The Internal Neutral: Why Doesn't Your Hospital Have One?

Through the use of a well-trained and experienced organizational ombudsman/mediator, who is also an experienced clinician, NNMC has improved patient safety, reduced medical malpractice costs, enhanced both staff and patient satisfaction and created an informal feedback loop that identifies and fosters systemic improvements within the hospital.

The data obtained thus far indicates that the presence of a well-trained and properly positioned internal neutral can be a highly cost-effective and efficient resource for resolving patient-provider conflicts.

The organizational ombudsman/mediator at NNMC is uniquely poised to achieve resolutions concerning patient-provider issues at the earliest possible opportunity and at the lowest possible level, well before they are elevated to legal claims. Typical interventions may involve medical errors, sentinel events, near-miss occurrences, patient-provider interactions which are a "poor fit", dissatisfaction with treatment outcome or quality of care, expected or unexpected patient deaths, or potential claims against the institution.

A significant focus of the program is to assist in the enforcement of the accrediting organization, JCAHO regulation RI.1.2.2, which deals with the mandate for disclosing medical errors: "Patients and, when appropriate, their families are informed about the outcomes of care, including unanticipated outcomes."

Related programs at other hospitals offer mediation, generally by attorney-mediators, for medical malpractice claims already in the litigation pipeline rather than the early resolution options offered at NNMC. Unlike the medical malpractice mediation model in place at other hospitals, the NNMC ombuds program has centered around creative options for resolution rather than the payment of funds.

The ombudsman/mediator serves as an impartial third party who facilitates discussions between patients and providers, focuses upon underlying issues, needs and interests, clarifies perceptions, frames issues, helps to create options and assists in developing terms of a settlement agreement that assists parties in reaching sustainable and mutually-satisfactory solutions to patient care disputes.

Techniques include listening, coaching, shuttling between patients and providers, or conducting a face-to-face mediation session. Patients are advised that they may not be provided with results of formal investigations or information regarding any action taken against providers by the hospital.

Both patients and physicians provide critical input into achieving meaningful resolutions. The Ombudsman/Mediator conforms to the Code of Ethics and Standards of Practice of The Ombudsman Association: confidentiality, neutrality, independence, and informality.

RESULTS

Program results are very encouraging, suggesting increased patient and family satisfaction. Of the 82 plus cases handled in the first eighteen months of operation, a 100% resolution rate was achieved, and 77% were resolved within 10 hours. To date, no claims have been filed on cases resolved.

Universally, patients seek an explanation of unexpected occurrences, an apology if warranted, and an assurance that processes or policies are being implemented to ensure that the adverse event does not recur with another patient.

Results reflect a reduction in legal costs, claims against the hospital, and negative publicity, with a concomitant increase in quality of care and system effectiveness. Lessons learned from cases are analyzed and translated into recommendations to facilitate a reduction in medical errors. Recommended policy or protocol changes are submitted via Patient Safety/Risk Management or individual service lines. Upward feedback is provided to senior management by tracking and analyzing the types of concerns brought forward.

Biography

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Susan	04/01/07
I am a law professor currently doing research for an article on the use of mediators in health care settings, particularly re: access to treatment in assisted reproductive technologies. I would love to hear from any professional mediators or health care professionals who have been involved in mediations concerning ART or patient treatment decisions of any kind. sapel@vermontlaw.edu Add New Comment

Karima ,    SC	04/01/07
I can turly appreciate this article. As a In-House Mediator in a healthcare facility. I find the medaitor provides a sense of ease for both the health provider and the patient,in that their concerns are heard, volidated and in many cases resolved without undue hardships and legal cost. Add New Comment

Carole Houk,   Alexandria VA	chouk@chi-resolutions.com      03/31/05
Response to Martine
This position, now titled the HealthCare Ombudsman/Mediator, (HCOM) is in place at 28 locations around the country and cumulatively they have handled over 3500 cases of unexpected adverse outcomes in both the inpatient and outpatient setting since 2001. The HCOM practices according to the Standards of Practice and Code of Ethics of The Ombudsman Association as well as the ABA's Standards for the Establishment of Ombuds Offices. In addition to being a highly skilled mediator trained in the narrative mediation model, the HCOMs practice as true organizational ombuds, reporting only to the top leadership of their medical centers, thus ensuring their independence. They provide voluntary, confidential, and neutral services to patients and families, providers, and the organization, and serve as an advocate for a fair process, not as an advocate for any one party. The position is a true hybrid - and a necessary one for healthcare. Add New Comment

Martine Conway,   Victoria, Canada	conwaym@uvss.uvic.ca      02/16/05
I read this article with interest. I am curious about the title for the position: ombudsman/mediator. The description of the role certainly corresponds to that of mediator, and the concepts of confidentiality, neutrality, independence and informality are consistent with mediation practice. What isn't clear to me is what aspects of the role correspond to the concept of ombudsman. Could you clarify how the TOA SoPs and Code of Ethics are applied to this setting? Thanks! Add New Comment

Carole Houk,   Alexandria VA	carolehouk@comcast.net      07/22/03
Response to Kathy
This position is designed as a true Organizational Ombuds in a Healthcare setting, in accordance with the standards of practice and code of ethics of The Ombudsman Association. The person deals with unexpected adverse outcomes as a process neutral, helping to achieve resolutions for both patients and providers. The experience that a clinician brings to the position has been critical to its success in its first several applications in both the public and private sectors. The cases obviously involve significant medical issues, but most importantly, depend very heavily on relationships with providers at the health care facility, particularly when the physician is moving from fear of litigation to open communication about adverse outcomes, real apologies, and assurances that the error won't be repeated again to another patient. We can teach a talented clinician dispute resolution skills in a relatively short time period; it would take much longer for a talented dispute resolution professional to develop the critical networks within a health care facility, understand the clinical condition, and navigate the medical record and treatment protocols. Add New Comment

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