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At Cleveland Clinic, a patient was asked to keep a journal of all the caregivers she saw over her five-day stay. She noted eight doctors, 60 nurses and so many others she lost track. The journal didn’t even track staff from non-clinical areas – food services, parking or billing. A May 2013 Harvard Business Review article by James I. Merlino and Ananth Raman reported on the Cleveland Clinic’s effort to get everyone in the organization to start thinking like a caregiver.
Core Concerns – Why are They Important?
The power of the core concerns comes from the fact that they can be used as both a lens to understand the emotional experience of each party and as a lever to stimulate positive emotions in yourself and in others.” Source: Beyond Reason: Using Emotions as You Negotiate by Roger Fisher and Daniel Shapiro.
Burnout in Healthcare
Health care has always been a stressful profession. Think high-stakes work, too many patients, overwhelmed employees. It all adds up to lots of potential conflict, and that’s bad news for patient care, safety, and satisfaction. Now, throw health reform changes linking reimbursement to quality and patient perception of care metrics into the mix and the implications are clear: Managers must help employees handle conflicts productively. If not, the organization may not survive.
Ethical Intelligence in Conflict Engagement
“If I Am Not for Myself, Who Will Be? Ethical Intelligence with Yourself” Dr. Weinstein talks about “Five Rules of Engagement” for dealing with anger using ethical intelligence. 2 Comments
Nurses Addressing Conflict
The Nurse Together blog has posted a four-part series on conflict in the healthcare setting. The first part looks at the sources and cost of conflict.
Lowering Malpractice Risk through Disclosure
The University of Michigan Health System implemented a system to respond to patient injuries and medical malpractice claims and has “lowered its average monthly cost rates for liability, patient compensation, reserves, and non-compensation legal costs” as well as reducing “its average monthly rate of new claims from 7.03 to 4.52 claims per 100,000 patient encounters, decreased the average monthly rate of lawsuits from 2.13 to 0.75 per 100,000 patient encounters, and reduced the time between claim reporting and resolution”.
Nursing Focus on Conflict Engagement
The American Nurse, the official publication of the American Nurses Association, published the article The Art of Engagement: Nurses, ANA work to address conflict. Here is an excerpt:
Conflict Engagement in Healthcare
Karl Bayer and I taught a three-hour course at the American College of Healthcare Executives (ACHE) national meeting in Chicago last week. Our topic: Introducing Conflict Resolution Skills in Health Care.
Collaboration Needed To Improve Health Care Delivery System
According to an American Hospital Association (AHA) News report, Don Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services, testified on February 10, 2011, at a House Ways and Means Committee hearing on the impact the Patient Protection and Affordable Care Act (PPACA) will have on Medicare.
Health Care Mediation Lacks Physician Participation
This week, a Wall Street Journal Health Blog headline stated, “Big Challenge for Mediation in Medical Malpractice: Doctor Participation.” The post discussed a study published in the Journal of Health Politics, Policy and Law which reviewed 31 cases from New York City non-profit hospitals. The study found that although mediation in a medical malpractice context has potential benefits, no physicians participated in the cases.
Defensive Medicine And The Role Of Tort Reform
Modern Physician recently reported about a study by Harvard researchers that says the nation’s “medical liability system” accounted for approximately “$55.6 billion—or 2.4% of total healthcare spending in 2008—with almost $45.6 billion of that figure being spent on the practice of “defensive of medicine,” which includes ordering tests and procedures or avoiding high-risk patients in an effort to avoid being sued.”
Connecticut Mandates Mediation In Medical Malpractice Cases
U.S. Politics Today reported that in Connecticut, “as of July 1, the presiding judge over a medical malpractice case must refer the case to a 120-day mediation period or other alternative dispute resolution (ADR) process ‘before the close of proceedings.’”
Implementation Of Accountable Care Organizations
In his book, Beyond Neutrality, Bernard Mayer says, “Conflict resolution professionals are not significantly involved in the major conflicts of our times. Many conflict resolution practitioners play useful but essentially marginal roles in large-scale public conflicts… we are not involved at the center of the conflict or decision-making processes.”
Mediation Used In Health Care Labor Relations
When we saw this link on mediate.com about nurses requesting mediation to achieve safe staffing levels, we wondered where else mediation was being requested in healthcare conflict.
