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INSTITUTIONAL HEALTH CARE MEDIATION (IHCM)

Hospital staffs, HMOs, clinic practices and other groups are institutions that use mediation to help resolve internal problems. In many ways, institutional mediation functions like a branch of a Human Relations office, but it involves policy makers and resolves internal conflicts rather than involving staffers dealing with employee complaints.

An institutional mediator can mediate "inside conflicts between groups." They can also mediate "individual conflicts" between an individual and a group or another individual. This essay describes how Institutional mediation mediates "inside" conflicts between groups and has three useful functions.

First, IHCM helps explore the models used by each group to define reality.

Institutional conflicts often arise because of three kinds of common problems with the models or images groups use to see the world. These problems are: metaphor problems, perception problems, linkage problems.

A. Metaphor Problems. Most people use metaphors to interpret the world or issues around them. Organizations are seen in metaphors and there are often problems created by the metaphor that is chosen to interpret the world.

If one side sees a hospital as a ship and the other sees it as a football game, there is a real distance. A ship has one captain and one crew. A football game has a number of sides. Each side has more than one captain. Understanding the metaphors being used often helps to resolve conflicts. While it is not a magic solution, understanding metaphor conflicts allows both sides to start working on the same solution.

B. Perception Problems. After metaphor problems, conflicts in institutions often come from different perceptions of what the truth is. This is a perception problem when neither side is engaged in falsehood, but both see the "truth" or facts differently. A common perception problem occurs when one group sees itself as generating revenue and the other side sees that group as a revenue drain. Such a conflict may underlie a decision on whether or not to make substantial "investments" or "expenditures" on additional equipment for the group perceived differently.

Another common perception problem often occurs when decisions are made on the location of break rooms or staffing levels or where offices are placed. Are break rooms a luxury or are they a legal requirement of the law? Both? Neither?

Approaching an issue like break rooms from the standpoint that they are a wasted luxury will produce a completely different viewpoint (and approach to a solution -- if any) than will setting up break rooms as a requirement of OSHA or when one is following a Human Resources Specialist attempting to improve efficiency.

C. Linkage Problems. Finally, many perceptions are seen as linked to each other when they are really separate. I.e. the location of an OSHA mandated break room is not related to shift assignments for nurses or the decoration budget or the number of doctors on a rotation or the policies used to determine who is allowed credentials.

It often helps to unbundle problems and to resolve them one at a time.

Second, once the preconceptions of the groups and the models they use for reality are understood, IHCM can help find guidelines that both sides can use to verify and define reality and to connect the models.

Often finding guidelines is a matter of agreeing and using outside rules and tools that everyone agrees are neutral.

For example, in settling the perception difference as to whether a center generates a profit or a loss, there are standard accounting methods that can be applied by a certified public accountant. Just as you don't want your attorney to perform your heart surgery, your heart surgeon isn't the person to perform your audit (or your CPA the guy to represent you in court).

Bringing in a CPA (or other outside neutral who finds facts according to set, neutral guidelines) prevents institutions from being like the man who sold widgets he bought at $1.00 an item for $.50 an item -- but was going to make up the losses by selling a in volume or the hot dog business that cut its costs down so far it had nothing left to sell (no cost, but no profit either).

Again, for room use and placement, principles can often be agreed on and then applied to determine what is "fair" rather than each side continuing to assert that the solution they want is the "fairest." There are standard ergometric design rules.

Further, on room use, whether or not there are fixed limits can be explored and accepted. For example, if State law or OSHA sets a certain minimum size, no matter how "fair" a smaller size may be, it is not within the limits of the situation.

Third, IHCM Mediators Educate.

That is, once the starting points of the conflict are identified, and the rules for constructing a fair model are determined, an institutional mediator aids in helping both sides work logically from the model on one problem at a time until the current problems are on their way to resolution.

The mediator unbundles the issues as appropriate and then aids the parties in working towards solutions one at a time until the next problem arises.

In an institutional setting, mediation requires aiding "sides" to identify each other by their shared interests (so that there are groups that can negotiate), tutoring individuals in the elements of negotiation (rather than allowing them to continue in the habit of inflexible demands) and educating entities in the concept and application of living resolutions.

A. Shared Interests. Finding and identifying often creates the groups that can act together to resolve a problem. Many professional institutions (e.g. Hospitals) have a number of loosely aligned groups delineated by profession or specialty affiliation and not by interest. Such groups can (and often do) fail to find one voice inside of themselves.

By helping the parties identify their interests and the interest group they belong to, the process of working towards a solution is often aided.

B. Negotiation tutoring. Many professionals practice in a setting where they do not compromise and do not acknowledge outside limits. Often they need to learn the elements of compromise and cooperation, by example and by practice. An institutional mediator needs to be alert to the need to train and educate as to these matters.

C. Living resolutions. A solution that leads to immediate conflict is not a solution. Thus most lawyers realize that a settlement that one side cannot abide does nothing but set the framework for the next law suit. Most union negotiators realize that settlements management can not pay for will result in breaches and most managers realize that Pyhrric victories over a union guarantee nothing more than a bitter strike "next time."

Too often those who work inside institutions do not realize that the same principles apply. The long absence of traditional market forces have insulated many institutions so that their history gives them no guidelines as to reaching resolutions that are living -- ones that form the basis for an enduring and healthy relationship -- rather than resolutions that lead only to more strife.

This is also an area where a mediator can be worth their weight in gold in educating, training and teaching the parties about elements they need to find and remain aware of in resolving their conflicts.

Conclusion

In conclusion IHCM is under appreciated and often not understood, but it offers substantial improvements in competitive edge and quality of life for those institutions that take advantage of it and those mediators who serve them.

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Copyright 2000 Stephen R. Marsh

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