In January 2009, the Joint Commission on Accreditation of Healthcare Organizations’ standards regarding conflict management went into effect. These new standards mandate that hospital leadership develop both skills and processes for handling conflicts amongst the leadership in order to permit the early identification of conflict within the organization, and improve the capacity to manage and resolve the conflict once it is known. The Joint Commission describes these new standards as directly related to the goal of protecting patient safety and quality of care (Joint Commission, 2008, pp. 6-7). As many bioethics consultations appear as manifestations of conflict, the leaders and participants in bioethics committees are in a unique place with respect to carrying out this new Joint Commission mandate for conflict management. An individual trained in conflict management will be capable of identifying points of disagreement, shaping the procedure for managing the conflict by defining and tailoring the process for intervening, and utilizing deliberate communication techniques that can foster openness, understanding, and (possibly) resolution (Conrad, Franklin, Rothschild, & Vandecaveye, 2009, pp. 3-4). The clinical bioethics community, as an interdisciplinary group, can be at the forefront of bringing these types of conflict-handling processes and skills into hospitals, providing not only critical guidelines to ethics consultants, but also a more general example of how it is possible to manage conflict in a hospital setting via processes of collaborative engagement.
One of the most significant culture shifts in the realm of clinical bioethics has been towards more democratic procedures of deliberation (Dzur, 2002). These shifts have been widely written about (Hoffman, 1994; Walker, 1993; Caplan & Bergman, 2007; Dubler & Leibman, 2004) and mirror the shifts within medicine toward shared decision-making and patient autonomy. By expanding on the work that has already begun in the field of bioethics towards integrating democratic, collaborative procedures of deliberation into a methodology for conducting ethics consultations, bioethics can offer an example to health providers of how to engage around situations of conflict. Through programs such as Nancy Dubler’s bioethics mediation paradigm (Dubler & Leibman, 2004), and the VA Hospital’s IntegratedEthics program (Fox, Berkowitz, Chanko, et al., accessed 2008) bioethics has already taken major strides in the direction of a methodology grounded in conflict management processes. These processes are empowering to the parties involved, in contrast to earlier models which took a more authoritarian approach (Purlito, 1989; Society for Health and Human Values, 1998). The democratic deliberative processes that have been explored within bioethics include facilitated dialogue, consensus-building models, and mediation (Society for Health and Human Values, 1998, pp. 11-15; Quist, 2007). When consultants are equipped not only with ethics knowledge, but also with communication and conflict resolution skills, they will be more effective in ethics consultation compared to those consultants with only a substantive ethics background. With this more extensive background, consultants will be able to create and sustain a space for deliberation around ethically sensitive issues, thereby improving the management of these issues, and serving as a conflict management model for hospitals on a broader scale.