Just a first, liminal reflection…
Thank you again @nadia for pointing this out.
I am not sure I fully grasped the purpose of this, as the text is touching on so many issues at once. I will just focus on the questions to the peers.
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Sustainability can be achieved by any of the mechanisms you mentioned, and more (how about connecting a parallel currency to your activity, creating a membership parallel economy, the likes of Sardex?)… However, the key is that sustainability is not something that can be described in general terms. One has to map the entirety of value chain, and interfaces to surrounding ecosystems, to form an idea of how to become sustainable.
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Again, much depends on what are the incumbents you are talking about, case by case (2 hospitals will react very differently, because their governance is managed by different individuals… even if the general administration may look the same), and by how much, and what kind of, intersection your activities have with theirs… Identifying a few “ambassadors”, people that may even be critical but willing to engage and discuss, on both sides (also within your own community) is possibly the first step… verbal communication is easier than written, and maps or other interpretable/symbolic representations can help confronting the different narratives to converge… I would avoid interfacing two different communities by exchanging long texts first
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In your case I am not sure why you would like to “work around” any of this… maybe a specific case could help me focusing on a pragmatic reply. In general demonstrating a solid, well thought-of scheme of access to information, education/training, mentoring, and peer evaluation, helps convincing that the operations are sensible and aligned with the purposes of the law. However, there are many details one should consider only on a specific plan: what safety nets are needed for you and your community? Can you keep track of activities and consequences? etc…
Registrations/certifications/licensing are in place as fences, one of the tools in the arsenal of safety in healthcare… it is possible to negotiate ways out when it is proven that safety is guaranteed never the less… this may imply lobbying and meetings with authorities, but one can find examples from prior cases that are useful… as instance medical students can practice some medical activities under mentoring before being graduated and licensed… but the University Hospital has a wide safety net set up…
It’s not impossible to find good solutions, and regulators are often discussing of innovation in this field of regulation, but there are no shortcuts…