The Maimonides Medical Center Model: Conflict Reduction through Mutual Respect and Conflict Resolution through Mediation
Givan, Rebecca, Dispute Resolution Journal
LABOR AND EMPLOYMENT
In almost any hospital, there are countless examples of doctors snapping at nurses, and of senior staff with big egos yelling and scream ing at whoever happens to be standing nearby. These conflicts not only tend to create an unpleasant workplace for employees, but for patients the consequences may be a matter of life and death. There are other causes of conflict as well. The high-pressure environment of a hospital, together with "high levels of task interdependence,"1 strong professional identities and reliance on medical expertise, as well as race and gender differences, often create massive levels of conflict and distrust. Sys temic problems that cause frustration and bad behavior also can lead to conflict. Conflict and disrespect be - tween individuals providing patient care can lead to misunderstanding in communicating crucial information, such as doses of medication or appropriate surgical procedure. These er rors can and do lead to patient deaths.2
Conflict in the hospital setting adversely affects morale, complicates the delivery of good medical care and efforts to reduce medical errors. Many hospitals have implemented alternative dispute resolution (ADR) systems to address employee conflicts. In re - cent years, there have also been scores of initiatives to reduce medical errors and improve patient safety in hospitals. 3 However, until recently, hospitals have not addressed the causes of conflict in the context of a dispute resolution system. Maimonides Med - ical Center in Brooklyn, N.Y., is an exception. It has focused on the behavior that leads to conflict and at the same time makes immediately available an ADR process (mediation) when a situation of conflict arises involving an employee. The system may also be used by patients. This article illustrates that ADR systems have the potential to be even more effective with additional supportive structures in place directed at changing the organizational culture to eliminate the causes of many types of conflict. This article discusses the Maimonides model, which involves five complementary strategies, two of which are a Code of Mutual Respect and mediation.
Maimonides is a busy urban hospital in the neighborhood known as Borough Park. The second largest hos pital in Brooklyn, it has over 700 beds. It trains 450 doctors in medicine and surgery annually and has over 100,000 patients per year. The hospital is heavily unionized with nurses, support staff, and interns and residents all belonging to unions. Journalist Julie Salamon vividly portrayed a year in the life of Maimoni - des in her book "Hospital: man, woman, birth, death, infinity, plus red tape, bad behavior, money, God, and diversity on steroids." The book illustrates the complex caseload and fastpaced hospital environment.4
The late 1990s at the hospital was notable for its icy labor-management relations, and a three-week nurses strike in 1998. The unions and management realized that there had to be a better way and formed a productive working partnership. This partnership functions through committees formed for the various units of the hospital. The committees are made up of union and management representatives within a particular unit. These committees are supported by three full-time hospital employees (two are former union staff) who work closely with frontline staff and managers to facilitate communication and improvement of hospital services and operations. The efforts of the labor-management partnership, from its inception over a decade ago, have contributed to improved hiring procedures and hospital efficiency. The partnership was responsible for instituting the requirement that relevant staff participate in the hiring process in all areas of the hospital. It also implemented changes that improved re - sponse times to a patient's bedside alarm, and changed work processes in lab and pharmacy orders, enabling the hospital to discharge patients earlier in the day. …