Challenges of democratic experimentalism: A case study of the National Quality Forum in health care

Abstract

Networks are an increasingly common aspect of administrative life in almost any public policy arena. In health care, networks have emerged in order to address “wicked” quality problems. One such network organization, the National Quality Forum (NQF), was created as a response to the fragmentation and information deficit that have plagued the health care industry’s efforts to improve health care quality. Its purpose is to bring diverse health care stakeholders from the public and private sectors together to discuss and debate quality and performance measurement issues. Democratic experimentalism offers one way of assessing the NQF’s efforts. The purpose of this article is to examine the NQF’s efforts through the lens of democratic experimentalism and to explore some of the virtues and shortcomings of applying a democratic experimentalist approach to health care regulation.

La gouvernance multiniveau et la nouvelle gestion publique : des idées nouvelles à intégrer aux approches traditionnelles du fédéralisme dans le contexte de l’étude des relations intergouvernementales

“…Aux États-Unis, une vision plus large du fédéralisme et des relations intergouvernementales, proche de celle de la GMN, est de plus en plus adoptée et soutenue par les chercheurs des domaines de l'administration et la gestion publiques (Kettl, 2000 ;Hoflund et Farquhar, 2008), du droit (Trubek, 2006 ;Blum, 2008) …”

“…La gouvernance multiniveau et la nouvelle gestion publique : des idées nouvelles à intégrer aux approches traditionnelles du fédéralisme dans le contexte de l'étude des relations intergouvernementales de la sociologie (Heimer et autres, 2008), de même que par les spécialistes des politiques au sein d'agences gouvernementales (Hoflund et Farquhar, 2008). Nous pensons que ces chercheurs sont plus enclins que les spécialistes du fédéralisme traditionnel à adopter une approche semblable à celle de la GMN.…”

Medical Device Regulation and Nanotechnologies: Determining the Role of Patient Safety Concerns in Policymaking

“…A Systems Approach to Protecting Research Participants (2001b), and it identifies the areas in which protection functions are necessary to ensure the safety of participants. The National Quality Forum in health care in the United States has recently been criticized for relying too much on legal approaches (Figueroa and Staton 2009; Buris 2008; Halpern 2008; Hoflund and Farquhar 2008). When it comes to patient safety, law tends to only deal with the tip of the iceberg (RAJ Devices 2009, 2008a).…”

Health care and new governance: The quest for effective regulation

“…The establishment of the National Quality Forum was a specific move to provide a forum for non-medical actors to create and implement systemic changes in health care using new tools such as best practices, benchmarks, and metrics. As Hoflund and Farquhar (2008) show in their article in this special issue, these tools can be seen as decentering the medical professionals' knowledge and usurping control of their institutions such as hospitals.…”

“…The idea then was that competing interests pursuing adversarial strategies would lead administrators to make fair and reasoned decisions (Trubek 2006). Instead, today, procedures are being developed that bring adversaries together into in a cooperative structure and encourage them to search together for solutions, as Hoflund and Farquhar (2008) show in their article in this special issue. In Europe, for example, use of the Open Method of Coordination, discussed by Hervey in this special issue, allows the EU’s member states to participate in mutual learning while allowing them to develop individual solutions to health care challenges using their own democratic processes (Hervey 2008).…”