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Class 9

Disaffiliation

Competency Based Disaffiliation

Business Based Disaffiliations

Class Exclusions

Remember:  CRM = Conflict Resolution Mechanism

The Ombuds:  An Ambassador At Large

  1. Retired senior physicians and administrators fill this role well.  (As attitudes adjust, senior nursing professionals also have excellent skills and abilities for these positions.  Only barrier is bias in some institutions).
  2. Independent.
  3. With authority to request and obtain access to information.
  4. Persons with a clear understanding of the duty of confidentiality.
  5. Necessary contract clauses to preserve confidentiality.
  6. They intervene before issues move to a peer review
  7. Especially needed when peer reviews are "too common"

Basic Peer Review of Institutions

  1. Uses an outside, disinterested sole neutral.
  2. The neutral is provided with information (the basis for the disaffiliation and any rebuttals) to review.
  3. Has the right to request more information.
  4. Sets up a short hearing to receive a final round of information.
  5. Issues non-binding findings of fact.

Expanded Peer Review for Institutions.

  1. Use 3 arbitrators instead of one.
  2. Note that both expanded and basic can be private or open, non-binding, semi-binding or binding (semi-binding is when the parties are agreed, or the contract provides, that the findings of fact shall be provided to the jury as evidence).

Reality Checks for Disaffiliated Physicians

  1. 3 member panel for weight and "gravitas"
  2. Triggered by the filing of suit (to avoid becoming "just one more" automatic layer)
  3. Streamlined to reduce cost, invoked early on, before discovery or other expenses.
  4. Uses complete outsiders to provide a neutral reality check for all involved.
  5. The panel reviews paper trail, accepts supplementation, has a hearing and issues findings
  6. Can be private or open, non-binding, semi-binding or binding (semi-binding is when the parties are agreed, or the contract provides, that the findings of fact shall be provided to the jury as evidence).

General Business Disputes:  these are classic ADR.  Finally, a place where Health Care ADR is the same as "normal" ADR.

Workforce Disputes (consider, these were the core of the initial case study).  Especially for resolving EEOC and Labor conflicts.  Can cover:

  1. Contractual issues
  2. Discrimination
  3. Sexual harassment
  4. Unfair Labor Practices claims
  5. ADA (Americans with Disabilities Act) Claims
  6. Work assignment conflicts (between professions/disciplines)
  7. Intra-organizational conflicts.

Processes:

  1. Internal transformative mediation works best here for many conflicts.
  2. Internal quasi-arbitration is also important (especially when an organization does not have a formal chain of command or decision making procedure, you can help them formulate one).
  3. Collective bargaining mechanisms
  4. External mediation and evaluation provisions are also used.
  5. Arbitration is building as a method to cut costs when suit would otherwise be filed.
  6. REMEMBER:  when you can, look to solve issues, not just end the current conflict, but if conflict can not be resolved, seek to end it cheaply and quickly.

Patient complaints:

  1. If hurt feelings, rudeness issues, an ombuds office can often help.
  2. If malpractice issues, arbitration often reduces cost (Kaiser).

Review Framing Assignment


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