Alternative dispute resolution: a conflict management tool in health care

This article focuses on methods of resolving conflict either within or between health care organizations using an alternative dispute resolution (ADR) strategy. After identifying the principal sources of contemporary disagreements within health services settings, the authors describe the basis of ADR. This is followed by a discussion of some common obstacles to settling a dispute. The principal communication guidelines and stages of a mediation session are presented. An alternative dispute resolution framework is proposed that includes an Office of Dispute Resolution (ODR). Also provided is a series of attributes that together comprise the core of mediation as a discipline.     

Health care for the homeless in a national health program

To assess the impact of adoption of a national health program on homeless care in the United States, care for this group in Britain's National Health Service (NHS) was evaluated. Although hospital and medication charges are eliminated, primary care for the homeless lacks central government directive, suffers from overlap of statutory agencies and mechanistic biases, is disproportionately delivered in emergency rooms, and has relied on advocacy by the non-profit sector. Disadvantages of this void in NHS provision are marginalization of the homeless and continuation of a two-class care system. Removal of financial barriers to care by enactment of a national health program in the US would not solve all issues related to delivery of quality care for the homeless unless its structure addressed the special needs of disenfranchised groups.     

Evaluation of a primary health care program for the poor

This paper examines the success in implementing a major program involving a partnership between public and private providers to deliver primary health care services to the poor. In 1985, the 69th Texas Legislature passed the Primary Health Care Services Act, authorizing the Texas Department of Health to contract for or directly provide primary health care services in those parts of the state that are medically underserved and have large numbers of people in poverty. This paper evaluates the potential impact of the projects with respect to access and cost. The study revealed that the basic concept of allowing local public and private providers to develop projects reflecting their community's unique needs and resources was successful. The approach lead to a wide variety of different types of projects, but the basic goals and activities of the projects are consistent with the legislation. The evaluation identified three major program areas that could be improved: (1) patient monitoring and follow-up to ensure the accessibility of the priority primary care services, (2) the need for the development of projects in other high need areas of the state, and (3) greater efficiency in service delivery.Charles E. Begley, Ph.D. is an Assistant Professor at the School of Public Health, The University of Texas Health Science Center at Houston, P.O. Box 20186, Houston, Texas 77225.Lu Ann Aday, Ph.D. is an Associate Professor at the School of Public Health, The University of Texas Health Science Center at Houston.Roy McCandless is a Faculty Associate, Center for Health Policy Studies, School of Public Health, The University of Texas Health Science Center at Houston.The research on which this paper is based was supported by the Bureau of Dental and Chronic Disease Prevention, Texas Department of Health. The authors wish to acknowledge the substantial contributions of Margaret Frank, M.H.S. and Kiyoko Parrish, M.P.H., Faculty Associates with the Center for Health Policy Studies, in the development and conduct of this research.     

The preventive-curative conflict in primary health care

Approximately 80% of the rural population in developing countries do not have access to appropriate curative care. The primary health care (PHC) approach emphasizes promotive and preventive services. Yet most people in developing countries consider curative care to be more important. Thus, PHC should include curative and rehabilitative care along with preventive and promotive care. The conflict between preventive and curative care is apparent at the community level, among health workers from all levels of the health system, and among policy makers. Community members are sometimes willing to pay for curative services but not preventive services. Further, they believe that they already know enough to prevent illness. Community health workers (CHWs), the mainstays of most PHC projects are trained in preventive efforts, but this hinders their effectiveness, since the community expects curative care. Besides, 66% of villagers' health problems require curative care. Further, CHWs are isolated from health professionals, adding to their inability to effect positive change. Health professionals are often unable to set up a relationship of trust with the community, largely due to their urban-based medical education. They tend not to explain treatment to patients or to simplify explanations in a condescending manner. They also mystify diseases, preventing people from understanding their own bodies and managing their illnesses. National governments often misinterpret national health policies promoting PHC and implement them from a top-down approach rather than from the bottom-up PHC-advocated approach. Nongovernmental organizations (NGOs) and international agencies also interpret PHC in different ways. Still, strong partnerships between government, NGOs, private sector, and international agencies are needed for effective implementation of PHC. Yet, many countries continue to have complex hierarchical social structures, inequitable distribution, and inadequate resources, making it difficult to implement effective PHC.     

Federal health program reforms: implications for child health care

The "Omnibus Budget Reconciliation Act of 1981" included a number of provisions designed to reduce federal spending for health care and to increase state authority over health programs. Evidence concerning the financial condition and health care needs of children served by federally-financed health programs, and recent trends in coverage and eligibility, make it possible to assess the likely impact of the new legislation. One conclusion seems clear: extensive federal funding reductions cannot be accommodated by eliminating excesses. While reforms of the Medicaid program may be advisable for a number of reasons, a simple reduction to funding will have serious, adverse consequences for poor children.     

Collaborative conflict resolution

With change comes conflict. Conflict can be positive or negative depending on the attitude and skills of the participants. Collaborative conflict is characterized by an approach in which people attack problems rather than each other. Essential components of collaborative conflict resolution include selection of basic technique, preparation for confrontation, and viewing the situation from the other person's perspective.     

A training program for interprofessional health care teams

Interprofessional approaches to practice have gained increased popularity. This paper describes a course in team training for professionals in health care. It is an overview of the course's content with a discussion of the problems and issues that arose as the course was designed and implemented. It concludes with a discussion of the outcomes and evaluations of the students' and faculty's experience.     

Creating a health-promoting group for elderly couples on a home health care program

The hospital home care social worker has a unique opportunity to develop a home-keeping, health-promoting group for frail elderly couples within his or her caseload. Through home visits, working as a filial professional, the worker enters, then strengthens the couples' pre-illness formal and informal support networks, and then goes on to create an additional informal peer support group, that meets in each other's homes. The group is capable of decreasing the chance of nursing home placement for all its members. It is proposed that home health care agencies within hospitals incorporate such groups into their regular programs.