ABSTRACT
Regulatory activities have increased dramatically in number and in scope, including external mechanisms such as mandatory public reporting, and internal mechanisms such as peer audit. Health care providers aim to build patient safety cultures, continually improve quality, and learn from adverse events. Regulatory mechanisms have expanded rapidly but in a haphazard way. The adoption of a general principle can serve an instrumental purpose in rallying people behind a common goal, while agreeing on principles at a high level of generality is easier than reaching agreement on specific mechanisms. Trust traditionally is the basis of regulation in the health care sector rather than law and inspections. A broad definition of transparency is the degree to which information is available to outsiders that enables them to have informed voice in decisions and/or to assess the decisions made by insiders'.
