The Balancing of Efficiency with Effectiveness in Doing Licensing Reviews/Inspections

In this RIKINotes Post we need to address the delicate balancing of efficiency with effectiveness in doing program monitoring and licensing reviews. Differential monitoring has been suggested as an efficient approach to program monitoring. However, I do want to caution licensing administrators when they are considering differential monitoring approaches such as key indicator predictor or risk assessment rule methods for conducting abbreviated reviews in making licensing decisions.

There is a delicate balance between regulatory compliance and program quality which has been delineated in the regulatory compliance theory of diminishing returns. In taking this relationship one step further we always need to make certain that our efficiency approaches do not negatively impact the overall quality of services being provided. In other words, abbreviated reviews should not be conducted if it is going to jeopardize program quality. Only a more comprehensive review which is far more effective in determining the overall quality of a program is in order to maintain this delicate balance. When a program has demonstrated this attained level of regulatory compliance and quality it would then be eligible for a more efficient, abbreviated review focusing on specific predictor rules or high risk rules.

As licensing administrators, you want to make certain that all clients are healthy and safe but also that they are receiving the highest level of quality care possible. Balancing “do no harm” and “doing good” is critical in maintaining the balance of efficiency and effectiveness in a program monitoring system. It is far to easy to drift to one extreme or the other in which too much emphasis on efficiencies in attempting to reduce the number of key predictor rules or the number of actual on-site reviews will decrease the overall quality of the program setting.

Differential monitoring is not suggested as a generic approach for all programs but rather only for those who have a history of high regulatory compliance and quality. The only exception to this would be if a state/province wanted to use the differential monitoring approach as a screening to determine what subsequent reviews would look like. This approach could work in high caseload jurisdictions in order to prioritize how to do comprehensive reviews (effectiveness) and those programs that would be eligible for abbreviated reviews (efficiency).