The implementation of care regulations in residential disability services in Ireland

Background Governments seek to monitor quality and safeguard citizens through regulation of various industries. Regulation is common feature of health and social care systems worldwide. Despite its prevalence as an intervention, there is relatively little attention paid to regulation with respect to its implementation in health and social care services i.e. how is compliance achieved? The aim of this thesis is to investigate how care regulations are implemented in health and social care services, including the processes and strategies that support the implementation process. Methods We adopted a multiple-methods approach to this research, albeit that the majority of the work was qualitative in nature. An overarching approach for the original research components of this thesis was to adopt an implementation science approach and regard regulation as an intervention. Firstly, a systematic review was undertaken to identify determinants of regulatory compliance in health and social care services. Secondly, an analysis of compliance data and inspection reports relating to residential disability services in Ireland was conducted to determine the level of non-compliance with regulations and to identify causes of non-compliance. Thirdly, a qualitative interview study was undertaken to describe how managers of residential disability services in Ireland engage with the implementation of care regulations. This study examined managers’ perspectives on regulation, the strategies, structures, and processes they use to implement it, and key factors shaping their approaches. Finally, a qualitative focus group study was carried out with inspectors of residential disability services in Ireland. This study sought to describe how inspectors worked to implement the regulation of residential care for people with disabilities in Ireland, focusing on their views about the regulatory system, the strategies they use to improve compliance and deal with poor performance, and the challenges they face in implementing these strategies. Results The systematic review found a large amount of studies (n=157), describing a wide range of determinants of regulatory compliance. The majority of studies were quantitative, located in the United States and focused on nursing homes. The analysis of compliance data and inspection reports showed that non-compliance with regulations was common in residential disability services in Ireland. Eight themes describing causes of non-compliance were identified, with the ‘insufficient resources’ theme appearing most frequently, followed by ‘governance and management failings’. In the interview study with managers of residential disability services, five themes were identified. Managers sought to foster a positive culture towards regulation in order to support implementation. They had instituted a range of structural and process measures to promote compliance and had used various strategies to manage their relationship with inspectors and other external stakeholders. In the focus group study, four themes were identified. Inspectors used skill and strategy to support implementation in the services they regulated. Notwithstanding this, they encountered legislative and bureaucratic barriers that inhibited their capacity to regulate effectively. Conclusion This thesis has contributed to knowledge in the field of regulation of health and social care services by regarding regulation as an intervention and adopting an implementation science approach. Further research on the implementation of regulations and the effectiveness of regulation is merited given the prevalence of regulation as a quality improvement intervention in health and social care services.

Grantor dc:publisher

University College Cork

Year dc:date.issued

2025

Author dc:creator

• Dunbar, Paul

Advisor dc:contributor.advisor

• Browne, John P.

• Regulation
• Health and social care
• Implementation science
• Quality improvement

Statement dc:rights

• © 2025, Paul Dunbar.

Licence dc:rights.uri

• https://creativecommons.org/licenses/by/4.0/

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10468/18407

OAI identifier oai:identifier

oai:cora.ucc.ie:10468/18407