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Keeping Our Eyes on the Prize

Jennifer Shack, November 26th, 2010

The setting of goals or benchmarks is an essential component for a quality ADR program. Without those, a program can lack clarity of purpose and have no ability to gauge its impact on those it is serving. When we set those goals, however, it is important to ensure they are the right ones. Via Genuine Evaluation come these two gems from the health field in Australia and the UK:

1. Victorian health service performance monitoring framework

This sorry saga seems to be continuing as an exemplar of goal displacement, where organizations achieve the required targets but at the cost of the real goals.

A survey of 124 emergency department doctors last month found that hospital chiefs were not allowing doctors to activate ambulance bypass procedures when emergency departments were full, because they did not want to fail to achieve a government benchmark that says hospitals should be on bypass less than 3 per cent of each year.

Seventy per cent of the doctors said this had been a problem for them and one said it had cost lives because ambulances were delivering seriously ill patients to overcrowded emergency departments that were unable to care for them. The Melbourne Age 11 Nov 2010 (click through for Tanberg’s cartoon that sums up the situation eloquently)

2. UK accident and emergency waiting time targets

By contrast, the UK government has scrapped its targets for waiting times in accident and emergency departments after evidence that this was leading to worse care:

Hospital waiting time targets, including the four hour wait in accident and emergency (A&E) departments, are to be scrapped. The Health Secretary Andrew Lansley made the announcement as he told MPs that a public inquiry would be held into the scandal-hit Mid-Staffordshire NHS Trust. Lansley said the “far-reaching reforms of the NHS [would] go to the very heart of the failures at Mid Staffs”, which he called “one of the darkest chapters in our national health service”.

At least 400 more people died at the hospital in Mid Staffordshire between 2005 and 2008 than would otherwise have been expected. An earlier inquiry into events at Mid Staffs found that patients endured “unimaginable distress and suffering” from poor care and were left “sobbing and humiliated” at the hospital, which had become focused on targets and cost-cutting.

Lansley told the Commons that the culture led to a situation where patients “were being discharged when they should not have been, and patients were being transferred to inappropriate wards where there was no provision to look after them”. He said that Robert Francis QC, who chaired the first inquiry, had been crystal clear that the obsessive chasing after targets had created a situation in which managers and frontline staff lived in fear of losing their jobs. “We will scrap such process targets and replace them with a new focus on patients’ outcomes – the only outcomes that matter,” he said. (Hansard, 9th June 2010: Column 333. via WebMD Health News)

We in the ADR field often tout the ability of mediation to resolve disputes quickly. And for many courts, this is the main rationale for developing mediation programs. Decreasing the time it takes for cases to reach settlement and attaining settlement through mediation are great goals that should be tracked. We can’t, however, lose sight of the main objective of mediation – to provide disputants with a positive experience that leads to the right solution for them. In short, let’s not focus so much on speed and settlement that we forget about the people participating in mediation.

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2 Responses to “Keeping Our Eyes on the Prize”

  1. Kent Lawrence says:

    All well and good … and the metrics for “positive experience..” and the “right solution for them…”?

    • Jennifer Shack says:

      That’s a good question, one that is hard to answer thoroughly in this space. A lot of research has been done on what creates a “positive experience” for litigants. Procedural justice – the sense that the process is just or fair – is considered to be the linchpin for a positive experience. Seminal research conducted by Allen Lind and Tom Tyler found that litigants’ perception of procedural justice is based upon feeling respected and heard in the process.

      Whether the mediation leads to the right solution for the parties is trickier, but self-determination and coercion go to the heart of it. Nancy Welsh has done some wonderful work in this area.

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