Instilling a mediation-based conflict resolution culture - Conflict Management

Physician Executive, July-August, 1999 by Marc Miller, Daniel Wax

HOW WOULD THE employees and managers in your integrated delivery system answer these questions:

1. How do your rate your organization 's responsiveness to employees with disputes?

2. Cooperation between employees, departments, and work teams is?

How do you think providers and members would assess your health plan if asked:

1. Rate your health plan's responsiveness to disputes?

2. Were you personally satisfied when you had a dispute with the plan?

The health care industry is in the throes of unprecedented change. Conflict thrives and grows in the increasingly competitive and uncertain operating environment. Conflict impacts health care organizations' performance in three arenas: (I) patient grievances and health plan member disputes; (2) internal employee and management disputes; and (3) payer, provider, and vendor, disputes.

In all these areas, "Grief Budgets" detract from an organization's health mission and erode its bottom line much more than is commonly recognized. A Grief Budget is the dollar impact of (1) hard, quantifiable costs, such as appeals, arbitration, and litigation, and increased medical cost ratios that are relatively easy to quantify; and (2) soft costs due to employee anger and turnover, lack of provider cooperation and patient hostility, negative public and government relations, decreased vendor compliance from poorly handled disputes, and conflicts that are ignored.

This article offers a strategy to solve conflict at an early stage, with measurable results that strengthen profits and improve customer service. In addition, it proactively counters government and consumer pressure for greater regulation and instills a mediation-based conflict resolution culture throughout your organization. The strategy evolved from our observation that, although managers. supervisors, unions, human resources personnel, health services and utilization staff, and risk managers deal with conflict every day, they face two hurdles that typically prevent them from achieving early collaborative problem-solving and (win-win) settlements. As a result, the conflict grows.

First, they are not perceived as neutral by the conflicted parties. Second, the formal and informal venues for conflict resolution, such as union grievance procedures, member appeals, arbitration, and litigation, are based on adversarial (win-lose) relations in which one side usually must 'lose.' Moreover, the conflict and its results often are a matter of public record. That is, the process itself tends to detract from the solution. Mediation, on the other hand, is non-adversarial, neutral, pro-active, and collaborative. It is confidential and protects the future relationship between the parties whether the dispute involves employees, patients/health plan members, providers, or vendors. The challenge, therefore, is to strategically implant mediation into the health care organization's structure, to intercept and solve conflict early on.

Stakeholders' underlying needs in dispute resolution systems

Conceptually, dispute resolution systems are an organization's attempt to balance respect for the individual consistent with meeting the organization's business needs and goals. To this end, it is important to incorporate employees', managers', providers, patients/members', and vendors' needs when a dispute resolution system is designed.

Our experience is that the needs of these stakeholders in a health care dtspute resolution system consist of four basic themes:

1. They need to be heard

2. They need to understand the system

3. The system should help them identify and clarify their issues

4. It should provide them with a sense of satisfaction

What is mediation?

As opposed to other dispute resolution approaches, mediation best meets this balance of organizational goals and Individual needs, Mediation is a process in which disputing parties meet with a trained, impartial, third party mediator. The mediator hears all sides of the problem and helps the disputing parties achieve a satisfactory resolution, The primary function is to create constructive communication between the parties in a controlled forum, where they can explore their needs and build a mutually satisfactory agreement.

Unlike an arbitrator or judge, the mediator has no power to impose a decision on the parties. Instead, the mediator helps them explore their concerns, construct their own solutions, and create a mutually acceptable agreement. Using internal mediators, a health care organization can address disputes before they escalate. As with arbitration and litigation, the mediation process can devise legally enforceable remedies to disputes if the parties desire it.

Perhaps most important, mediation offers a cooperative forum for resolving disputes that preserves ongoing relationships, is confidential, and often empowers the disputants. One side need not necessarily lose; there can be a win-win' result. Mediation is faster than arbitration or litigation, costs less, and can be applied at an earlier stage in disputes.