Intelligently Designing Deliberative Health Care Forums: Dewey's Metaphysics,Cognitive Science and a Brazilian Example

Imagine you are the CEO of a hospital [. . .]. Decisions are constantly being made in your organization about how to spend the organization's money. The amount of money available to spend is never adequate to pay for everything you wish you could spend it on, therefore you must set spending priorities. There are two questions you need to be able to answer . . . How should we set priorities in this organization? How do we know when we are doing it well? When people seek to achieve good public policy, the result will tend to be good public policy. In a collective choice process, public‐spirited individual participants produce good public policy by deliberating—talking with each other, listening to each other's arguments, and being willing to learn and change their minds based on such dialogue. – Steven Kelman (1992 : 181)

Public policy scholars agree that those persons (or agencies) vested with the authority to establish health care priorities should elicit public input before making rationing decisions. The two most common approaches are (i) consultation and (ii) deliberation. Though deliberation has obvious advantages over consultation, it falters in the face of the objection that ordinary citizens lack the cognitive resources for the extended, rigorous inquiry required of them in undertaking the priority‐setting task. To overcome this objection, I propose that deliberative forums for health care rationing should be designed so that they imitate the natural pattern of human experience. The experience of deliberation should encompass both prolonged periods of less‐demanding cognitive activity, in which citizens passively receive information, and briefer periods of more‐demanding cognitive activity, in which they engage in active problem‐solving. In arguing for this thesis, I rely on two theoretical sources and one practical case study, in the following order: (i) John Dewey's metaphysics of experience, (ii) cognitive science research on schemas and frames, and (iii) the Health Care Council in São Paulo, Brazil.     

Public Involvement in NHS Inquiries

Opportunities for engaging the public have changed over the fifty years since the inquiry into the Ely Hospital, Cardiff. NHS inquiries, and inquiries more widely, tend to be called where events have led to public concern and loss of public confidence. Involvement of the public could therefore be assumed to form a part of restoring that public confidence. This paper explores the mechanisms for public involvement in NHS inquiries over the past fifty years, assessing the roles played by the public. It uses the framework outlined by Geoffrey Howe to examine how members of the public have been involved in four NHS inquiries. Findings suggest that the roles and mechanisms have varied, but that understanding the extent of public involvement is a dimension to assessing each of the potential functions of an NHS inquiry.     

Public Inquiry Methods,Processes and Outputs: an Epistemological Critique

Public inquiries are an important phenomenon in modern British society, often used to address controversial or difficult issues of major concern to policy makers, the media and the public. Although people often comment adversely on how costly inquiries are and how long they take, inquiry methods are rarely discussed, let alone critiqued or challenged. However, from a social sciences perspective, inquiry methods, processes and outputs are often at odds with accepted standards for research methods. This paper discusses this divergence and the implications for how we should regard the inquiry as a way of knowing, or learning.     

A Tale as Old as (Devolved) Time? Sewel,Stormont and the Legislative Consent Convention

Interparliamentary relations do not attract much in the way of public or even academic attention. However, they are an aspect of parliamentary life in which there has been a series of experiments by select committees in the House of Commons. While one of the more prominent examples of such experimentation was the international grand committee on Big Data, Privacy and Democracy spearheaded by the Digital, Culture, Media and Sport Committee, this article will look at another example of select committee-led interparliamentary relations, namely the ‘joint inquiry’ conducted by the House of Commons Defence Committee and the Assemblée nationale’s Standing Committee on National Defence into Future Cruise and Anti-Ship Missiles in 2018. This article, written by an official involved in the inquiry, offers the first reflections on the experience of this joint inquiry, demonstrates how the model undertaken for the inquiry differed from the approaches taken by other select committees involved in interparliamentary working, and explores whether it might offer a blueprint for future joint inquiries.     

Sir Henry Bland and the Fraser Government's Administrative Review Committee: Another Chapter in the Statutory Authority Wars?

