The need for a regulatory rethink: a perspective from Australia.

Traditional 'hierarchical' regulation involves checks and balances and external accountability and review bodies. There have been high profile failures of this approach in England (Mid Staffs) and Australia (Bundaberg, Queensland). The regulatory framework needs to be transformed to recognise the increasing use of market and market-like mechanisms in health care. Improvement in the ability to measure quality and safety of care using routine (already collected) data facilitates this. New regulation needs to ensure quality and financial incentives are aligned. New instruments such as incorporating safety/quality measures into service descriptions, use of patient reported outcome measures, and making information about expected outcomes of care to patients available, ought to be used more widely. Improved data capture, including whether a diagnosis was present on admission, will help in improving quality and safety of care and its measurement.