- Email: [email protected]
Health care mediation
Health Care
Mediation Victoria Hekkers, RN, BS
P
atients complain, coworkers bicker, vendors demand, Medicare denies, insurance companies challenge, doctors disagree, and
the legal department appeals. Health care has more than its share of conflict. It is tangible and concrete and provides more visibility than any of us want and are comfortable with. November/December 2005
TCM 77
Four years ago, I left the gratifying world of case management to begin a year of education in dispute resolution. It was an expensive process both in time and financially. My decision to change careers this late in the game left many of my friends wondering if my eccentricity had gotten the best of me.
Even if mediation goes unresolved, the process itself allows issues to be placed on the table, with an opportunity for
That’s right, the very best part of a career in nursing is the many different arenas that are available for us to explore. We can move from floor nursing to the emergency room to home health care to workers’ compensation insurance—all with the skills we learned in nursing school. What other career offers you that opportunity?
My particular interest in a career in dispute resolution and mediation began during my years as a case manager and, in particular, as the owner of a case management company. More and more occasions required negotiation; conflict was everywhere. As case managers, we negotiated with hospitals, home health agencies, and patients and families themselves. Everyone wanted to participate in decisions that affected them. Differences were apparent, and we used negotiations to resolve issues.
This career exploration into the world of mediation, however, was vastly different than any of my other nursing paths. It was personally difficult, because I had come from an administrative role in health care and found myself back in the classroom, surrounded by law students and lawyers, not many of whom had any background in health care. I was bombarded by terms that I had never heard of, although they were used frequently by my classmates. Instead of discussing arterial blood gases or passive range of motion, we discussed summary judgments, defendants, plaintiffs, and the value of a caucus.
The program I attended is now part of a graduate degree in dispute resolution. The professors were remarkable TCM 78
November/December 2005
discussion in a safe framework. individuals, all with law degrees themselves and all noted mediators in their own specialty. One specialized in environmental mediation, another in special education, and yet another in the world of restorative justice. The education from these individuals was as interesting as it was expansive.
The best part of the program was the time we spent in small claims court, where we had actual hands-on experience in mediating cases for the court system. My three cases included a contract dispute between two roofers, an elderly gentleman who thought the neighbor ’s garden was causing him respiratory distress, and a couple who were splitting up after 3 years of cohabitation (they both wanted the dog). It was fascinating, challenging, and a whole new world for me. At times I felt like I was in over my head (a challenge I enjoy), and at other times, I felt very comfortable, like I had been doing it all of my life.
My first referral came from a friend (what are friends for?) less than 1 week after graduation. His mother, who had early stage Alzheimer disease, had just had a stroke and now was hospitalized with a bowel obstruction. Surgery had been suggested, although she had a clearly defined power of attorney for heath care. My friend wanted to be certain that all members of the family were in agreement that the surgery should not be performed. He asked me to arrange a family meeting with the appropriate physicians and staff for the next morning.
The hospital was marvelous in their support of family mediation. Everyone arrived on time, and the physicians and staff were very responsive to my questions and facilitated the process. I respected the physicians’ time and arranged for them to be first for a 15minute question and answer period. Reviewing issues and concerns with the family took another 2 hours. They made their decision armed with knowledge and understanding, and they all agreed to keep their mother comfortable but not to allow the surgery. The family left the mediation together and went to her room to spend the remaining time with her. She died that same day.
My second referral came from the hospital itself. They knew my background as a case manager and asked me to negotiate with an insurance company for payment of an investigational treatment for a dying patient. Both sides made concessions, and treatment was provided in a timely and cost-effective manner. It is too early to tell if the treatment worked, but the family was grateful for the quick intervention.
My third referral came from one of the physicians who had been involved in my friend’s family mediation (word of mouth is grand). He was a partner in a large clinic embroiled in a dispute between the financial staff. He suggested that the male manager was having problems with one of his direct reports, a female accountant who had just filed a harassment suit against him. The physician was afraid the parties would not agree to mediate and that the dispute would escalate. We reviewed strategies to encourage their participation and were successful.
