Published on December 9, 2014

The design of healthcare institutions benefits greatly from citizen participation: Claudia Landwehr

NHS Citizen

By Emily Graham

Emily is Project Coordinator at Involve. Working primarily on NHS Citizen, Emily is committed to the importance of people’s participation in building a transparent, accountable and more inclusive democracy.

In this blog-post on Democratic Audit UK, Claudia Landwehr outlines how citizen participation can be beneficial in the design of healthcare institutions. The full article is available here.


Here is an excerpt in which Claudia Landweh describes about her research:

“Engaging citizens in institutional design

Are citizens interested in questions of institutional design? Or is the matter too abstract and complex for non-experts? I argue that, to a considerable extent, any one of us is an expert where we have to make decisions about how to decide. We engage in such decision-making permanently in our everyday lives: at the workplace, the school board, the sports club, within the family. We all know, for example, that strict unanimity requirements make final decisions difficult to reach. And most of us are aware of who the relevant stakeholders in a given decision are.

This is why our team at the University of Mainz organised a citizen conference in which 20 citizens – selected in a two-step random sampling procedure – where tasked with developing suggestions for the institutional design of an agency that takes priority setting decisions in health care. Without any topical input, the citizen group was able to identify criteria for fair and democratic institutional design and to translate these into specific reform proposals.

In the discussion, members of the group raised arguments very similar to those in academic debates and made several innovative and truly original points and suggestions. Not only was the quality of deliberation high, the citizen group was also able to formulate a joint vote that has been presented to the public and sent out German MPs and respective interest groups.

Our positive experience with citizen deliberation on institutional design shows that we can make design processes more transparent, inclusive and democratic. Even if institutions like NICE do achieve ‘accountability for reasonableness’, their very set-up and design should enjoy a clear democratic mandate and be subject to democratic challenges and revision.”


Full blog-post available here:

Feature image: “Governor’s Island, NY Old Post Hospital First Floor Plan 1871” by army.arch, Creative Commons, see the image on flickr 


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