The release of the 1976 Commonwealth cabinet records on 1 January 2007 provided the opportunity to review the work of the Administrative Review Committee (ARC) appointed by the Fraser government and headed by Sir Henry Bland and so to open up a hitherto little appreciated chapter in Australian administrative history. At first glance, it appeared that Bland's ARC had been strongly opposed to widespread use of statutory authorities, for so long a regular part of Australia's machinery of government, thus providing an interesting point of comparison with the Uhrig inquiry of 2003-04, which attracted much notice for its antipathy towards statutorily independent agencies. Given the unusual methodology of the ARC, it was also likely that an account of its work would shed further light on public inquiries generally, perhaps assisting in development of a typology of such inquiries.     

Policy learning and the public inquiry

Can public inquiries learn lessons in ways which can reduce the likelihood of future failure? Political science research has consistently stated that the answer to this question should be an emphatic no and defined the public inquiry as an ineffectual lesson-learning mechanism. This article, however, contends that this conventional wisdom needs to be revisited. Drawing upon policy learning research for its theory, and 100 interviews across four international cases for its evidence, this article returns to the question above and finds that inquiries regularly produce ‘instrumental’ and ‘cognitive organisational’ forms of learning, which propel substantive reform agendas. By contrasting these outcomes against the types of learning that inquiries struggle to produce, the article delivers a nuanced evaluation that indicates that we need to reconsider what we think we know about these important institutions.

     

The 2009 Victorian Bushfires Royal Commission: Lessons for the Conduct of Inquiries in Australia

Royal commissions with their wide powers, independence and uncertain outcomes are adopted sparingly by government. Hence, those charged with establishing such an inquiry are often left to begin anew. The 2009 Victorian Bushfires Royal Commission (VBRC) provides a means of exploring lessons for public administration in light of its inquiry approach and internal operation. Similarly, recent reports on the conduct of statutory inquiries provide the opportunity to examine good practice. This article explores the central issue of what mode of inquiry is suited for particular circumstances. It characterises three different types of inquiry and analyses their features. The author provides participant observer insights from the VBRC and reflects on lessons learned.     

Why Don't Housing Choice Voucher Recipients Live Near Better Schools? Insights from Big Data

Housing choice vouchers provide low‐income households with additional income to spend on rental housing in the private market. The assistance vouchers provide is substantial, offering the potential to dramatically expand the neighborhoods—and associated public schools—that low‐income households can reach. However, existing research on the program suggests that housing choice voucher holders live in neighborhoods with schools that are no better than those accessible to other households with similar incomes. Households, in other words, do not seem to spend the additional income provided by the voucher to access better schools. In this analysis we rely on a large‐scale administrative data set to explore why voucher households typically do not live near to better schools, as measured by school‐level proficiency rates. We combine confidential administrative data from the Department of Housing and Urban Development on 1.4 million housing choice voucher holders in 15 states, with school‐level data from 5,841 different school districts, to examine why the average housing voucher holder does not live near to higher‐performing schools than otherwise similar households without vouchers. Specifically, we use the large‐scale administrative data set to test whether voucher holders living in areas with good schools nearby and slack housing markets move toward better schools when schools become salient for them—that is, when their oldest child becomes school eligible. We take advantage of the thick sample of households with young children provided through our administrative data to implement both a household fixed effects and a regression discontinuity design. Together these analyses shed light on whether voucher households are more likely to move toward better schools when schools are most relevant, and how market conditions shape that response. We find that families with vouchers are more likely to move toward a better school in the year before their oldest child meets the eligibility cutoff for kindergarten, suggesting salience matters. Further, the magnitude of the effect is larger in metropolitan areas with a relatively high share of affordable rental units located near high‐performing schools and in neighborhoods in close proximity to higher‐performing schools. Results suggest that, if given the appropriate information and opportunities, more voucher families would move to better schools when their children reach school age.     

Trust Matters: Enhancing Government Legitimacy through Participatory Budgeting

Legitimacy is a problem of contemporary governance. Communities lack trust in elected officials—in their effectiveness, fairness, and representation of the public interest. Participatory budgeting (PB)—a set of democratic processes where residents determine how to spend a public budget—helps bridge that distance by letting the public make spending decisions. Since 2011, some of New York City’s (NYC) council members have been implementing PB with their capital budget—setting aside a million dollars in their districts each budget cycle for PB. Participatory budgeting has the potential to rebuild relationships between government and communities. Using data from over eighty interviews conducted by New York University (NYU) graduate students in 2013 and 2014 with PBNYC participants over two years, this article suggests that in council districts using PB, residents have greater feelings of access to and voice in local government, and better understanding of the complexities of spending public monies, often leading to a more positive view of government officials, and bolstering legitimacy of local government.     