This case was a hotbed of emotion as I started the mediation with the manager and the accountant. My role as a mediator is not to determine right or wrong but attempt to help the disputing parties come to some sort of resolution, so I listened intently as each party gave their sometimes tearful perception of the events that brought them to the table. The longer the relationship
between the parties, the more water over the dam and the more issues that come into play, so hours flew by as I listened first to the manager and then to the accountant. I took volumes of notes and finally asked the parties for a caucus.
she was not a fit for his department. He said that he knew of another position within the company that did not pay as well but might be a better fit for her. I asked him if he would share that comment with the accountant to see her response.
A caucus is a private and confidential meeting with each individual that allows the mediator to ask personal questions and perhaps suggest options for resolution without the other party in the room. I am a great proponent of the caucus process, because it allows the mediator and the party to really identify problem areas and discuss options for resolution.
Sometimes the transformation of individuals during mediation is remarkable. I was surprised that soon after the three of us resumed the mediation, the accountant offered an apology to her manager for the trouble she had caused. The manager was taken aback and immediately offered concern for her unhappiness and told her about the other job in the clinic. I sat back in amazement as these two individuals, who had been feuding hours earlier, began to discuss the future and how the accountant could move to the new position and still help out the financial department in a part-time role.
The caucus with the accountant took about 2.5 hours; she shared with me her frustration with the manager and the other staff. She indicated that she had loved her previous job, where she played a visible role in training and public relations. She admitted to being an extrovert who loved to be out and about and how extremely frustrated she was with her current role, “stuck in a cube” looking at financial data all day.
At one point I asked her directly if she thought her manager was responsible for her dissatisfaction. She pondered the question for a while and admitted that he was not. She even indicated that she was sorry that she had filed the suit against him. We talked about various options for resolution and agreed that I would caucus with the manager to see if any options were possible without betraying the confidences she had shared.
Meeting with the manager was challenging; he was incredibly angry and not interested in understanding the accountant’s discontent. He indicated that he had done everything possible to meet her needs, and she just kept coming up with more issues. I asked him directly if he wanted to fire her, and he also took several moments to respond. He indicated that he liked the accountant personally but thought that
Mediation helps open the door for discussions of issues that previously have been underground. Getting parties to the table to open that door is the most difficult part of the mediation. Parties may • Be afraid • Not be able see what is in it for them • Think they will lose power • Not know any better, because they do not understand the process • Think they can win if they pursue the issues in another venue
before them in the mediation. I have heard many times that, although the mediation was unsuccessful, the parties were able to work together in a more effective manner after having the opportunity to air their grievances.
Can you tell that I love mediation? It allows me to use all of the skills that I have accumulated over my many years in nursing. It is a perfect fit for this time in my life. I get to set my own schedule, to work with bright and respectful people, and to still see my grandchildren on a regular basis.
As you can see, while mediation has been used for many years in labor disputes, the new surge of interest has extended well beyond that arena. Mediators are active in community, family, and interpersonal conflict cases. Settlements can be reached when parties are empowered and recognized. To learn more about the fascinating world of mediation, see the next issue of The Case Manager. ❏
Victoria Hekkers, RN, BS, is the president of Hill Street Group and a certified case manager, mediator, and Myers/Briggs trainer.
Reprint orders: E-mail [email protected] or telephone (toll free) 888-834-7287; reprint no. YMCM 336 doi:10.1016/j.casemgr.2005.09.003
Winning or proving the other party wrong is very important to some individuals. They will spend a great deal of time, energy, and money in an effort to win, but, they often lose, which is devastating. I often ask parties during caucus to describe how they will feel if they lose their case. Discussing this possibility generally stimulates them to consider other possible alternatives.
