I read with great interest the Report to the Cabinet Secretary for Health and Sport into cultural issues related to allegations of bullying and harassment in NHS Highland by John Sturrock QC, published in April this year.
The report is extremely comprehensive and one area of recommendations drew my attention. It was about using mediation and giving people mediation skills to help facilitate difficult conversations which could make a big impact in helping to change the culture of NHS Highland into one which deals positively with conflict.
One of the key findings of the report was that once people take their conflict into disciplinary and grievance procedures, that prolongs the disputes and prevents the sorts of conversations which, if heard at an earlier stage, might allow issues to be resolved earlier. It can also have an effect on future relationships, people’s confidence, mental health and well-being and ultimately how NHS Highland, or indeed any other organisation, functions.
The other big impact would be that which comes from embracing conflict and understanding the positive effect that constructive and respectful dialogue have in improving organisations, in the case of NHS Highland, its ability to serve the health needs of the population.
The report argues that early intervention, either through mediation of facilitated discussion would create a space where people would have an opportunity to ‘see the other’s point of view’, ‘share perspectives’ and do so in a way where blame isn’t the issue.
In my experience where agreement is made in mediation it tends to be ‘stuck to’ as people have been the architects of their own agreement and it hasn’t been something perceived to have been imposed upon them. Such processes may also give people who have raised issues more of a feeling that they have been listened to, as a key part of mediation is the exploration of concerns and getting to bottom of what people need.
It is not uncommon for organisations to have trained internal mediators. Such mediators cannot all come from HR and are usually best spread throughout an organisation. In the case of NHS Highland it should be possible to deploy internal mediators who will be independent and seen to be independent.
In certain cases perhaps an agreement with another NHS board could be in place to reciprocally share mediators or, if needed, hire someone external to the organisation. The report suggests that this could be done on a cross public sector basis in the Highlands, which makes a lot of sense.
The report also suggests the need to equip people to conduct skilled facilitation. There is a strong crossover with the skills mediators use and such a development would compliment the introduction of mediation.
The report references how internal culture can impact on the outward facing culture and how complaints from patients are dealt with. I think that’s an important correlation and one worth pursuing.
Scottish Mediation are currently working in partnership with the Scottish Government Healthcare Improvement Directorate to deliver conflict skills seminars to complaint handlers across health boards in Scotland. That work is designed to help facilitate better conversations with complainants so that ultimately complaints are resolved and perhaps, just as importantly, that the learning is taken from the issues and situations raised.
That work also supports a scheme whereby NHS complaints can be mediated. More recently we have had requests for mediators to facilitate meetings (rather than a more structured mediation process). Participants have said to us that it has helped them to reach agreements they didn’t think possible and that the safe space within which to have an open and respectful discussion has been invaluable.
Even where agreement hasn’t been reached, the ability to air the issues has helped parties to better understand each other and why they hold their particular views.
All of the above leads me to believe that there is a massive potential to both use mediation and to reap the benefits from spreading the skills of mediation. The benefits will not just be for those involved in a mediation or facilitated discussion but for other members of staff working in a better work environment. Patients can also benefit from a collaborative working environment and ultimately from less time spent on resolving disputes.
This is a strong case for preventative spend.
Graham Boyack, director, Scottish Mediation.