Congressional response to public crisis: how corporations can prepare

Public policy is at the heart of US congressional investigations, where private corporations can confront a unique set of rules and mores—in a very public forum, often covered in the news and televised. This article traces the historical precedents to congressional inquiries, highlighting cases such as the ‘Teapot Dome’ scandal and the ensuing US Supreme Court case, McGrain v. Daugherty, confirming the Legislative Branch's independent investigative authority to compel a witness to testify and produce documents. The article explains the two types of congressional investigations, oversight and legislative, and how their differences could impact the corporations involved. It reviews recent examples of investigations, illuminating how a corporation's public relations and legal rights can both overlap and point to differing interests. Based upon first‐hand experience, the author provides a legal perspective in explaining the investigation procedures, the legal limits to congressional authority, and the steps taken to prepare a witness for testimony. Finally, the author explains how readiness for congressional inquiries is an integral aspect of prudent risk management for any major corporation. Copyright © 2012 John Wiley & Sons, Ltd.     

‘And What Good Came of it at Last?’ Press–Politician Relations Post‐Leveson

James Margach famously argued that Prime Ministers from Lloyd George to Callaghan had been intent on exploiting the media in their determination to centralise power. From Margaret Thatcher onwards, however, there is a strong argument that the power relationship has been reversed, and that the Leveson Inquiry—set up in the wake of the phone hacking scandal—exposed a political class which had become deeply fearful of the power and influence of the national press. Citing evidence to Leveson and subsequent recommendations by the inquiry, this article presents two case studies—on data protection and on media ownership—where the public interest clearly demanded political intervention, which would be inconvenient for the major publishers. And yet, despite recommendations by Lord Justice Leveson and despite clear support from leading politicians of all parties, there has been virtually no policy progress in either case. While the Leveson Inquiry was billed as a watershed in press–politician relations and an opportunity to counteract decades of unhealthy press power, political inertia in these two areas suggests that very little has changed.     

Understanding Employee Turnover in the Public Sector: Insights from Research on Teacher Mobility

Employee turnover is a key area for public administration research, but one about which there is much still to be learned. Insights from an extensive body of research on employee turnover in a specific area of the public sector—public education—contributes to the understanding of employee mobility in public organizations more generally. The authors present a conceptual framework for understanding employee turnover that is grounded in economic theories of labor supply and demand, which have formed the foundation of many studies of teacher turnover. The main findings of this body of work are documented, noting connections to the literature on public employee turnover, lessons that can be learned, and potential new areas for empirical inquiry for scholars of turnover in the public sector.     

When Mayors Matter: Estimating the Impact of Mayoral Partisanship on City Policy

U.S. cities are limited in their ability to set policy. Can these constraints mute the impact of mayors’ partisanship on policy outcomes? We hypothesize that mayoral partisanship will more strongly affect outcomes in policy areas where there is less shared authority between local, state, and federal governments. To test this hypothesis, we create a novel dataset combining U.S. mayoral election returns from 1990 to 2006 with city fiscal data. Using regression discontinuity design, we find that cities that elect a Democratic mayor spend a smaller share of their budget on public safety, a policy area where local discretion is high, than otherwise similar cities that elect a Republican or an Independent. We find no differences on tax policy, social policy, and other areas that are characterized by significant overlapping authority. These results suggest that models of national policymaking are only partially applicable to U.S. cities. They also have implications for political accountability: mayors may not be able to influence the full range of policies that are nominally local responsibilities.     

