Exploring & explaining the dynamics of
osteopathic regulation, professionalism, &
compliance with standards in practice
Prof Gerry McGivern (Warwick Business School, University of
Warwick; gerry.mcgivern@wbs.ac.uk),
Dr Michael Fischer (Oxford University),
Zoey Spendlove, Prof Justin Waring (Nottingham University)
& Dr Oliver Thomson (British School of Osteopathy)
Background research on
clinical regulation
• Previous ESRC/ GMC funded research on regulatory transparency in
medicine and psychological therapies
• McGivern, G. & Fischer, M.D. 2012. ‘Reactivity & reactions to
regulatory transparency in medicine, psychotherapy & counselling.
Social Science & Medicine, 74 (3) p286-296)
– Regulators had little understanding of the effects of regulation in
practice
– Importance of ‘formative spaces’ within regulatory processes
– Non-rational narratives & anxieties shaping professionals’ defensive
attitudes towards regulation in a perceived ‘inquisition’ like wider
environment
– Echoed earlier study on consultant appraisal: McGivern, G. & Ferlie, E.
2007. Playing Tick Box Games: Interrelating Defences in Professional
Appraisal. Human Relations, 60 (9) p1361-1385
The Francis Inquiry
• Mid-Staffs/Francis-report:
– Focus on superficial compliance with standards/numbers
– Professional disengagement; ‘kept their heads down’
– ‘There is a tendency when a disaster strikes to try to seek
out someone who can be blamed… we have still not
managed to move successfully away from the culture of
blame which … Donaldson, in Organisation with a Memory
and.. the Bristol Inquiry, were so keen to banish… blame
will perpetuate the cycle of defensiveness, concealment,
lessons not being identified and further harm.’ (Francis,
2013: 35)
– Call for culture change: Professionalism & internalisation
of standards
The GOsC-funded research
• Current General Osteopathy Council (GOsC) funded research
• Exploring osteopaths’ & other regulatory stakeholders’
perceptions & experience of regulation in practice
• Explaining factors that encourage or inhibit compliance with
osteopathic standards & regulation
• Links to osteopathic professionalism
• Aim to help GOsC understand how it can encourage
compliance with osteopathic standards & thus support safe &
high quality osteopathic practice.
Why is osteopathy interesting?
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Protected professional title (4800 UK osteopaths)
No agreed definition of osteopathy
Limited evidence-based
Communication/professionalism important
Independent professionals (sole; private practice)
GOsC revalidation pilot: reflective discussion part
of GOsC fitness to practice regulatory process
(following PSA ‘right-touch’ regulation, 2012)
What are we doing?
• Literature review: (1) osteopathy & (2) clinical regulation
• Qualitative semi-structured interviews (n=50; on-going)
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Representative range of osteopaths;
Representatives of the osteopathic educational institutions;
Public/patient representatives;
Regulators (e.g. HCPC, GOsC, General Chiropractic Council);
Other stakeholders affecting the wider regulatory climate (e.g.
lawyers, journalists, policy-makers, politicians)
• Online survey of 4800 GOsC-registered Osteopaths (June)
• Stakeholder validation and feedback workshop
Where have we got to?
• Still early in the project
– Literature reviews: (1) osteopathy and (2)
regulation/revalidation/FTP;
– Preliminary review of public FTP information and
GOsC revalidation pilot findings
– Ethical approval
– Sampling framework
– Interview questions 2 pilot interviews done;
– More interviews arranged
• No results to report yet (available end of 2014)