Designing Dispute Resolution Systems in the Health Care Industry

Abstract

By almost any definition of need, the health care industry is a natural arena for experimentation in the design of innovative dispute resolution systems. Whether one's interest lies primarily ha addressing the medical malpractice "crisis," reducing the cost of liability insurance, improving working conditions for health care workers, or improving the quality of health care for consumers, there can be little doubt that: (1) disputes in this industry have high stakes for everyone involved; and (2) the costs currently associated with dispute resolution are high and in need of control (Slaikeu, 1988).This article describes a pilot project for the design and installation of a comprehensive conflict management system in a 335-bed metropolitan hospital. Following a summary of assumptions or postulates of system design that have guided this effort, the article will summm-ize the project itself, and suggest implications for systems design in health care and in other industries. Postulates of Dispute Systems DesignDispute systems design draws on organizational theory both as a framework for predicting the occurrence of disputes and as a means for creating systemic procedures and rules for their resolution. The following is a partial list of assumptions or postulates of systems design that are grounded in the twin disciplines of dispute resolution and organizational theory:1. ~Ihere is a definable continuum of theoretical options for resolving any dispute. The various strategies for resolving disputes (e.g., negotiation, mediation, arbitration, and the like) can be placed on a continuum, and grouped accor~ng to how tile decision is reached and who finally makes the decision to resolve the conflict. As pictured in Figure 1, avoidance is a method of resolution that leaves the decision to chance, with the hope that some lvaldom event

Not necessarily mediation: The use of convening clauses in dispute systems design

“…Others (Ury, Brett, and Goldberg, 1989;Slaikeu, 1989) have pointed to dispute systems design as a way to control the costs of conflict. The central "cost/benefit" question is: To what extent can a dispute resolution system reduce the costs of conflict?…”

“…Wc agree, and further suggest that one tool for bringing about this change may be the convening clause, NOTES 1. For a more detailed discussion of the principles of dispute systems design, see Ury, Brett, and Goldberg (1988), Rowe (1991), and Slaikeu (1989).…”

“…2. These steps are based on the assumption that there are essentially four distinct methods for resolving disputes involving individuals and groups: avoidance; collaboration (negotiation and mediation); referral to higher authorities; and unilateral power plays (Slaikeu, 1989).…”

“…As Slaikeu (1989) has previously noted, any method oi1 the continuum may be appropriate at any given time. In some cases, avoidance, or a "wait-and-see" approach may be the best first step.…”

“…Building on these principles and previous models (Slaikeu, 1989), it is possible to identify a five-step path for resolution of most disputes in organizations. The convening clause is designed to direct the flow of those disputes while at the same time recognizing the parties' right to not "resolve" or work on the problem if they wish.…”