Delivering Institutional Mediation in a Health Care Environment: Reflections on a Case Study

(Hospital Mediation -- A case study report).  

These reflections are on the experiences of Warren Robicheaux in instituting a successful institutional mediation system in a hospital.  His work has been duplicated at Randolph AFB, and Lackland, AFB, both in Texas.

Table of Contents:

1. General Observations
2. Methodology/Structure
3. Other Issues, Comments
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Rules/General Observations

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First
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1. Take a step, any step, towards implementing institutionalized mediation processes.
2. Learn by experience.
3. Formalize what works in your environment.
4. Set up an intake arrangement (a way to formalize moving people and problems into the process).
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Second
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1. Initiate a cadre of volunteer mediators to co-function in mediation as well as their regular assignments.
2. Provide training to volunteers (with competitive bidding and local Dispute Resolution Centers, Warren paid $100.00 per day to have his cadre trained)(that is per day, not per person, per day).
3. Set up a process.
4. Track results.  (Slowly weed out those not suited to mediation by failing to assign them more mediations.  Do not create pressure for settlements, do encourage satisfaction with the process).
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Third
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1. The process must be understandable to those who participate.  (Use a long script and do outreach).
2. The process must be private and confidential.
3. No evaluation/no decisions made by the mediators.  In an institutional setting, refusing to render decisions or to provide evaluations makes an observable improvement in the percentage of cases that reach a satisfactory conclusion and an observable improvement in the satisfaction parties have with the process.
4. The best success they had with the mediator's role was the mediator as a neutral facilitator wo communicates issues and helps to explore solutions.
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Fourth
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1. He began with 100% volunteer, "non-reimbursed" (but, already full-time employees who received time released from other duties to participate).  Some new-hires for co-ordinators/etc. seemed to justify itself as well.
2. Using volunteers helped to educate the members of the environment as to the process and to involve them in it.
3. Including on-going training (using HR, Legal and Labor Relations personell) is very important.
4. Excellent for resolving EEO and other conflicts.
5. Used co-mediators at first to bridge confidence gaps (e.g. "a mediator just like the party" co-mediator) until the process became familiar.
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Methodology/Structure
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.Intake
..

1. EEO Complaints
2. Negotiated Grievance Procedures & Arbitrations
3. MSPBC Appeals
4. Unfair Labor Practice Allegations
5. Local Negotiations
6. Inter-agency agreements (took in other cases from related entities)
7. Intra-agency agreements (took in cases from other branches of the same entity).
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Model
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1. Intake and preliminary arrangements made. (pre-mediation was part of the model)
   • decide which "extra" parties are needed.
   • contact parties and arrange when/who/where to meet, etc.
2. Introductory statement by the mediator.
   • intended to educate the audience.
   • intended to establish presence and neutrality.
3. Initial statements by the parties (not their represenatives), uninterrupted.
4. Two way exchange
   • eye contact between the parties was considered very important.
   • the better the parties can be brought to work together now, the better they will deal with each other later when the mediator is not present.
   • caucuses are often avoided in this model.
   • an "ask & answer session" is a central part of this to educate the parties, help them to learn from each other and to allow the mediator to observe how the parties work together.
5. Issue and problem clarification.  
   • Usually issue and problem clarification is done in joint session.
   • T charts are used to list each parties issues and problems that they see.
   • This is to find interests, identify needs, and generate the first agreements (you both agree this is a problem, etc.).
6. Generating options (brainstorming -- usually in joint session).
   • Allow the parties to have ownership of the ideas (let them generate the ideas -- not the mediator, cf the value of a lack of background knowledge by the mediator).
   • Intended to move away from conflict towards solutions.
7. Exchanges and negotiations begun.
8. Agreement reached.
9. Agreement reduced to writing.
10. Closure.
    • Even if no complete agreement reached, closure usually includes positive support and comment.
    • Congratulate parties for participating, promote the process.
    • Remind them of alternatives
      

..See the slideshow at Mediation Model and Mediation Ethics Slideshow

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Other Issues
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Common Questions/Anticipated Problem Spots
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1. Vis a vis collective bargaining agreements, the process was used informally in parallel with (much as settlement conferences are used).
2. A separate position for a mediation director can be avoided by a successful steering group if they are willing to take the time (and the entity can spare them).  Lackland AFB found it more economical and efficient to have a full-time employee as a director once the process became established.
3. Large group vs. small group models were both effective.
   • Lackland AFB brings in every party that might be affected by the issues mediated between the "instant" parties (the ones in conflict).
   • Other institutions bring in only the instant parties (the ones in obvious conflict).
4. Statutory and Collective Bargaining Timelines may or may not be an issue.
   • Fort Wayne keeps the time lines in effect and moves the process in parallel.
   • Houston has not had the timelines become an issue.
   • Oklahoma City V.A. has a contractual clause that allows them to set aside some time constraints if they feel it a benefit to mediation processes.
   • Overall, the attitude is that mediation should be concurrently and quickly handled.
5. Agreements were generally in writing at the close of the mediation, but with a general practice of mediation for any conflict in enforcement or meaning.  This is an important factor since in an institutional setting the parties are going to continue interacting again and again (vs. a mediated automobile accident case).
6. There was a strong case against background knowledge.  Mediators who did not have background knowledge seemed to be more effective in helping the parties express themselves fully and letting the parties reach their own resolutions (which tended to be more lasting and to create more satisfaction).
   ..

Other Notes
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1. The amount of screaming and yelling that was considered "abuse" rather than "normal interaction" differed a great deal by group.
2. Many participants felt that attorneys were not qualified to mediate, with rare exceptions.
3. Caucuses were seen as an important option for three reasons.
   • To reduce tension if it got too high in spite of the presence of the mediator.
   • To allow parties to save face.
   • To accellerate negotiation cycles.
4. Post Agreement mediation and change in agreements was not seen as a failure.
   • Agreement as a road test of the solution was the model that was promoted.
   • Agreements needed to cover Who/What/When/Where/How/etc.

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