How Alternative Dispute Resolution Can Help Hospital Administrators Handle Conflicts

You never expected a senior leadership position at a large hospital to be simple or easy. You wanted a challenging career, and it’s an important personal goal to assist in the effective provision of medical care, but you never imagined it would look like this.

A new HR complaint was just filed by a nurse against one of your hardest-working anesthesiologists. Construction on the new wing of the hospital was delayed (again) because several workers tested positive for COVID-19. Speaking of Covid, the medical industry has been particularly hard hit, and everyone at every level of the organization is exhausted from the marathon. The nurses are either working too much or quitting, and the financial incentives required to bring in visiting nurses are so big that there are a lot of nurses making more than the doctors. Your boss, the CEO, is pushing you hard to set up more meetings with big donors, and has mentioned something about reading an article from Johns Hopkins about preventable deaths. And the talented new GI doc whom you appointed to head up diversity equity and inclusion (DEI) efforts just sent you an email with the subject line “Need a face-to-face ASAP.” You suspect that the underrepresented minority residents are angry that their preferred candidate didn’t get the DEI leadership job, but you aren’t sure. Maybe it’s a brand-new problem. You console yourself a little by reminding yourself that at least you aren’t running a teaching hospital, where you’d have all this and writing, tenure and promotion issues to deal with.

Two distinct things make this basket of problems especially difficult.

First, these problems are numerous and urgent, making prioritization difficult and calendaring a chore. Do you respond to the pushiest person? Someone who shows up at your door over someone who calls on the phone or sends an email? Or do you respond to the most recent email or the email that came from the most important person –and is that your boss, your colleague, a patient, a patient’s lawyer or someone else? If you can’t handle them all at once, which problems can be deferred? You’d love to delegate some of these, but everyone around you is overworked—and many of the people who work with you or for you aren’t capable of dealing with conflict effectively.

Second, each of these problems impacts a large constituency, each with its own set of organizational cultures and subcultures, histories and individual personalities (who have varied preferences and schedules)—all of whom are impacted by COVID-19 and the “Great Resignation.” Negotiating one-on-one is a skill you possess, and while you can run a good meeting, you may not be equipped to be a facilitator, a mediator, a convenor, a trainer, a scheduler or a conflict systems designer in charge of multiple big groups.

The time seems ripe for a new option, and one seems to be emerging from the field of alternative dispute resolution (ADR). ADR has traditionally consisted of mediation and arbitration, where parties in conflict ask a neutral to facilitate or decide, respectively, the outcome of a defined problem. Neutrals now use their skill sets to address sprawling, complex matters that aren’t amenable to the neat framing associated with resolution of a litigated case or formal grievance. ADR professionals now perform initial assessments that lead to structured events—such as facilitated conversations, meetings and workshops—designed specifically to address the needs of the diverse stakeholders. These events provide a road map for progress, and they assign responsibility for the oversight of the project to a professional, trained in conflict management. 

How might our JAMS help our senior leader? After identifying and hearing from all relevant stakeholders, our neutral facilitator would design and execute a sequenced series of meetings, workshops and conversations appropriate to the preferences of the participants (and their calendars) and the needs of the conflict. This might mean conversations about how to improve the climate for underrepresented minority residents, workshops on resilience and rejuvenation for nurses, and mediation among the parties involved in the construction. The order of events, the logistics, the mechanics and the execution of all these processes would be in experienced hands. Leaders would become participants in only those aspects of the plan that required their input, and while free to check in at any time on status of the overall project, they would otherwise be liberated to return to the core business of health system administration.

So the next time your plate of problems is spilling over, consider having a conversation with an ADR professional about how to proactively approach conflicts at your hospital. It’s much more efficient, effective, satisfying and productive than hiring that same person to mediate a single employment lawsuit—a dispute which would cost a lot of money for both lawyers, result in a likely settlement, and only provide a short term fix while failing to address the core issues.

Your world has gotten more complex. And luckily, so has ADR.