How Healthcare Staff Can Impact Quality
We suggest that organizations that develop the capacity of staff and physicians to engage in healthy conflict in the workplace may move closer to achieving improved patient care. We welcome your comments on this topic.
Physician Survey Reports: 4.5% Of Medical Liability Cases Resolved By ADR
An August American Medical Association (AMA) survey of 5,825 physicians illustrates a need for medical liability state and federal reforms.
Positive Results Of Conflict
In May, we wrote about Dr. Donde Plowman’s presentation in Austin where she spoke about the opportunity leaders have to create organizations where innovation can occur. One aspect of innovation in organizations, she believes, is the presence of conflict. So often, leaders are responsible for reducing conflict, but Dr. Plowman argues, conflict often results in innovation. She states, perhaps conflict in the organization means there is life in the organization.
Why Isn’t ADR More Popular? A Report From Harvard
The article below was published this week on the Program on Negotiation at Harvard Law School website. It sheds light on a topic that I am asked about often — Why isn’t mediation more popular? In light of the potential for increased conflict with the implementation of health care reform, this question, and the answers below, appears to be even more pertinent.
How To Disclose Adverse Events To Patients
The May/June edition of the Physician Executive Journal (PEJ) provides a step-by-step approach for reporting adverse events to patients. The seven-step approach is based on principles used in the Program for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health.
AHRQ Awards $23.2m In Grants For Medical Liability Reform And Patient Safety
The Agency for Healthcare Research and Quality (AHRQ) announced that seven demonstration grants for the Medical Liability Reform and Patient Safety initiative have been funded for a total amount of $19.7 million. Thirteen planning grants have also been funded for a total amount of $3.5 million. The grants support the implementation and evaluation of evidence-based patient safety and medical liability projects.
Where Does Mediation Fit In The Spectrum Of Healthcare Conflict Resolution?
The need to manage conflict in the healthcare setting is not new. Much has been written about disruptive behaviors creating breakdowns in the teamwork, collaboration and communication needed to deliver high quality patient care. A study by The Institute for Safe Medication Practices (ISMP) found that forty percent of clinicians have remained passive or kept quiet during patient care events rather than confront a known intimidator.
Conflict Management in The Joint Commission’s Medical Staff Standard 01.01.01
Last March The Joint Commission announced its long awaited, revised medical staff standard (MS) 01.01.01, which will replace MS 1.20. The new MS 01.01.01 becomes effective March 31, 2011, to allow facilities and medical staffs to prepare for implementation. The intent of the MS 01.01.01 is, inter alia, to establish a conflict management process in the event of a conflict between/among the medical staff, medical executive committee, and the governing body of a facility. The goal is to enhance patient safety and the quality of care by creating a positive working relationship between a facility and its medical staff.
Jazz Improves Physician-Patient Communication
The American Medical News published this week Jazz offers lessons for doctor-patient interaction. This article discusses the use of jazz music to help physicians hone their patient communication skills. Dr. Paul Haidet, president-elect of the American Academy on Communication in Healthcare says”Jazz is all about harmony in communication. When jazz musicians play, they play in a way that goes along with [how] the rest of the band is playing.”
Bad Behavior In Health Care
After hearing Dan O’Connell speak earlier this month, I found this on-line presentation by Dan titled, Bad behavior — preparing for and dealing with disruptive behavior by providers. Dan is a clinical psychologist who works as an educator, consultant, clinician, department chair and executive director in medical and behavioral health settings.
Operations Management Approach To Conflict in Organizations
Last week, I had the opportunity to attend the University of Texas “Innovation in Health Care Delivery Systems: Maintaining Quality and Reducing Costs Through Management and Information Technology”. One breakout session featured Donde Plowman, Ph.d., Business Professor and Department Head from the University of Tennessee. She has recently undertaken a study to increase the relevance of health services research to leaders in the health field.
