Sarah Barclay, Founder/Director, The Medical Mediation Foundation.
Conflict between patients, families and health professionals is upsetting for all and can affect decision-making about medical care and treatment. All too often the warning signs are missed. This can lead to a breakdown of relationships that may end up in court. Although recourse to the courts will lead to a decision, there are inevitably perceived to be winners and losers. Complex, often agonising dilemmas for families, patients and health professionals are portrayed (and felt) as battles.
Mediation is an option which has the potential to preserve relationships between clinical teams and families. It enables exploration of alternative solutions which all parties can accept.
‘Mediation is an option which has the potential to preserve relationships between clinical teams and families’
When I’m asked what a mediator does in a healthcare context, my answer is that we help the parties to have conversations they might not otherwise be able to have. We provide a safe and confidential space in which to try to find a way forward. Research suggests that conflict in medicine often stems from a breakdown in communication leading to entrenched positions, misunderstandings and increasing reluctance by all parties to engage with each other openly and honestly. Mediation helps to break down some of those barriers in a non-adversarial, more human way.
It takes courage to agree to mediate and to step back from the wish, explicit or otherwise, to “have one’s day in court.” However, when mediation works, the feedback from those involved is that it has helped them to come to terms with a situation which has not been so much about winning or losing, right or wrong, as about acknowledging that difficult and painful decisions have been reached which allow everyone to move forwards.
‘when mediation works, the feedback from those involved is that it has helped them to come to terms with a situation’
For the past four years, part of my work at The Medical Mediation Foundation has been as co-director of The Evelina Resolution Project – originally a pilot funded by the Guy’s and St Thomas’s charity and now funded by the Evelina London Children’s Hospital itself. The project provides training in recognising and managing conflict for multi-disciplinary groups of health professionals and formal mediation in cases where conflict has occurred and where the clinical team is unable to resolve or de-escalate it.
The training we’ve done at the Evelina and which we’re now also doing in other paediatric and adult settings, involves using the skills which I would describe as “mediation skills” – listening, acknowledging, verbal cues, not making assumptions or rushing to solutions. Many health professionals tell me that they find it difficult to stand back and “explore before explaining” when faced with a potentially difficult conversation. Failing to do this is often why communication can start to break down.
We’ve now taught more than 1,300 staff at the Evelina and several hundred more in other hospitals. We followed up an initial cohort of just over 300 of the Evelina staff six months after they’d done the training. Out of 178 staff who reported experiencing a conflict with a parent in the six months post training, 95% said training had helped them recognise the triggers/warning signs and 91% said the training had helped them de-escalate the conflict.
“Listening is more than hearing the words: it’s listening beneath the words, asking questions and allowing time for answers.”
One consultant paediatrician commented in the feedback that what the training had taught her was that “Listening is more than hearing the words: it’s listening beneath the words, asking questions and allowing time for answers.”
Of ten cases referred for formal mediation so far, outcome was rated on a 0-10 scale, with 10 indicating greatest satisfaction. The mean score was 8.2. There were no differences indicated between staff/relatives when assessing the outcome of mediation.
We can’t abolish conflict between health professionals and patients. What we can do is recognise, understand and manage conflict in the same way as we might go about recognising and understanding the symptoms of a disease; diagnosing it early and treating it appropriately rather than allowing it to become the elephant in the room – the thing everyone knows is there but is afraid to mention.
ICS Member Discount to Mediation Event: Closing the Gap: mediating conflict between patients and health professionals 14/07/17 ICS with the Medical Mediation Foundation and FICM. Download the flyer here.
Sarah Barclay is the founder of The Medical Mediation Foundation www.medicalmediation.org.uk a not for profit organisation providing mediation and conflict resolution training to NHS hospitals. She is also Co-Director of The Evelina Resolution Project, which provides mediation and conflict management training to clinical and non-clinical staff at the Evelina London Children’s Hospital. In 2014 Sarah was voted an “NHS Innovator” by The Health Service Journal for her work on the Evelina project. She has a Masters in Medical Law and Ethics from King’s College London and is a former award-winning BBC social affairs presenter.