Interest-based mediation of medical malpractice lawsuits: a route to improved patient safety?

Mediation of medical malpractice lawsuits provides savings for the parties by shortening the litigation process. In theory, information that aids emotional healing and improves patient care can also surface through mediation. The study discussed in this article used structured interviews of participants and mediators in thirty-one mediated malpractice lawsuits involving eleven nonprofit hospitals. The study measured perceptions of the process and mediation's effects on settlement, expenses, apology, satisfaction, and information exchange. Defense lawyers were less likely than plaintiff attorneys to mediate. Both plaintiff and defense attorneys were satisfied with the process, as were plaintiffs, hospital representatives, and insurers. Changes in hospitals' practices or policies to improve patient safety were identified. This study demonstrates that major challenges stand in the way of achieving mediation's full benefits. Absence of physician participation minimizes the chances that mediated discussion of adverse events and medical errors can lead to improved quality of care. Change will require medical leaders, hospital administrators, and malpractice insurers to temper their suspicion of the tort system sufficiently to approach medical errors and adverse events as learning opportunities, and to retain lawyers who embrace mediation as an opportunity to solve problems, show compassion, and improve care.     

RHETORIC AND REALITY IN THE REFORM OF JUVENILE JUSTICE POLICY

In the 1960s and 1970s dissatisfaction with the administration of juvenile justice led to a reform movement which advocated "diversion, deinstitutionalization," and the decriminalization of status offenses as strategies to reduce the harmfulness of official contacts. This paper argues not only that these reforms have not been successfully implemented, but also that the traditional system has been maintained and extended. Explanations for the failure of these reforms are offered and a new direction is suggested.     

Money,people or mission? Accountability in local and non-local NGOs

Little is known about how ownership affects accountability in non-governmental organisations (NGOs). This article explores differences between locally- and non-locally-owned NGOs in South Africa. Our data suggest that locally-owned NGOs more often claim to implement downward and internal accountability mechanisms, while non-local NGOs more often claim to implement upward accountability mechanisms. Bigger NGOs also perform better at downward and upward accountability mechanisms than smaller ones. The data suggest there is much these organisations can learn from each other to strengthen their accountability mechanisms. Furthermore, assuming there is a positive relationship between local ownership and development effectiveness, these findings may have important implications in furthering effective development interventions.