Patients Engage In Their Own Care More Often When Encouraged By Providers
An article in the March/April 2010 Patient Safety and Quality Healthcare Magazine by Andrea C. Scobie and D. David Persaud titled, “Patient Engagement in Patient Safety:Barriers and Facilitators” examines the impact of patient engagement in their own care on patient safety. One barrier to patient engagement, of interest to the field of conflict resolution, is:
Study Captures Nurses Experiences With Disruptive Behavior
The Journal of Nursing Care Quality published this month the results of a qualitative study titled “Hospital RNs’ Experiences with Disruptive Behavior”. The study describes the different types of disruptive behavior the study group of registered nurses had experienced on the front lines of patient care, identifies the triggers of this behavior, learns how nurses respond to disruptive behavior and identifies the impact of this behavior on the individual and the organization.
Medical Staff Standard Includes Conflict Resolution Requirement
Where Does ADR Fit In Health Care?
Readers have asked us, “where does ADR fit in health care? It’s a good question and one we have contemplated ourselves. To learn more, we are undertaking an informal survey asking leaders in the field to share their thoughts and experiences on this topic. So far, we have learned that ADR techniques can be applied with the following groups:
Disruptive Physician Skit Highlights Healthcare Communication Issues
The American College of Healthcare Executives (ACHE) held their annual national meeting in Chicago the week of March 22, 2010. During the meeting, Joseph Bujak, a physician and vice president of medical affairs at 246-bed Kootenai Medical Center, in Coeur D’Alene, Idaho and co-presenter Kathleen Bartholomew, a registered nurse and well-known author on nursing, acted out a unique role-playing presentation on doctor-nurse communication.
Can Conflict Resolution Skills Help Risk Managers And Physicians Disclose Medical Errors?
A new study published in the March edition of the Joint Commission Journal on Quality and Patient Safety (the full article is available for purchase here) and reported on American Medical News (available here) found that physicians are less likely than risk managers to tell patients when a medical error occurs. Physicians, however, are more likely to use the word “error” in describing the event and are quicker to say, “I’m sorry” than risk managers.
Applying Conflict Resolution Skills In Health Care PART V : Use Objective Criteria
One month ago, we started our health care conflict resolution series (see Part I, Part II, Part III, and Part IV) focusing on the Roger Fisher, William Ury Getting to YES principled negotiation method involving:
Applying Conflict Resolution Skills In Health Care PART IV: Invent Options For Mutual Gain
Conflict in health care differs from conflict in other arenas because it can result in significant negative outcomes – in some cases, life or death. Part IV in our series on applying conflict resolution skills in the health care setting follows the Principled Negotiation techniques described by Roger Fisher and William Ury in Getting to Yes with a focus on “inventing options for mutual gain”.
Texas Doctor Proposes Physician-Led Solution To Cut Health Care Costs
The New York Times posted last week an interview with Dr. Howard Brody, professor of family medicine and director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston, discussing a proposal for health care reform involving physicians. A physician-led effort to determine guidelines and recommendations against overuse of the “Top Five” procedures or studies could have a tremendous impact on curtailing future medical costs. We suggest that the process outlined by Dr. Brody could benefit from applying conflict resolution techniques.
Applying Conflict Resolution Skills In Health Care PART III: Focus On Interests, Not Positions
Our health care conflict resolution series began with Part I, applying the “principled negotiation” method to health care (post available here) and followed with Part II, examining a case study of “Separating the People from the Problem”.
Applying Conflict Resolution Skills In Health Care PART II: Separate The People From The Problem
Last week, we started our health care conflict resolution series with applying the principled negotiation method to health care.
Applying Conflict Resolution Skills In Health Care PART I: Principled Negotiation Method
Difficult situations arise every day in the health care setting, between staff and patients, between staff and family members, between physicians and nurses, between staff and administration. In the national bestseller, Getting to YES, a universally applicable method for addressing conflict resolution is offered by Roger Fisher and William Ury. This post, the first in a five-part series, applies this method specifically to healthcare.
Harvard Medical, Dental, & Public Health Newsletter: Conflict Resolution In Health Care
I recently read a healthcare conflict resolution article in FOCUS, the newsletter of the Harvard Medical, Dental, & Public Health Schools. The article begins with the statement, “Everyone in health care, it seems, has a war story about conflict at work.”
