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11 Disp. Resol. Mag. 5 (2004-2005)
Curing Conflict

handle is hein.journals/disput11 and id is 7 raw text is: Cuing Conflict A prescription for ADR in health care By Dale C. Hetzler, Virginia L. Morrison, Debra Gerardi and Lorraine Sanchez Hayes I NCREASING PRESSURES, THE COM- plex nature of health care struc- tures and an explosion of diverse interests lead to chronic conflict from the waiting room to the board room, and current resolution methods are inadequate to address it. The need for ADR---creatively adapted to this field-is acute, and extends well beyond set- ling malpractice lawsuits and mediating labor negotiations. Sources of conflict The national focus on health services cost con- tainment includes declining government and insurance reimbursements that are not structured to pay for improving quality of care or safety.' This competes with expensive demands-in some cases, unfunded regulatory mandates-for safer care, high-tech services, updated facilities and extraor- dinary insurance and labor costs. Safety and quality concerns are driving cul- ture change at the intersection of law and medicine, with expectations of disclosing medical errors, placing professionals in vulnerable positions with heightened liability fears.' The national nursing shortage and physician discontent, along with fewer carriers writing malpractice policies, jeopar- dize recruiting and retaining personnel and affect the quality of services pro- Date C. Hetzler (dalehetzler@choaorg), vice president and general counsel at Children's Health- care of Atlanta, is a mediator and a member of the AHLA panel of dispute resolvers. Virginia L. Morrison (gmorrison@ healthcaremediations.com) and Debra Gerardi (dgerardi@healthcaremediations.com) are CFO and CEO of Health Care Mediations, Inc, which provides mediation, conflict management systems design and training to health care organizations internationally Lorraine Sanchez Hayes (lorraine@ theconsensusgroup.com) is a partner with Bunting Sanchez Hayes and the practice leader for the firm's ADR practice group. vided. Meanwhile, accrediting bodies and multiple state and federal agencies require compliance with such a volume of regulations-some of them conflict- ing-that paperwork consumes patient care time and threatens to obscure the regulations' purposes. Health care's structure and orga- nizations also fuel conflict.3 The indi- viduals involved are accustomed to autonomous problem-solving, but this is in tension with necessary interdepen- dence with other professionals-and is often complicated by poor informa- tion-sharing structures. Additionally, the health care arena is distinguished by the variety of stake- holders within it, each with diverse interests and priorities. Patients have different interests based on demo- graphics, beliefs about disease and treatment and disease propensity due to genetics or behavior. Administrators, physicians, nurses and other profes- sionals-and within each profession, the specialists-bring different per- spectives to delivering care. Types of conflict Health care conflict is rarely a matter of simple two-party disputes; it stems from a variety of sources across clinical and business environments. But here we focus on the conflicts that resonate most with consumers: con- flicts between doctors and patients that run the gamut of concerns from per- ceived medical errors and dis- closure, coordination between levels of care and providers, end-of-life decisions, pain management, medical neces- sity, length of stay, level of care, services and equipment, informed consent, appropri- ate notices and privacy. One of the greatest areas of conflict involves concern about the quality and safety of treatments. The height- ened focus on medical error in the media and through pro- fessional patient safety orga- nizations has increased the need for improving collabo- ration between providers and patients. A typical scenario: A patient is admitted to an outpatient facility for routine cardiac testing. The patient does not bring her list of medications and is uncertain what she has taken that day. The clinic does not have access to an electronic record of her current medications and her written record is in her primary physician's office at another location. The patient waits more than 30 minutes to be seen by the physician who has been called to help with an emergency elsewhere. Upon arrival, the physician is hurried; the patient does not want to interrupt the busy physician with questions and the physician does not take time to ask. During the patient's test,.she has a respiratory arrest and has to be resus- citated. There is some question as to what dose of sedative the patient received, since vials with a different concentration than usually used were found on the procedure cart. Addi- tiorally, it is later determined that the patient had earlier taken an anti-anx- iety drug that might have interacted DISPUTE RESOLUTION MAGAZINE FALL 2004 5

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