Conflict Resolution Mechanism

Purpose

To provide the physicians at Capital Health with an informal mechanism to address issues of interpersonal conduct and/or behavior to the values, policies and procedures of the CH or any departmental code of conduct. This process will address physician to physician conflict only.

This mechanism is not meant to address issues where consideration is being given to the revocation, suspension or variation of medical staff privileges at the CH or any other matter which falls within the purview of the processes outlined in the Medical Staff (General or Disciplinary) By-laws. Specifically, it is not meant to address situations where it is felt the physician in question has engaged in conduct which:

a) Exposes or is reasonably likely to expose patients, medical staff, employees or the public to harm or injury at any hospital site in the district ,or:
b) Is adversely impacting or is likely to adversely impact the delivery of patient care, or
c) Is defined as harassment under policy CH 40-085 Harassment.

This mechanism should not be used as a first recourse and a reasonable effort to address the matter at the departmental level must be made before this mechanism is invoked. Such efforts would include speaking with the individual involved and seeking resolution with them and or reporting and discussing the issue with someone at the next highest level who would initiate the discussion to resolve the issue. Should these efforts not be successful, the matter may be referred to a Conflict Resolution Committee.

A CRC will be comprised of no more than four members of the CH Medical Staff. This panel will be appointed by the VP of Medicine CH in direct consultation with the Chair of the District Medical Advisory Committee and the President of the District Medical Staff Association. The Chair of the CRC will be decided by the panel members (Medical Staff) in direct consultation with the VP Medicine, the Chair of the District Medical Advisory Committee, the President of the District Medical Staff Association, or their alternates. Membership may change over time depending on the nature of the issue and the department or service where the conflict has arisen.

Participation in this process is voluntary and both parties are required to proceed in good faith. It is confidential, without prejudice and non-adversarial. Ultimately, the process is directed toward reaching a resolution which is acceptable to all parties. During the process input may be warranted from other parties but will only be sought with the permission of the involved parties.

Process

  • Once a situation arises that cannot be solved at the Division or Department level, any member of the Medical staff can request the assistance of the VP of Medicine, the President of DMSA or the Chair of DMAC. The VP of Medicine, the President of DMSA and the Chair of DMAC will jointly determine whether the disciplinary bylaws or CH harassment policy apply or if the matter should be referred to the CRC.
  • If neither the disciplinary bylaws nor the CH harassment policy apply, the VP of Medicine, the President of DMSA and the Chair of DMAC will then verify with the parties whether reasonable attempts were made at the departmental level to resolve the matter. If they are satisfied that reasonable attempts were made and they determine that the matter is appropriate for consideration by the CRC pursuant to this policy, the VP of Medicine will write to both parties indicating that there has been a request to invoke the process and ask that the parties indicate within ten days their willingness to participate.
  • During the ten day interval, the VP Medicine will consult with the Chair of DMAC, President of DMSA and the panel members (medical staff) to determine an appropriate Chair for the CRC. The VP Medicine will approach the preferred candidate and secure a commitment to participate, determining if there are any perceived conflicts that would prohibit involvement. The VP Medicine will also ensure the involved physicians have confidence in the Chair before proceeding. If conflicts are perceived, the physicians must present them to the VP Medicine for consideration.
  • If the VP Medicine, President of DMSA and Chair of DMAC determine the CRC is not the appropriate option, an external mediator may be appointed by the VP Medicine. Other options for resolution, as appropriate in the circumstances, may be considered if agreed to by both parties.
  • Within ten days the Chair of the CRC will meet with each party separately to gain an understanding of the issues. At that time the Chair will take the opportunity to:
    • Explain the process and answer any questions
    • Determine whether each party is ready to engage in the conflict resolution process, the degree of flexibility of each in reaching a resolution, whether each party is able to negotiate fairly, openly and equitably in reaching an agreement, and whether the parties will follow through once a mutual agreement is reached. During these conversations, it is important that the Chair listen to the affected individuals and encourage their participation in a positive way.
  • Within ten days of the Chair meeting with each party, if a determination is made that the CRC would be a suitable option and a verbal commitment has been given by both parties, the Chair of the CRC contacts the physicians involved in the matter in writing to confirm their participation in the process.
  • Within ten days of the Chair receiving confirmation of participation from the involved parties, all parties meet face to face in a confidential and neutral setting with the CRC. Each party is granted the opportunity to present his/her own issues while the other party actively listens and then communicates what they have heard and what they understand the other party’s issue(s) and concerns to be.
    Note: If after considering the matter it is determined that the a more formalized approach is warranted due to the nature of the complaint, the CRC will advise the parties as such and with the consent of the Parties conduct an investigation of the situation by soliciting written and or verbal presentation from other members of the medical staff or other CH staff where appropriate.
  • The CRC then actively engages in the conversation, attempts to provide guidance, suggests mechanisms to resolve conflict and assists in identifying areas of common ground and in searching for options or solutions. The CRC can make recommendations and suggest specific steps to resolve the conflict, which will be outlined in a letter to the parties.
  • Should this approach not reach a successful outcome other dispute resolution processes may be followed including, but not limited to, the appointment of external mediators. In this case, the Chair will inform the VP Medicine of the request. The VP Medicine facilitates the alternative dispute resolution process and follows through with the parties to ensure a resolution is met and the process is completed. 
  • If the parties reach a consensual decision a “memorandum of agreement” is drafted by the CRC which reflects this. This memorandum will include details of the mechanism to confirm resolution and outcomes. It is circulated and signed by each party and forms the basis for the ongoing relationship between the parties. This will also include a commitment to reconvene in three to six months to review progress.
  • The VP Medicine follows up with the District Department Chief and/or Department Head to notify of the outcome.
  • Conclusion should be reached in a  maximum of three months from the initial time of contact. Further discussions may continue as long as both parties are still willing to engage in the process.

Characteristics of an Effective CRC

Members should preferably have:

  • Respect and confidence of the medical staff
  • Substantial knowledge about the process of mediation