Mediation In Healthcare: Interview With Healthcare Neutral Richard Webb
I recently conducted a Q & A via email with Richard J. Webb (pictured left) who writes the Healthcare Neutral Blog. Mr. Webb is a graduate of Yale University (B.A., cum laude, 1975) and the Duke University School of Law (J.D. 1978). His additional alternative dispute resolution training currently amounts to 177 hours of classroom time, including 60 hours of advanced mediation courses at the Straus Institute for Dispute Resolution at Pepperdine University in Malibu, California. He has received a peer review rating of AV from Martindale-Hubbell, and has been recognized as a New Jersey SuperLawyer in the field of healthcare law.
More On ‘Bad Faith’ Mediation In Texas
In the Winter edition of the Texas Mediator, Susan Schultz calls for the “mediation community to engage in communal reflection” regarding the passage of the bad faith section of Texas HB 2256 which requires the mediator to report “bad faith mediation”. Overall, the bill provides a procedure for mediation of out-of-network health benefit claim disputes.
2009 Developments In Mediation: Joint Commission Standard On Code Of Conduct
Health care leaders have known for years that disruptive behaviors are a serious problem. Verbal outbursts, refusing to take part in assigned duties and condescending attitudes all create breakdowns in the teamwork, collaboration and communication needed to deliver patient care. A study by The Institute for Safe Medication Practices (ISMP) found that 40 percent of clinicians have remained passive or kept quiet during patient care events rather than confront a known intimidator.
2009 Developments In Mediation: Mediation Confidentiality
Our August post on the “bad faith” mediation section of Texas House Bill 2256 that requires the mediator to report bad faith mediation to the insurance commissioner or the Texas Medical Board, as appropriate, prompted our attention to how other states are addressing confidentiality in mediation.
2009 Developments In Mediation: President Barack Obama's Plan For Tort Reform
In September 2009, President Obama instructed the Secretary of Health and Human Services to move forward with awarding medical malpractice demonstration grants to states funded by the Agency for Healthcare Research and Quality (AHRQ) to help doctors focus on putting their patients first, not on practicing defensive medicine.
2009 Developments in Mediation: Foreclosure Mediation Programs
In light of the subprime mortgage crisis, several states have adopted mediation programs to assist homeowners and lenders reach a solution to a mortgage foreclosure action. Keith Seat, at Mediate.com posted recently an update on foreclosure mediation across the United States. Highlights include the introduction of federal legislation that would encourage state and local governments to create strong foreclosure mediation programs. The Preserving Homes and Communities Act of 2009, (S. 1731 and Status) calls for federal matching funds of $80 million for mandatory mediation programs.
2009 Developments: Mediation Option For ‘Balance Billing’ In Health Care
In June, we discussed the passage of Texas House Bill 2256, which provides a procedure for mediation of out-of-network health benefit claim disputes. Patients in Texas now have the option to mediate when they are ‘balance-billed’ by their insurance company for services provided by out-of-network facility-based physicians like radiologists, pathologists, neonatologists, and emergency room physicians.
The Uniform Mediation Act And Confidentiality
As discussed in a previous post, an attempt has been made to explore confidentiality in the Uniform Mediation Act (UMA) and provide an updated list of the states who have implemented the Act, those where legislation is pending, states who have rejected the act and those who have chosen to adopt similar bills.
A recent post on the “bad faith mediation” section of Texas HB 2256 has prompted comments and discussion regarding the confidentiality of mediation.
Industry Responses To Medical Malpractice Reform In President Obama's Health Care Plan
President Obama’s Plan on Health Care includes a provision on medical malpractice reform that instructs the Secretary of Health and Human Services to award medical malpractice demonstration grants to states funded by the Agency for Healthcare Research and Quality.
Texas House Bill And Bad Faith Mediation In Balance Billing
As discussed in my previous post, Texas House Bill 2256 was signed into law on June 19, 2009. The bill provides a procedure for mediation of “balance billing,” which is the practice of billing insured patients for amounts or balances not covered by the insurer.
Mediation In Healthcare
A new leadership standard issued in January 2009 by The Joint Commission, the accrediting body for hospitals, addresses the development of a code of conduct that defines acceptable, disruptive, and inappropriate behaviors; and requires the creation and implementation of a process for managing disruptive and inappropriate behaviors. 1 Comment
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