Even if mediation goes unresolved, the process itself allows issues to be placed on the table, with an opportunity for discussion in a safe framework. It allows individuals the opportunity to go home or to go back to work and consider the many options placed November/December 2005
TCM 79
Mediation Victoria Hekkers, RN, BS
P
atients complain, coworkers bicker, vendors demand, Medicare denies, insurance companies challenge, doctors disagree, and
the legal department appeals. Health care has more than its share of conflict. It is tangible and concrete and provides more visibility than any of us want and are comfortable with. November/December 2005
TCM 77
Four years ago, I left the gratifying world of case management to begin a year of education in dispute resolution. It was an expensive process both in time and financially. My decision to change careers this late in the game left many of my friends wondering if my eccentricity had gotten the best of me.
Even if mediation goes unresolved, the process itself allows issues to be placed on the table, with an opportunity for
That’s right, the very best part of a career in nursing is the many different arenas that are available for us to explore. We can move from floor nursing to the emergency room to home health care to workers’ compensation insurance—all with the skills we learned in nursing school. What other career offers you that opportunity?
My particular interest in a career in dispute resolution and mediation began during my years as a case manager and, in particular, as the owner of a case management company. More and more occasions required negotiation; conflict was everywhere. As case managers, we negotiated with hospitals, home health agencies, and patients and families themselves. Everyone wanted to participate in decisions that affected them. Differences were apparent, and we used negotiations to resolve issues.
This career exploration into the world of mediation, however, was vastly different than any of my other nursing paths. It was personally difficult, because I had come from an administrative role in health care and found myself back in the classroom, surrounded by law students and lawyers, not many of whom had any background in health care. I was bombarded by terms that I had never heard of, although they were used frequently by my classmates. Instead of discussing arterial blood gases or passive range of motion, we discussed summary judgments, defendants, plaintiffs, and the value of a caucus.
The program I attended is now part of a graduate degree in dispute resolution. The professors were remarkable TCM 78
November/December 2005
discussion in a safe framework. individuals, all with law degrees themselves and all noted mediators in their own specialty. One specialized in environmental mediation, another in special education, and yet another in the world of restorative justice. The education from these individuals was as interesting as it was expansive.
The best part of the program was the time we spent in small claims court, where we had actual hands-on experience in mediating cases for the court system. My three cases included a contract dispute between two roofers, an elderly gentleman who thought the neighbor ’s garden was causing him respiratory distress, and a couple who were splitting up after 3 years of cohabitation (they both wanted the dog). It was fascinating, challenging, and a whole new world for me. At times I felt like I was in over my head (a challenge I enjoy), and at other times, I felt very comfortable, like I had been doing it all of my life.
My first referral came from a friend (what are friends for?) less than 1 week after graduation. His mother, who had early stage Alzheimer disease, had just had a stroke and now was hospitalized with a bowel obstruction. Surgery had been suggested, although she had a clearly defined power of attorney for heath care. My friend wanted to be certain that all members of the family were in agreement that the surgery should not be performed. He asked me to arrange a family meeting with the appropriate physicians and staff for the next morning.
The hospital was marvelous in their support of family mediation. Everyone arrived on time, and the physicians and staff were very responsive to my questions and facilitated the process. I respected the physicians’ time and arranged for them to be first for a 15minute question and answer period. Reviewing issues and concerns with the family took another 2 hours. They made their decision armed with knowledge and understanding, and they all agreed to keep their mother comfortable but not to allow the surgery. The family left the mediation together and went to her room to spend the remaining time with her. She died that same day.
My second referral came from the hospital itself. They knew my background as a case manager and asked me to negotiate with an insurance company for payment of an investigational treatment for a dying patient. Both sides made concessions, and treatment was provided in a timely and cost-effective manner. It is too early to tell if the treatment worked, but the family was grateful for the quick intervention.
My third referral came from one of the physicians who had been involved in my friend’s family mediation (word of mouth is grand). He was a partner in a large clinic embroiled in a dispute between the financial staff. He suggested that the male manager was having problems with one of his direct reports, a female accountant who had just filed a harassment suit against him. The physician was afraid the parties would not agree to mediate and that the dispute would escalate. We reviewed strategies to encourage their participation and were successful.
