Professional Governance Systems that Work: Managing risks and ensuring regulatory effectiveness in a global and digital age

To ensure well-functioning health systems and health service delivery, it is essential that the regulation of health professionals is effective, safe, and serves the public interest. Nevertheless, there is no clear agreement on what 'effective' professional regulation should look like, especially in a globalizing and digitalizing context that is fundamentally altering both professional work and professional governance. In the United Kingdom (UK), current discussions on regulatory reform have focused on increasing autonomy for regulators, to allow them to act flexibly without the need for parliamentary approval, revising fitness to practise procedures, and potentially harmonizing procedures between regulatory bodies around a new legislative template. Discussions around regulatory reform are also occurring in Canada, where several provinces have either recently made, or are currently in the process of implementing, substantial legislative changes altering health profession regulation (including British Columbia, Nova Scotia, Quebec, Alberta, and Ontario). In addition to legislative policy changes, regulatory bodies are adapting processes in response to technological changes and the spread of generative artificial intelligence, both of which are altering professional practice and - in some cases - regulatory practices and processes. Moreover, widespread healthcare workforce shortages in Canada and the UK have raised demands for internationally educated health professionals, necessitating policy changes to facilitate their entry to practice. These changes combine to alter the risks that professional regulation aims to manage, and raise questions about how to address these risks effectively while ensuring the public interest is served. Declining public (and government) confidence in the ability of health profession regulators, in both Canada and the UK, to 'get it right' makes these risks and uncertainties all the more concerning, and heightens the need for research to shed light on best practices for professional governance systems that work. Through a scoping review, we will generate a synthesized understanding of effectiveness in health profession regulation in a digitizing and globalizing world. The rapid pace of change, in a context where regulatory and healthcare reforms are increasingly regarded as urgent, means that a knowledge synthesis of research and policy practices internationally is essential. The project objectives are to answer three research questions: 1) What regulatory risks are raised by international migration of healthcare practitioners and digitization? 2) Are these risks relevant to everyone or for some groups more than others? 3) How can regulatory effectiveness in these areas be identified, demonstrated and measured? Our knowledge synthesis will not only seek out research and grey literature on best practices in health profession regulation, but will draw on the insights of regulators and government policymakers as collaborators throughout the research process. We will engage a range of cross-sectoral system partners through integrated knowledge mobilization activities to help ensure the findings can be used in both nations to inform regulatory frameworks that facilitate effective professional practice in the public interest.