Pedagogy of regulation: Strategies and instruments to supervise learning from adverse events

Diverse scholars have argued that standards and performance measurements are “instruments of control” that have a profound influence on the day‐to‐day lives of individuals and organizations, causing constitutive effects. Regulatory bodies increasingly use standards to oversee and monitor the regulated. This paper discusses the Dutch Health and Youth Care Inspectorate's use of both standards and a performance measurement system introduced to monitor how Dutch hospitals investigate and learn from serious adverse events. Rather than focusing on how standards affect regulated practices and organizations, our study examines how the use of these instruments affects the standard maker, that is, the Inspectorate. We explore how the Inspectorate's work practices, standards, and coupled performance measurement system influence its regulatory pedagogy, reviewing practices, and decisionmaking. We conclude that standards and performance measurement systems are not by definition “instruments of control” as their constitutive effects are (under)determined by the relationships in which they are enacted.     

Detection of firearm imprints on the hands of suspects: effectiveness of PDT reaction.

Pyridyldiphenyl triazine (PDT) and three of its analogues were compared as practical reagents for visualizing unseen impressions left on the hands of a person who has held a firearm. The parent compound, PDT, gave the best results using intensity and clarity as measuring criteria. The effectiveness of the PDT reaction was then studied on 147 volunteers who had held firearms in their hands. Identifiable impressions of the metallic parts of the weapons were developed on the hands of 103 volunteers (70%). Results with females were slightly higher than with males, however, the difference was possibly statistically insignificant, and needs further study. Ferroprint and Ferrotrace, 5 commercial preparations that are based on the PDT reaction, have become a part of the professional equipment of every crime scene technician in Israel.     

'Management by Contract': A Study of Programmatic and Technological Aspects

The practice of 'Management by Contract' can — as with any practice — be characterized by programmatic and technological dimensions. These dimensions contain concepts and ideas at the programmatic level, which shape the mission of the practice (concrete tasks and routines) at the technological level. Thus, the former attach the practice to the broader conceptual dimension. In this paper both of these dimensions will be analysed. The aim is to study how quality issues have been managed by contract. The first part presents some of the conceptual arguments of 'Management by Contract'. The arguments of a structure generally used (the Purchaser/Provider split) and a method often used (competitive tendering) will be discussed. The second part presents some technological effects through empirical findings. The paper concludes with an analysis of the interaction or non-interaction between these two dimensions.     

Performance regulation in a networked healthcare system: From cosmetic to institutionalized compliance

This article studies the role of a public regulator in managing the performance of healthcare professionals. It combines a networked governance perspective with responsive regulation theory to show the mechanisms that have added to significant changes in medical cost management in the Netherlands. In a five-year period, hospital practices transitioned from cosmetic compliance with performance regulation and strategic upcoding to institutionalized compliance more in line with regulatory goals. The article demonstrates how policy changes transformed incentive structures, introduced new forms of accountability, and added actors to the network with technocratic disciplining tasks. The networked character of performance regulation offered opportunities for a responsive, non-coercive regulatory strategy that engaged various actors in a regulatory conversation about strategic coding. Responsive regulation can reduce strategic responses to performance regulation and manage the gap between administrative and clinical logics. The case study contributes to our understanding of the effectiveness of responsive, non-punitive regulation in networked settings.