Designing safer health care through responsive regulation

• Self-regulation by the health professions, while improving, is no longer enough; external drivers for safer health care include governments, funders and consumers. • Enforced self-regulation is often more promising than a "command and control" strategy. • Research evidence on the responsive regulatory pyramid and its options offers lessons for health care policy makers and managers. • Start at the base of the regulatory pyramid - try persuasion first; move up the pyramid to secure compliance, and then be willing to move back down. • Use existing capacities and structures, and if possible avoid new bureaucracies of control.