Health mediation (also known as conciliation) is a process in which an external mediator facilitates those involved to resolve the difficulties that have arisen between a patient and NHS staff. It has long been considered as an effective method to resolve complaints and other concerns regarding NHS services.1,2
The impact of complaints on NHS staff is often overlooked. A study noted that the: ‘Negative experiences of a complaint [for GPs] were shock, being out of control, depression, suicide, doubts about clinical competence, conflicts with family and colleagues, defensive practice, and a decision to leave general practice’.3
Despite the clear advantages of health mediation and common usage in many other countries, the process has been severely underused in the NHS. In my view this has been mainly due to a lack of awareness and dedicated funding.
This article summarises the five steps a GP partner would take to resolve a complaint using mediation.
1 Consider whether mediation might help resolve the complaint in question
Complaints made against GPs include problems with approaches to treatment, bereavement, patient/GP relationship problems, patient referrals, practice procedures and GP role and responsibilities. Sometimes mediations involve complaints about other members of staff.
It is likely that the majority of complaints or concerns can be dealt with effectively by the practice, but mediation should be actively considered when complaints involve complex issues or when communication is difficult for any reason. It should also be considered when positions have become polarised.
Sometimes, a complaint or concern has not been raised by the patient. Instead the partners may wish to discuss a sensitive matter with a patient, and require some assistance to ensure that the discussion is effective and takes place in a safe and controlled environment, for example if a patient continues to behave in an inappropriate way or repeatedly fails to recognise practice procedures.
The use of an external health mediator should not be considered as a failure to deal with a complaint effectively, but rather the recognition that an independent and impartial mediator is best placed to facilitate the communication, which can lead to resolution and a positive outcome for all.
2 Find a mediator
Health mediation should be delivered by independent and impartial external mediators. One of the main reasons for the effectiveness of a mediator is their independence; impartiality and crucially, that they are perceived in this way by the practice and patients.
Mediators should have successfully completed an accredited training in the field and acquired a high level of experience. They may be found via CCGs, CSUs, hospital complaints leads or other GPs, to name a few avenues.
Questions to ask a prospective mediator could include:
- What mediation training have you undertaken?
- How many health mediation cases have you completed?
- Can you provide references from previous clients?
- Do you have professional liability insurance?
- What can I expect from working with you on a patient complaint?
3 Prepare the staff
The mediator facilitates the setting up of the mediation. This can involve initial contact with the complainant and partners to explain the process and seeking their written agreement to participate in the process.
For complainants this would also involve agreement that the partners can discuss relevant details of the case with the mediator and that the mediator can have access to relevant confidential correspondence and medical records. The mediator is then responsible for setting up and confirming all meeting arrangements.
4 Go through the mediation process
Health mediation is a confidential process in which an external mediator facilitates those involved to resolve the difficulties that have arisen between a patient and NHS staff. Mediators are independent and impartial. They have no legal power, do not offer advice or impose solutions and make no attempt to judge the situation. The mediator, or either party, has the right to conclude the process at any time.
Mediation is comprised of two stages. In the first, the mediator has an initial private meeting with each party in order to explain how mediation works and answer any questions. Those involved are asked to discuss how they see and feel about the situation. The main issues are clarified and ways of resolving them explored. At the end of the meeting, the mediator confirms with the party their agreement to continue with mediation and discusses how they wish to proceed.
In the second stage, a face-to-face meeting between the parties is normally arranged. This meeting can only take place if the mediator and parties involved choose to participate and agree to the meeting arrangements and procedures.
When facilitating face-to-face meetings, the mediator confirms how the meeting will be conducted, what the role of the mediator is and what is expected from the parties. Each of the parties is then given an opportunity to speak about the situation, without being interrupted. The issues to be discussed at the meeting are confirmed. The mediator works through these issues with the parties, helping them to communicate and work towards their own agreement or understanding.
Any agreement reached is the responsibility of the parties themselves and is not legally binding.
5 Reach a resolution
The meditator will write to the parties, confirming that the mediation has concluded and thanking them for their work during the process. Since health mediation is confidential, don’t expect a summary or report related to the discussions.
There is a good chance that the complaint or concern will be successfully resolved. Camden PCT noted that 24 out of 26 cases referred to health mediation during 2004-5 at the local resolution stage were resolved.4
Terry Leigh is a mediation consultant based in London who has previously provided mediation services to NHS organisations.
1 Department of Health. Listening, Responding, Improving: A guide to better customer care. 26 February 2009: 27.
2 Donaldson, Sir Liam. Foreword In: Ward Platt, Anne. Conciliation in Healthcare. Radcliffe Publishing 2008.
3 Jain A, Ogden J. General practitioners’ experiences of patients’ complaints: qualitative study. BMJ 1999; 318: 1596.
4 Camden Primary Care Trust. Annual complaints report, 2004-2005.