As a patient, I would be outraged by the idea that medical professionals alone (link to 2001 paper) should decide the outcome measures that would be used to decide the benefit and utility of medical innovations.
But, without a squeak of protest, objection, or insight, I have written favorably about, and been involved with designs of outcome measure approaches that are designed entirely by courts, legal aid, and academics, without any client or litigant input. I suspect that personally I have been guilty, as a lawyer, of believing that “of course,” I and people like me know what makes a difference for our clients. After all I was meant to be their “advocate.”
So let me now urge that outcome measures design processes should have litigant and client voices built in from the start, and that those voices should be heard throughout the measure design process. For example, what do tenants care about? Staying in the house? not being homeless? not losing their job? not owing money? staying off the landlord eviction registry? staying in the neighborhood, keeping the family together?
Similarly, how would family law litigants measure the success of the case as a whole? Custody? Money? lack of conflict? Feelings about other family members? Autonomy?
Also to be a asked is if the relative weightings vary for different litigants, and what kind of systems would allow for appropriate variation in weightings.
I think a process should probably begin with a litigant/client focus group to get a sense of the range of outcomes that matter, and that from that point on every state in the measure design process should involve litigant perspectives. The final stage, that may be about weighting of outcomes, should be driven largely by clients and litigants.
It is true that the so-called “public trust and confidence” research does focus on litigant valuing of process outcomes. But even there, I suspect that the process was to hypothesize that litigants valued these goals, and then confirmed that by surveying, rather than going from the first and asking people what they cared about. In any event, the outcome weighting process here would be critical.
I hope that this insight can be integrated into the outcomes to be developed in the Justice for All Strategic Planning processes, and in the outcome measures required to be developed in the next few years by LSC grantees.
Of course it takes more time to do it this way, but that is just another argument for building common measures, rather than starting from scratch each time. It would be good to start by hearing mch more about those programs and courts that have engaged in this kind of approach.
It is noteworthy that within HHS there is an entire institute dedicated to Patient-Centered Outcomes Research (PCORI).
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