Moving from Reaction to Constructive Response Catholic Health East October 7, 2009 Philadelphia Mediation Group

2 Presenter introductions Michele Mathes, JD is the Director of Education and Research Programs at the Center for Advocacy for the Rights and Interests of the Elderly (CARIE) and an Associate Fellow at The University of Pennsylvania Center for Bioethics. Barbara Foxman, LCSW is a clinical social worker and a mediator specializing in elder and family mediation and training in health care, aging and social work ethics.

3 Session 2 of 3: Objectives Understand conflict resolution skills as a core competency in bioethics consultation Identify and monitor reactions to conflict Appreciate the benefits of using a mediative approach when responding to conflict Apply a mediative approach to conflict Implement a mediative approach within a health care facility

4 Conflict resolution as a core competency for ethics consultation SHHV-SB C Task Force ASBH Clinical Ethics Task Force Model Code Of Ethics for Bioethics

5 Possible reactions to conflict Anxiety Withdrawal/Avoidance Being directive/Taking control Deciding who is right or wrong Privileging “the facts” over the emotions involved

6 Monitoring the directive/evaluative impulse in conflict situations The directive/evaluative impulse may lead us to: 1. Focus exclusively on factual issues 2. Tell someone how s/he should think or feel 3. Try to shape the outcome 4. Control the way the discussion happens 5. Override the judgment of the parties 6. Make legal, ethical or moral evaluation 7. Assess the practicality of proposed courses of action 8. Focus on finding solutions 9. Focus on oneself

7 What is a mediative approach to conflict resolution? A mediative approach expands our options for responding to conflict A mediative approach uses mediation skills to support communication in response to the emotions and interpersonal dynamics of conflict

8 A mediative approach attends to: The quality of the communication in the present interaction, both prior to and throughout the process of determining the outcome Microfocus (What is happening here and now in the communication between the parties?) and Macrofocus (How are we going to resolve this?)

9 A mediative approach expands the focus to include… Who is involved in the conflict? What are the interpersonal issues? What emotions are involved? How is the communication working? Is each person able to ask questions freely and express feelings and concerns? Are people listening to one another? Is there a regard for differences? What support do people need to communicate effectively and resolve the conflict?

10 What are mediative skills? Listening Assessing Reflecting Summarizing Asking open-ended questions Checking in Intentional silence Brainstorming for options

11 The potential value of using a mediative approach A mediative approach can improve: – Communication – Decision-making – Patient’s experience of care – Emotional well-being of patient – Patient/family/provider relationships – Staff satisfaction and morale

12 A mediative approach within a health care facility First response – Active Listening – Assessment and referral Consultation with trained personnel – In-depth active listening – Assessment and possible referral Facilitated meeting with in-house facilitator Formal mediation with professional mediator

13 Resources for implementing a mediative approach Multi-level staff trained in active listening and identifying the presence of conflict Selected trained staff (pastoral care, ethics committee members, social workers, patient advocate, in-house facilitator, etc.) to conduct assessment and facilitate meetings using mediation skills Access to outside professional mediators for use as needed

14 Preview of Session 3: Mediation as an Option for Conflict Resolution View a videotaped facilitation demonstration Distinguish facilitation from formal mediation Identify the types of conflicts that may benefit from facilitation or mediation Examine ethical issues in the use of facilitation/mediation in health care settings Consider how facilitation/mediation may be integrated into a health care facility