This case was a hotbed of emotion as I started the mediation with the manager and the accountant. My role as a mediator is not to determine right or wrong but attempt to help the disputing parties come to some sort of resolution, so I listened intently as each party gave their sometimes tearful perception of the events that brought them to the table. The longer the relationship
between the parties, the more water over the dam and the more issues that come into play, so hours flew by as I listened first to the manager and then to the accountant. I took volumes of notes and finally asked the parties for a caucus.
she was not a fit for his department. He said that he knew of another position within the company that did not pay as well but might be a better fit for her. I asked him if he would share that comment with the accountant to see her response.
A caucus is a private and confidential meeting with each individual that allows the mediator to ask personal questions and perhaps suggest options for resolution without the other party in the room. I am a great proponent of the caucus process, because it allows the mediator and the party to really identify problem areas and discuss options for resolution.
Sometimes the transformation of individuals during mediation is remarkable. I was surprised that soon after the three of us resumed the mediation, the accountant offered an apology to her manager for the trouble she had caused. The manager was taken aback and immediately offered concern for her unhappiness and told her about the other job in the clinic. I sat back in amazement as these two individuals, who had been feuding hours earlier, began to discuss the future and how the accountant could move to the new position and still help out the financial department in a part-time role.
The caucus with the accountant took about 2.5 hours; she shared with me her frustration with the manager and the other staff. She indicated that she had loved her previous job, where she played a visible role in training and public relations. She admitted to being an extrovert who loved to be out and about and how extremely frustrated she was with her current role, “stuck in a cube” looking at financial data all day.
At one point I asked her directly if she thought her manager was responsible for her dissatisfaction. She pondered the question for a while and admitted that he was not. She even indicated that she was sorry that she had filed the suit against him. We talked about various options for resolution and agreed that I would caucus with the manager to see if any options were possible without betraying the confidences she had shared.
Meeting with the manager was challenging; he was incredibly angry and not interested in understanding the accountant’s discontent. He indicated that he had done everything possible to meet her needs, and she just kept coming up with more issues. I asked him directly if he wanted to fire her, and he also took several moments to respond. He indicated that he liked the accountant personally but thought that
Mediation helps open the door for discussions of issues that previously have been underground. Getting parties to the table to open that door is the most difficult part of the mediation. Parties may • Be afraid • Not be able see what is in it for them • Think they will lose power • Not know any better, because they do not understand the process • Think they can win if they pursue the issues in another venue
before them in the mediation. I have heard many times that, although the mediation was unsuccessful, the parties were able to work together in a more effective manner after having the opportunity to air their grievances.
Can you tell that I love mediation? It allows me to use all of the skills that I have accumulated over my many years in nursing. It is a perfect fit for this time in my life. I get to set my own schedule, to work with bright and respectful people, and to still see my grandchildren on a regular basis.
As you can see, while mediation has been used for many years in labor disputes, the new surge of interest has extended well beyond that arena. Mediators are active in community, family, and interpersonal conflict cases. Settlements can be reached when parties are empowered and recognized. To learn more about the fascinating world of mediation, see the next issue of The Case Manager. ❏
Victoria Hekkers, RN, BS, is the president of Hill Street Group and a certified case manager, mediator, and Myers/Briggs trainer.
Reprint orders: E-mail [email protected] or telephone (toll free) 888-834-7287; reprint no. YMCM 336 doi:10.1016/j.casemgr.2005.09.003
Winning or proving the other party wrong is very important to some individuals. They will spend a great deal of time, energy, and money in an effort to win, but, they often lose, which is devastating. I often ask parties during caucus to describe how they will feel if they lose their case. Discussing this possibility generally stimulates them to consider other possible alternatives.
Even if mediation goes unresolved, the process itself allows issues to be placed on the table, with an opportunity for discussion in a safe framework. It allows individuals the opportunity to go home or to go back to work and consider the many options placed November/December 2005
TCM 79