FranklinSolutions offers:  mediation and conflict management services, and facilitation of important discussions


Jeanne Franklin
fax: 703.533.8977

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Franklin Solutions provides assistance to clients, be they individuals, businesses, or groups, by working with them to resolve their specific disputes through mediation, and by helping clients manage conflict so they can move forward productively. Conflict is inevitable; it surfaces in business as well as in so many other areas of human endeavor. Law suits are one form or stage of dispute. Also, dispute can exist more subtly, exerting a corrosive influence upon productivity.

Franklin Solutions helps clients to:  avert or resolve unnecessary conflict; minimize the harmful and costly effects of unresolved conflict by addressing it promptly; harness positive outcomes from substantive disagreement; and, from the clash of ideas and concepts, make new beginnings.


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Back From CA

The annual meeting of the American Health Lawyers Association in early July in San Diego was full of cutting edge information. Relevant to a conflict management/dispute resolution practice, there were a good number of lawyers heard expressing interest in earlier, better ways to help disparate interest groups in health care work together. An area of potential disputes crying out for effective dispute resolution and communications assistance is that of medical staff relationships and peer review proceedings. The issue is ripe for effective communications facilitation and for constructive interventions.

(This was also discussed in a MAY issue of the American Medical Association News.)

Jane Reister Conard and I will speak on this subject, specifically skills and process for use by medical staff support offices and leaders, at the NAMSS Annual Educational Conference in Florida from September 21-25. Our program is scheduled for the afternoon of the 23rd.

Another area ripe for constructive intervention is how physicians and hospital leaders should negotiate more effectively to be better prepared to work together in successful employer-employee relationships. The pitfalls - differences of opinion - that can readily occur between administration and medical staff  should be anticipated and acknowledged. How to work through some of these issues during negotiations and later in the course of the employment relationship in a problem solving manner was discussed by Theresa Williams and Ann Bittinger at the AHLA meeting. 

 General Counsel Paul Harris also spoke of changes made by leadership and others in a health system to forge trusting work relationships. In the context of a rapidly expanding health system, such relationships are more critical. His observations that it is easy  [for all of us] to dip back into prior habits, that it takes years to settle firmly into newer work protocols and relationships, and that it is important to create accountability for those who hold fast to old ways of communicating  (e.g. the hard line in the sand school of negotiation) were both wise and practical. He is a firm believer in strenghtening communication and constructive problem solving approaches and can see concrete results from their use.

Work Relationships in healthcare  built on Respect are values we have urged for some time. It is hopeful to hear these "R" words repeated more frequently. Learning communication and problem solving skills and being alert for opportunities to use them is not pie-in-the sky theory or wishful thinking but is the timely, practical response to the enormous change and uncertainty that permeates healthcare delivery. New tools for new times. New needs call for new attitudes.




Communications,Conflict Management, Getting Along  

The American Medical Association News published an article in May about "Calming the Culture Clash," to help medical staff and hospital administration find better ways to work together. Dispute resolution of specific disputes is one kind of tool to avert unnecessary blow ups, medical errors, and other adverse consequences. Conflict Competence is broader, and includes emphasis on good communications practices, early and at the right time,  and simple steps that people can take when faced with a quickly igniting problem or a gulf between groups that need to pull together.

Jane Conard and I (EADRSolutions) have been writing about and urging these concepts and skills for years. Much is offered on this subject under the EADRSolutions tab on this website menu bar above.

On July 2, Jane Conard is presenting a program to the American Health Lawyers Association Annual Meeting in San Diego about this work, and I will be on hand to add comments as asked to do. The program begins with the example of mergers and what makes them successful beyond the negotiation of the deal. It will go on to cover the quasi immersion training course that we have developed for on site delivery at health facilities. One facility will have its General Counsel present on the panel to discuss its experiences following our course. These concepts, skills and the need for training and leadership are very important for all who work in healthcare.



Key Issue for Facilitation: Who Provides Primary Care and How?

 A very real problem that is immediately relevant and requires facilitation was highlighted in the May 16, 2013 New England Journal of Medicine. As between primary care physicians and APRNs (Advanced Practice Registered Nurses) what is the appropriate scope of practice for each professional, what degree of supervision should be mandated if any ( primary care teams),and should the two professions be paid the same fees for delivering the same services?

We are facing a known primary care physician shortage as more people are expected to try to access services. How should their need for services be met? The Institute of Medicine, having departed somewhat from its usual objective stance, collaborated with a group that is advocating for a particular result in favor of advanced practice registered nurses, and released a study report on the subject.

A subsequent survey of the two professions revealed significantly polarized answers by profession to the key questions. While there appeared to be agreement that the professions should practice to the full limit of their scope of practice, they differed on what that scope is and the basis for any conclusions drawn about proper scope.  NEJM recommends a facilitated dialogue to try to find workable common ground and called for shared training so that dialogue and mutual understanding begin much earlier in the professional lives of the primary care practitioners. Ruling out use of worn out, inflammatory langauge and getting past preconceptions are recommendations made to improve dialogue. 

Neutrals reading this are surely nodding their heads "yes," as th e latter recommendations are classic features of mediation process. Additionally, I would prepare the dialogue by helping the groups define the scope and goals of the conversations over time. Who really does need to be in the conversations (knowing the power of the absent to derail agreements)? Relevant discussion items are: What will be the definition of primary care? What will primary care services entail in the future? What market forces will affect answers to that? How can transition to new forms of practice be planned in a way that preserves human resources and protects morale and quality? How will success be measured? Setting up better listening as part of the conversations, along with possible reframing of the issues would be important. Let's hope that we can get going on this effort!

Virginia, by the way, was cited in NEJM for its new law and regulations which are the product of facilitated dialogues that created agreed specifications for primary care teams. Stay tuned to news as to how that works.