A knowledge, attitude, and practice survey on mediation among clinicians in a tertiary-care hospital in Singapore

Abstract

Healthcare delivery is a highly complex, deeply personal and costly endeavour that involves multiple specialties and services. There is an imbalance in knowledge between the healthcare provider and consumer that may contribute to doubts and uncertainty over treatment and outcomes. It is unsurprising that conflict and dispute can develop between healthcare providers and patients and their next-of-kin. The use of mediation in the healthcare setting has recently been promoted in many developed countries, including Singapore. We administered a detailed 32-item survey in a large tertiary-care teaching hospital to improve our understanding of the knowledge, attitude and practice of dispute resolution among clinicians to pave the way for better strategies to improve the adoption of mediation in healthcare setting. Ninety-seven respondents had an average of 62% (SD: 12%) knowledge score. The most common misconceptions held by the respondents about mediation were: (1) mediation was about fact-finding, (2) mediation is limited to only certain types of dispute, (3) mediation proceeds by both parties giving their account of the dispute, then a third party decides a settlement, (4) the average time it takes to resolve a dispute through mediation, (5) the cost of mediation, (5) the venue of mediation, (6) the person determining the outcome of mediation, (7) confidentiality of mediation. In general, the respondents were positive about the use of mediation as a dispute resolution tool. When asked to indicate the relative importance of different outcomes of dispute resolution, financial compensation and waiver of hospital bill attracted mixed responses while understanding facts of dispute, assurance that the same error would not recur, and offering corrective treatment were rated as being important. By contrast, seeking an apology from the complainant was considered neutral to somewhat important and the respondents were least concerned with the publicity of the dispute. Direct negotiation with the complainant was considered the most time- and cost-efficient means of resolving a dispute while the opposite was true for litigation. Mediation was considered the approach where the clinicians are most likely to achieve their desired outcome while litigation was considered least likely to produce a favourable outcome. Approximately half of the respondents reported having personal experience or known of a colleague who had been involved in a medico-legal dispute. A quarter of these cases were resolved by direct negotiations with the complainant while lawyers, the judge and mediation, resolved approximately 15% each, respectively. The knowledge base of the clinicians in this study about mediation was moderate and probably reflected the general lack of direct experience in the resolution of a dispute or training in mediation. This further corroborated with the general response that the uptake of mediation in the healthcare setting is currently poor in Singapore due to the lack of awareness and perceived lack of avenue among the surveyed clinicians. Any further work to be done with clinicians may be in the direction of (1) increasing general understanding of mediation, (2) increasing awareness of avenues for mediation, and (3) becoming better aware of when to propose mediation.