Thematic Analysis of Health Professions Sunset Reports: Foci, Gaps, Impacts, and Best Practices

Background

Sunset reviews, along with performance audits and judicial reviews, orientate regulatory boards to act in the public interest and to address any weaknesses in the boards’ efficiency. Although sunset reviews gained popularity after their introduction in the 1970s and 1980s, their limited success in terminating agencies, along with the resources needed to conduct the reviews, have led to sunset legislation being repealed in several jurisdictions in favor of broader program evaluation or general audit processes. Increased interest in trying to limit the growth of the number of professions requiring a license to practice has seen a revival of interest in both sunrise and sunset reviews over the past decade.

Purpose

To review existing sunset reports related to nursing and other health professions licensing boards and identify the foci, best practices, and criteria used by states in their evaluations.

Methods

A review and systematic examination of existing literature was performed with a mixed-methods approach and a range of analytical techniques. Manual and computer-based qualitative analyses were used to identify themes. Documents were analyzed for thematic content, the centrality of various themes, and how they may inform the development of more standardized approaches to assess the performance of regulatory bodies.

Results

A total of 329 reports were identified from 24 US states. The 329 reports were analyzed and varied in length from 3 to 727 pages with an average report length of 68 pages. Collectively, 22,420 pages were analyzed. The review identified that many evaluations were based on opinion or survey responses rather than quantifiable or empirical evaluations. As a result, objective analysis of the approaches is difficult to assess, both within and across jurisdictions. The study identified 26 themes with considerable overlaps and connections between them. By coding various themes to the content of the reports, researchers identified groups of the most strongly related themes. The most connected group, main areas of performance scrutiny, relates to the major responsibilities and functions of licensing boards. The next most connected group encompasses the administrative and operational concerns involved in the conduct of the review. The least connected group is those elements that delineate the authority and focus of the review and encompass the basis of the legislative authority used to enable the review. Best and promising practices were also identified, including the following: (a) information provision (e.g., guidance notes that explain the process and provide public input); (b) comparative data sets (e.g., conducting reviews on a range of boards simultaneously); (c) accountability and publication of responses (e.g., improvement recommendations or commendation for best practices are made available).

Conclusion

Analysis of published sunset review report thematic content identified a range of potential metrics that, if standardized, could offer greater interdisciplinary board and interjurisdictional learning. The criteria used to conduct sunset reviews and the foci contained within reports provide insights for board members and staff education content creators. Related opportunities for further research were also identified.