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Mediation in Healthcare Clinical Settings

 

MEDIATION IN HEALTH CARE CLINICAL SETTINGS

Evi Avlogiari (Greece) 

Attorney-at-Law, MSc in Bioethics, Medical School PhDc, Accredited Mediator & Mediator’s Trainer 

Alternative Dispute Resolution Helenic Center, Thessaloniki. 

Aristotle University of Thessaloniki, Medical School. 

 

Introduction: 

Mediation is an innovative approach to resolving clinical ethics disputes. It is a private, voluntary, informal process in which an impartial third person facilitates a negotiation between people in conflict and helps them find solutions that meet their interests and needs. In the hospital setting, health care providers, faced with intense demands on their time, are called on to explain complex information and deliver bad news to physically and emotionally vulnerable patients and their families. In such environment, where large numbers of physicians, nurses and other providers 

interact with one another and with the patient, communication breaks down and disputes arise.* 

 

Objectives: 

Professionals who work in the clinical setting— administration, physicians, nurses, chaplains, social workers, patient advocates, risk managers, ethics committee members,— must learn and use Mediation skills as: rapport building, distinguish positions from interests, non verbal communication, active listening, questioning, paraphrasing, reflecting, reframing, summarizing, reality testing, demonstrate respect, empathy, genuineness e.t.c 

 

Methods: 

Mediation Techniques Training emphasizes to learn-by-doing. The instructors—experienced mediation professionals which also are highly familiar with clinical realities—initially familiarize participants with the "mediator's toolbox" of skills essential to conflict resolution. Then they integrate those skills into a variety of simulation exercises. Each participant will serve both as mediator and as disputant. All case scenarios are based on real cases in health care and each practice simulation is followed by in-depth debriefing with extensive feedback to participants. Each scenario highlights distinctive challenges that arise for conflict resolution in health care**. 

 

Results:

Mediation Techniques are bringing distinctive skills to difficult conversations by assisting people in conflict to listen carefully, define the problem(s), identify underlying interests, problem-solve creatively e.t.c. 

Well-developed mediation skills, transform a festering problem everyone avoids, into an opportunity to enhance future communication, improve quality of care and increase satisfaction for patients, families, and care providers alike. 

 

Conclusion: 

All health professionals can benefit from the strategies mediators employ in resolving conflicts. There has also been recent acknowledgement that the same techniques can be used in more general clinical communication break downs or challenging clinical encounters.The framework of distinguish positions from interests and the strategies of managing the interpersonal highlight some of the central techniques and insights clinical ethics mediators use when they work with difficult “patients” families or patient- provider interactions***. 

Mediation training and services are now available for medical staff conflicts, difficult patient care decisions, employee disputes, medical malpractice claims and bioethics disputes. 

 

References: 

*Bioethics Mediation, A guide to shaping Shared Solutions by Nancy Neveloff Dubler and Carol B. Liebman 

** Medical Error Disclosure, Mediation Skills and Malpractice Litigation by Carol Carol B. Liebman and Chris Stern Hyman 

*** “Contentious Conversations: Using Mediation Techniquesi in Difficult Clinical Ethics Consulations by A.Fiester

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