The Three Tensions of Investigating Intelligence Failures

This paper offers a framework for analyzing governmental inquiries into intelligence failures. The paper argues that all investigations face three inherent tensions over their timing, purpose, and process. The benefits and disadvantages of conducting inquiries immediately after the intelligence failure or years later, engaging in investigations designed to ascribe blame or find solutions to endemic intelligence problems, and conducting adversarial, legal-style investigations or collaborative inquiries, are all discussed. In many cases, but not always, the two first tensions are exacerbated by the politicization of the inquiry. Using examples from governmental inquiries around the world, the paper investigates each tension and offers some strategies for mitigating them.     

Parliament Scrutiny of Government Performance in Australia

This article examines how the Commonwealth Parliament of Australia seeks to hold responsible ministers directly and senior public servants indirectly accountable for the performance of departments and programs on the basis of published performance data and inquiries conducted by parliamentary committees. From the perspective of an outsider, the scrutiny process in the Australian parliament, although not without its problems, is more systematic and substantive than is the case in other parliamentary systems such as Canada. Creating a more meaningful dialogue in the Australian parliament on performance issues will depend more on changes to the intersecting cultures of the legislature, government and the public service than on organisational and procedural reforms to any of those institutions.     

Strategic Ignorance and the Search for Extraterrestrial Intelligence: Critiquing the Discursive Segregation of UFOs from Scientific Inquiry

Since the late 1940s, a tenacious disconnect between popular interest and professional disinterest in unidentified flying objects (UFOs) has typified the controversy surrounding the subject. Numerous high-profile scientists have seen the topic of UFOs as an opportunity to denounce and rectify a popular, yet allegedly misguided, conviction—that some UFOs are physical anomalies indicating the existence of extraterrestrial intelligence—and thus to advance the explanatory authority of science. Rather than constituting rigorous, informed, and effective assessments, however, the ways in which many prominent scientists publicly address the UFO question often exemplify both the problematic “boundary-work” of scientific discourse in this area and, more specifically, the role that logical fallacies can play in the rhetorical construction of scientific authority in public domains. Through a critical discourse analysis, this article argues that ignorance of UFO phenomena is socially and discursively constructed in ways that are conducive to the public faces of individuals and institutions. More broadly, it suggests that the rudimentary standard of science communication attending to the extraterrestrial intelligence (ETI) hypothesis for UFOs inhibits public understanding of science, dissuades academic inquiry within the physical and social sciences, and undermines progressive space policy initiatives.     

Public Administration, the History of Ideas, and the Reinventing Government Movement

Public administration writers, with some notable exceptions, generally have not paid a great deal of attention to the history of ideas. However, public administration inquiry is profoundly affected by longstanding political and social ideas. This article shows how the idea of the state as a purposive association—that is to say, a collective enterprise that is driven by some set of substantive ends or purposes—has helped to shape the thinking and discourse of some public administration writers, particularly those of the reinventing government movement. The implications of this for public administration inquiry and education are examined.     

A Belated Debate

The three televised leaders’ debates dominated the 2010 general election campaign. The House of Lords Communications Committee report on Broadcast General Election Debates is the product of a welcome but belated public inquiry into their organisation and conduct. The report is supportive of the view that ‘broadcast general election debates should take place during future campaigns’ and makes a number of cautious recommendations to the broadcasters. At the time of writing it was unclear whether the format proposed by the broadcasters for 2015 would be an improvement on that for 2010—or even if there would be any debates at all.     

Issue compensation and right‐wing government social spending

It is well‐established that prolonged left‐wing incumbency has a positive long‐term effect on welfare effort in terms of high levels of social spending and reduced levels of economic inequality and poverty. Prolonged left‐wing incumbency also influences the institutional set‐up of welfare states, in particular generating strong support for existing arrangements in countries with large welfare states. The issue ownership literature furthermore shows that the public comes to distrust right‐wing parties as defenders of the welfare state. In countries that have a tradition of left‐wing incumbency it is particularly important for right‐wing governments to compensate for the distrust of the public because of the popularity of the welfare state and strong vested interests. While right‐wing governments on average are negatively associated with social spending, there is a strong positive association between right‐wing government and social spending in traditionally left‐wing countries. It is even the case that right‐wing governments in these countries spend more on social welfare than left‐wing governments. This indicates that right‐wing governments are forced to compensate for the lack of public trust by being even more generous than the left.