individual takes to renew a license and viewing each one as a possible point of friction: “How are they falling in the registration? Are they using something online? Do they have to do it by hand? Do they have to find a stamp? Do they have to go to the mailbox? It provides all of these opportunities to think about where you might simplify complex processes.”

Her college analyzed open and click-through rates – common measures in marketing that indicate how email recipients open and interact with emails – to determine how registration reminders emailed to members could net more early renewals and fewer suspensions. By simply sending email reminders on Saturdays instead of Wednesdays, her team was able to achieve nearly 52% open rates and 13% click-through rates, numbers that would make any email marketer blush. And yet, according to Abel, the insight that informed the change was simple: “Early childhood educators are not office workers. They do not have access to email during the day. They’re often working with young children. It’s a very demanding job for many. It’s long hours, sometimes starting at seven in the morning and going to after six at night. And often they don’t have the opportunity to open an email in the middle of the day.”

Other opportunities to creatively engage members and the public at large were later explored in Jimi Bush’s discussion, “Managing the Social Media Presence of the Regulated and the Regulator,” in which the Washington Medical Commission’s director of quality and engagement encouraged regulators to be more active, experimental, and creative on social media. In addition to recommending strategies for responding to online trolls, she and co-presenter Kym Ayscough, executive director of regulatory operations at Ahpra, encouraged the audience to consider the digital footprints and fingerprints of practitioners to inform character assessment. They highlighted the growing importance of video and declining relevance of Twitter amidst the sustained growth of platforms like Instagram, where few regulators play but enormous opportunity exists, especially with a considerable workforce demographic shift on the horizon.

What can we learn from the consequences of regulatory failure?

Social media. Influencing behavior. Innovation. The vitality of knowledge and research. All the ideas that emerged through the conference also appeared in Cary Coglianese’s excellent keynote, “Regulation is a Verb”, wherein the founding director of the Penn Program on Regulation stitched together examples of the impacts of regulation gone wrong to illustrate the need to change behavior to get regulation right.

Lamenting the kind of “regulatory accounting” prevalent across, most notably, the U.S., where “two-for-one” de-regulatory mandates (those that permit regulators to add a new rule if they remove two old ones) are not uncommon. “This kind of regulatory accounting is the epitome of regulation as a noun,” Coglianese intoned, calling on the audience to think instead of regulating, “as a verb; a suite of ongoing actions.”

He underscored what every regulator knows as well as any CRMO: that most successes are silent. “While disasters and crises are always visible, regulatory successes are not.”

He chronicled some very visible failures of regulation as a noun, such as when a singular focus on structural integrity amongst New Zealand’s building regulators led to 90,000 buildings suffering mold infestation and over $11 billion in damages. Or when Australia’s meta-regulation approach to electricity regulation led to industry “basically doing nothing” in what he described as “an abdication of regulatory responsibility.”

Which leads us to the question: how may regulatory successes become less silent? May the answer lie in… research?

The quiet potential of research and analysis

Kieran Washe might think so. One of the biggest takeaways of the conference was hidden in a subdued closing statement on the closing day of the conference, a mid-afternoon session some might have missed in favor of slipping out for a stroll during a rare spell of sunshine on a Friday afternoon in the heart of Dublin.

In his appeal, the professor of health policy and management at the University of Manchester hammered home the value of research not just for, but by regulators: “I’m a real advocate for research and evaluation of regulation. I don’t think that means it needs to be done by people like me in universities. I really think every regulator should have its own in-house capacity to do meaningful research and evaluation itself so that it can put research and evaluation alongside the innovations of its initiatives and form examples about effectiveness and impact.”

The singularity of an idea like “regulation” masks the wild complexity of the act of regulating and the many unique disciplines it encompasses. Indeed, in a research function a regulator may unearth a whole new dimension of value, for by benchmarking current states against both past performance and regulatory brethren abroad, the act of regulating may be made better for the public at large.