van de Bovenkamp, H. M., Stoopendaal, A., Bochove, M. v., & Bal, R. (2020). Tackling the problem of regulatory pressure in Dutch elderly care: The need for recoupling to establish functional rules. Health Policy. doi: https://doi.org/10.1016/j.healthpol.2019.12.017
This article speaks to the importance of reflection in reducing regulatory burden. It also points to the importance of dialogue in developing functional rules; that is, rules that support rather than hinder good care. This article does not study reflection groups per se. Rather the researchers study a number of interventions and conclude that in order to reduce regulatory burden it is important to have conversations about rules, their origins and their functionality. Indeed, the authors find that it is necessary to create “comfort zones,” where staff can discuss the relationship between rules and work routines. In this space for safe reflection, they can explore why the rule is in place, whether it is meeting its goal, how strict it is, and how staff might adapted or discard it in order to meet care goals. The authors suggest that these spaces for dialogue should also be expanded beyond staff in a given unit or facility to include a diversity of stakeholders. The authors consider the example of the Dutch inspectors who meet with facility managers. Here they have conversations about where rules are working and where they are not. This points a move from control-oriented approach to accountability towards a more learning and relational centered model.