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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