Decline of the “Little Parliament”: Juries and Jury Reform in England and Wales

Lloyd-Bostock and Thomas take a historical look at the English jury and place the jury and jury reform in the context of the English legal and political system

Alternative Dispute Resolution and Civil Justice Reform: Is ADR Being Used to Paper Over Cracks?

Published in cooperation with the American Bar Association Section of Dispute Resolutio

Withering the citizen, managing the consumer: complaints in healthcare settings

This paper considers concepts of citizenship and consumerism in light of complaints about healthcare, which have risen since the early1990s, due to a greater willingness by the healthcare user to complain, and also the reforms in complaint systems. The narrow legal model for dealing with complaints has been replaced by a managerial model based on corporate sector practice that views complaint handling as a way of retaining customers and organisational learning. The managerial model has proved difficult to embed into the English NHS and has been superposed with a centralised regulatory system that aims to manage performance while also being responsible for reviewing, complaints and being responsive to complainants. It is argued that this may have positive consequences in terms of improving healthcare quality but more negatively, the promotion of consumerism within complaints processes has led to a loss of the right to due process and public accountability

Aristotle's Peculiarly Human Psychology

For Aristotle, human cognition has a lot in common both with non-human animal cognition and with divine cognition. With non-human animals, humans share a non-rational part of the soul and non-rational cognitive faculties (DA 427b6–14, NE 1102b29 and EE 1219b24–6). With gods, humans share a rational part of the soul and rational cognitive faculties (NE 1177b17– 1178a8). The rational part and the non-rational part of the soul, however, coexist and cooperate only in human souls (NE 1102b26–9, EE 1219b28–31). In this chapter, I show that a study of this cooperation helps to uncover some distinctive aspects of human cognition and desire

The hearing of fitness to practice cases by the General Medical Council: Current trends and future research agendas

Over the last three decades a risk-based model of medical regulation has emerged in the United Kingdom. To promote a risk-averse operational culture of transparency and professional accountability the regulatory state has intervened in medical governance and introduced best-evidenced practice frameworks, audit and performance appraisal, Against this background the paper analyses descriptive statistical data pertaining to the General Medical Council’s management of the process by which fitness to practice complaints against doctors are dealt with from initial receipt through to subsequent investigative and adjudication stages. Statistical trends are outlined regarding complaint data in relation to a doctor’s gender and race and ethnicity. The data shows that there has been an increase in rehabilitative and/or punitive action against doctors. In light of its findings the paper considers what the long-term consequences may be, for both patients and doctors, of the increasing use of risk-averse administrative systems to reform medical regulation and ensure professional accountability

Extra-Legal Factors and Product Liability: The Influence of Mock Jurors’ Demographic Characteristics and Intuitions about the Cause of an Injury

Two experiments were performed to investigate the role of extra-legal factors in a simulated product liability trial. In cases where the factual evidence was identical, subjects’ liability judgments varied as a function of the case-specific factor of the alleged source of the plaintiff’s injury. In deciding cases differently depending on the alleged cause, subjects relied on intuitions about what injury sources are more or less likely to cause a certain kind of injury. Juror- specific factors also influenced subjects’ verdicts. There was no difference between students and non-students, but race and SES—factors that are often correlated with student status—did affect subjects’ verdicts. Low-SES and minority subjects were more likely to find the defendant liable than high-SES and white subjects. The results are considered in terms of general decision-making processes, and the implications for jury selection and mock jury research are discussed

Independence in complaints procedures: lessons from community care

This article looks at internal complaints procedures and considers the role of independent elements in procedures which are designed to be simple, informal and low cost. Taking the example of local authority community care services as a case study, the article discusses research which looked at the views of complainants, potential complainants and those who run the procedure. Most people do not make formal complaints at all and very few people seek an independent review of their complaint. When they do seek such a review, they expect it to be transparently independent of the body complained about. The article concludes that the current system of local authority complaints review panels or committees does not provide the independent element that complainants seek

A meta-ethnography of the facilitators and barriers to successful implementation of patient complaints processes in health-care settings

Objective: To synthesize experiences of the patient complaints process for patients and health-care professionals to identify facilitators and barriers in the successful implementation of patient complaints processes. This will assist the development of cultural change programmes, enabling complaints managers to incorporate stakeholder perspectives into future care. Design: Systematic literature search and meta-ethnography, comprising reciprocal syntheses of “patient” and “professional” qualitative studies, combined to form a “line-of-argument” embodying both perspectives. Data sources: MEDLINE, CINAHL and PsycINFO (database inception to April 2015) were searched to identify international literature in primary and secondary health-care settings, involving qualitative data collection and analysis. Further studies were identified from hand-searching relevant journals, contacting authors, article reference lists and Google Scholar. Results: A total of 13 papers, reporting 9 studies from the United Kingdom, Sweden, Australia and New Zealand, were included in the synthesis. Facilitators and barriers to the successful implementation of patient complaints processes were identified across the perspectives of both patients and health-care professionals. Patients sought to individualize the complaints process by targeting specific professionals who engaged in practices that undermined the identity of patients. In contrast, professionals obscured their own individualism through maintaining a collective identity and withholding personal judgement in relation to patient complaints. Conclusions: Complainants recognized health-care professionals as bearers of individual accountability for unsatisfactory care, in opposition to the stance of collective responsibility endorsed by professionals. Implementation of patient complaints processes must reconcile the need for individualized resolution, whilst striving to improve the future provision of health care through a collaborative approach between patients and professionals.</p

Patient-centered insights: using health care complaints to reveal hot spots and blind spots in quality and safety

Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential. We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low‐level problems, and errors of omission). Systematic analysis of health care complaints can improve quality and safety by providing patient‐centered insights that localize issues and shed light on difficult‐to‐monitor problems. Context The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data. Methods We analyzed 1,110 health care complaints from across England. “Hot spots” were identified by mapping reported harm and near misses onto stages of care and underlying problems. “Blind spots” concerning difficult‐to‐monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission. Findings The tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty‐three percent of problems entailed major or catastrophic harm, with significant regional variation (17%‐31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low‐level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns. Conclusions The analysis of health care complaints reveals valuable and uniquely patient‐centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry‐exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files