Mediation in Healthcare

By Holly Hayes

While the use of mediation for conflict resolution is gaining strength in a number of industries, a recent accreditation standard (LD.01.03.01) issued by The Joint Commission is expected to prompt hospitals to explore an expanded use of mediation to manage conflict in the healthcare setting.

The new Leadership Standard: Conflict Management Standard LD.01.03.01 became effective January 2009. The overall standard states, “The governing body is ultimately accountable for the safety and quality of care, treatment, and services.”

Elements of Performance, or how The Joint Commission will score the standard, include: Development of a code of conduct that defines acceptable, disruptive, and inappropriate behaviors; and creation and implementation of a process for managing disruptive and inappropriate behaviors.

Mediation is one tool a governing body can approve and a leadership team can implement to manage disruptive behavior among: management and staff, all levels of clinical staff, vendors and hospital staff, governing board members; and patients and staff to name a few. An outside, neutral mediator can be hired or contracted on a contingency/as-needed basis or internal staff can be trained in mediation techniques.

By definition, a mediator is impartial and neutral; a facilitator, not a decision maker; and does not advise, evaluate or advocate for any particular resolution. Mediation gives the parties involved the ability to determine the outcome and resolution of their issues.

The mediation process is simple, but can have a profound effect on the outcome of a dispute. Both parties share their concerns without interruption. The mediator may then ask questions for clarification and will develop a problem statement to summarize the issues to be addressed during the mediation. At some point, the mediator may meet privately with one or both of the parties and anything discussed privately cannot be shared unless agreed upon by the party and the mediator. Typically, the parties then brainstorm together to develop solutions for their issues. If an agreement is reached, a written resolution is developed which is final and binding when signed by both parties.

As stated by the American College of Physician Executives (ACPE) and American Organization of Nurse Executives (AONE), “Disruptive behavior in a health care setting can lead to an unsafe environment for patients.” Mediation can be an effective tool to resolving conflict to enhance patient safety and improve the future working relationship of the parties involved.