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Evidence-Based Healthcare & Public Health (2004) 8, 412–413

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1For examplEnvironment, aMcGraw Hill; 20

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CONCEPTS, SKILLS, AND RESOURCES

Alternative Dispute Resolution: managing upsetsand keeping people safe

A. Donald

The airline industry has found that the biggest ADR usually refers to a structured problem-

threat to plane safety, and the worst cause ofmajor accidents, is poor relationships in thecockpit, where junior officers are too cross orupset to warn seniors of imminent dangers – andvice versa.1

In healthcare, too, the evidence is mounting thatmanaging relationships in professional teams isoften the most important part of keeping peoplesafe. In a much investigated paediatric heartsurgery unit in Bristol (England), junior and nursingstaff were too frightened and senior surgical stafftoo alienated to function as an effective team,leading to more than 30 excess deaths.2 Most of uscan remember ‘bad scenes’ in hospital and generalsurgeries, in which unresolved disputes betweenkey workers kept them subdued, angry, and toodepressed to make things better – for themselves,or for their patients. One skill set that can help tosmooth the way to good relationships withinprofessional teams is alternative dispute resolution(ADR).

What is ADR and where did it come from?

Alternative Dispute Resolution has been used fordecades to resolve legal and union disputes. It hasbeen a mainstream part of legal practice for sometime. ADR draws from ancient Roman practices ofarbitration to settle disputes.

In theory, ADR refers to any means of settlingdisputes outside of a courtroom. In practice,

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solving process involving at least one aspectof negotiation, arbitration, mediation andconciliation.

ADR can be applied to any dispute and inany setting, for example, domestic, professional,military or corporate. It can also be used fordelivering bad news, or communicating difficultmessages.

Examples where ADR has worked include:

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Establishing fair responsibilities in family clinicsbetween lead GPs and locums

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Delivering news of cancer to patients and theirfamilies

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Resolving nursing union disputes with hospitalemployers

How does ADR work?

At the very least, ADR helps individuals andteams acknowledge their difficulties and begin todevelop their own solutions, rather than remainmired in intractable hostility. Sometimes, however,ADR can move everyone to a much happierequilibrium very quickly, by highlighting, decon-structing, and dislodging age-old disputes. Itcan also bring about change for the better byrevealing just how intractable and destructivepeople’s positions are, and helping them tosee for themselves the need to change tack.Finally, ADR gives people a vocabulary, a method,and confidence to identify and solve problems asthey arise, rather than letting them fester foryears.

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CONCEPTS, SKILLS, AND RESOURCES 413

What does it involve?

Alternative Dispute Resolution can involve alengthy, formal process, but it can be equallyeffective in a short meeting over a cup of coffee. Inessence, ADR uses simple, structured steps to leadpeople through a process of identifying how theyfeel about a dispute or conflict, what they thinkabout it (what caused it, what has happened, andso forth), and what they see as ways forwards.Although ADR-type questions can seem deceptivelysimple, however, they are harder to apply to realsituations and the process certainly needs practice.Yet, with surprisingly few attempts – and you canalways try first with a mock-dispute with friends orfamily members—ADR can yield near-miraculousresults in professional settings.

There are plenty of people with specialist ADRskills. You can also make a great deal of progresswith real-life problems just by studying andpractising from a good book.

Suggested resources:

BOOKS (all available from amazon.com or ama-zon.co.uk)

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Dana D. Conflict resolution. New York: McGrawHill; 2000.

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Stone D, Patton B, Heen S, Fisher R. Difficultconversations: how to discuss what mattersmost. London: Penguin; 2000.

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Weeks D. The eight essential steps to conflictresolution: preserving relationships at work, athome, and in the community. New York: G PPutnam’s Sons; 1994.

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Fisher R, Ury W, Patton B. Getting to yes:negotiating agreement without giving in. Lon-don: Random House Business Books; 1991.

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Patterson K, Grenny J, McMillan R, Switzler A,Covey SR. Crucial conversations: tools for talkingwhen stakes are high. New York; London: McGrawHill; 2002.