Introduction: The practice of registered health professionals in New Zealand is regulated under the Health Practitioners Competence Assurance Act 2003. Under this Act, Responsible Authorities (RAs) aim to protect the public through ensuring practitioners are competent and fit to practise their professions. To ensure appropriate regulatory action, RAs require a clear understanding of the risks present within the professions they regulate. Although literature is available that describes disciplinary complaints against each profession, there seems to be little known about how regulators perceive the risk of harm inherent in each profession’s practice. This study seeks to explore participating New Zealand health regulators’ perspectives on risk and harm. Of particular interest are regulators’ perceptions of specific risks, their overall understanding of risk and harm, and how these perceptions are formed. A pragmatic mixed-methods approach was utilised to explore this novel topic. The intent of this research is to facilitate efficient cross-profession regulation by identifying areas of commonality between professions and provide an understanding of the validity of RA perceptions of risk.

Methods: This study utilised a pragmatic mixed-methods approach, incorporating two parallel study arms. The first arm consisted of a two-phase sequential explanatory design. In the first, quantitative, phase of this arm, eleven of sixteen potential RAs (69%), completed a bespoke questionnaire regarding their perceptions. The resulting data were reported using descriptive statistics. Five participating RAs were purposively selected for participation in the second, qualitative, phase utilising semi-structured interviews. Data were analysed using reflexive Thematic Analysis. The second Triangulation arm consisted of a parallel qualitative review. All published cases from the Health Practitioners Disciplinary Tribunal as of 21 August 2020 (n=432) were reviewed and analysed using a directed Content Analysis approach. Integrated analysis was then performed using a process based on the Complementary Integrative Analysis Strategy.

Results: In Complementary Phase 1, 54% (n=6) of 11 participating RAs reported significant risk factors were present in normal practice or that practice errors were likely/highly likely. Eighty-one percent (n=9) of participating RAs saw practice errors as high risk, whereas 55% (n=6) saw practitioner misconduct as a moderate risk. Communication error was also identified as a high risk (73%, n=8). From Complementarity Phase 2, seven themes were identified: ‘Knowing Risk’ is a challenge, Perceptions of risk relate to societal expectations, Perceived risk profiles are similar but distinct, Perceptions of relative risks relate to the clinical role and Environmental pressures amplify clinical risks were identified in participants view on the development and characteristics of risk. Communication is a moderator of harm and A team approach supports risk mitigation were apparent in exploring risk management. In the Triangulation arm, seven major themes were identified, being Disruptive behaviour, Boundary violations, Inappropriate care, Medication/Drugs, Health Information, Costs/Advertising and Regulatory requirements & Fraud. Integrated analysis showed areas of significant alignment within the complementarity arm, including support from Triangulation arm findings.

Conclusions: RA perceptions of risk and harm are varied, evolving and are strongly influenced by data from complaints and notifications. While differences in risks between professions are apparent, there is a need for regulators to align their understanding of risk. Limitations of data arising from complaints creates challenges for regulators in developing an accurate perception of risk, and it is imperative that the voice of the health consumer is at the centre of this understanding.