• Accountability;
  • Medical errors;
  • Agenda-setting;
  • Comparative policy analysis;
  • Health-care system reform;
  • Patient safety regulation


This article examines the major malpractice incidents in the late 1990s through early 2000s in the UK and Japan, comparing how these incidents opened up pathways for a new type of hospital regulation in each case. Applying John Kingdon's three-stream model of agenda-setting and policy change, the article argues that governance arrangements as well as the policy instruments that a government has at its disposal determine how an event could be translated into a political agenda by throwing light on the problems within the public domain. The long-term effect of such adverse events is therefore determined by how open the relevant institutional arrangements are, and is enhanced if actors constantly scrutinize the system by proactively setting the agenda. A higher level of political accountability in the UK led to British politicians taking a greater role in promoting patient-led reforms than Japanese counterparts. However, a political system with clear accountability is more conscious of its own involvement and any potential blame it might receive for policy failures. Therefore, the political class could become more engaged in continuous reforms and the delegation of tasks rather than a constant search for remedial actions. The article sheds light on the interactive aspects of the particular triggering events discussed through the decade of regulatory developments in the two health-care systems.