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<xTITLE>Dear Healthcare Leader</xTITLE>

Dear Healthcare Leader

by Debra Gerardi
October 2004 Debra Gerardi
Dear Healthcare Leader,

I am writing to request your help with a large project aimed at improving quality and safety within your organization. Your role in this endeavor is essential and the key criterion for success is your solid commitment to begin a new dialogue among your colleagues. The communities you serve are depending on you to take on the task of changing the culture in which healthcare services are delivered. I invite you to envision how to create healthy environments that enable patients and professionals to work together- to develop creative approaches which reduce adversarial interactions and promote collaborative care. It is time to return hope to healthcare.

As you know, the current culture of healthcare is not sustainable. It is a culture in which technology supercedes human connection, efficiency reigns over safety, hierarchy presides over community, and cure takes focus over care. It is a culture in which vast amounts of data are gathered with little communication among caregivers. Extraordinary amounts of money are invested in research for technology and pharmaceuticals and little is invested in development of effective management practices. Reimbursement is designed to reward how many things are done and not how well they are accomplished. Quality is questioned, fear of errors is common, trust has been diminished and healthcare professionals are disheartened. Litigation concerns affect decision-making and therapeutic relationships are damaged as the legal system intercedes between the patient and the physician. Demand for services continues to increase while the supply of experienced care providers struggles to keep pace. Caring for the sick and injured is the reason healthcare professionals come to work and yet patients are seldom part of the team. The loss of social supports and community contribute to the complexity of providing continuity of care and the diversity of patients seeking services places a strain on organizations. An excess of regulation has substituted for accountability and individuals feel powerless to affect meaningful change. A pervasive sense of frustration leads to apathy, and at times hopelessness, as healthcare workers struggle to meet the needs of patients and search to find meaning in the work they feel called to do. Despite the persistent presence of highly emotional situations, few people have the opportunity to share their stories.

A new dialogue is needed to begin to create solutions to these seemingly intractable problems. This dialogue requires a gathering together of those with diverse viewpoints, who can contribute to a greater understanding of the impact of the current system and reinforce the desperate desire for a new direction. Dialogue is driven by questions and inquiry. It is an opportunity to think together about what matters and how to begin to move the system forward. Individuals and groups must enter the dialogue open to pursuing alternative choices and the need to work differently, to communicate openly and collaborate intentionally. This dialogue can begin on units, within practice groups, across departments and throughout communities.

Questions to begin the dialogue include:

  • What is the impact of current work design on the ability of clinicians to create healing environments?
  • How can organizations be changed to improve collaboration and communication?
  • How can patients be more fully integrated into care decisions?
  • How can patients and healthcare professionals work together to resolve disputes without using power-based, adversarial approaches?
  • What changes are needed in the education of clinicians, administrators, and managers to improve the delivery of health services?
  • What skills are needed to effectively manage large-system changes?
  • What is the common ground shared by all who commit themselves to delivering health services?
  • What are ways in which organizations can intentionally create space for relationship-building and conflict management?
  • How can the financing structures be changed to reward better outcomes and quality improvement?
  • How can consumers become more aware of the realities and limitations of current models for delivering care and become more responsible for their role in maintaining health?
  • How can we increase funding for research into management of complex organizations?
  • What would be the substitute for increasing regulation that would ensure accountability and safety?
  • What would be a good way to monitor competence and address complaints against licensed providers that would involve options for both patients and providers to participate in the process?
  • How can we improve the opportunity for those involved in healthcare to tell their stories and have a forum for being heard?

Creating the time and space to gather a group to discuss these and other questions can help to focus on the issues that are most important. As groups gather together to look for solutions, new paradigms may develop. Providing the leadership and resources to enable these gatherings is a critical step on the road toward a better healthcare system.

Thank you for taking time to reflect on possibility. Thank you for taking time to return hope to healthcare.

Best Regards,

The Dispute Resolution Community


Ms. Gerardi is a mediator and health care dispute resolution consultant and Chair of the Program on Healthcare Collaboration and Conflict Resolution at the Werner Institute for Negotiation and Dispute Resolution at Creighton University.

Ms. Gerardi is a licensed critical care nurse with more than 15 years of clinical and administrative experience in academic health care organizations. Her healthcare background includes patient safety program design, management of surgical and medical intensive care units, administration of VIP medical/surgical services and of ambulatory health services. Her mediation experience includes complex multi-party disputes, organizational mediation, civic dialogue facilitation and community mediation. She has trained more than 5,000 professionals in conflict management, creativity, negotiation and communication skills.

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