By: Orna Rabinovich-Einy
In early July of 2006, yet another scandal regarding
professional and ethical standards in Israeli hospitals erupted
when it was revealed that a series of experiments on women and the
elderly were conducted at several major Israeli hospitals without
obtaining patient informed consent, or approval by the appropriate
authorities. A couple of weeks earlier, the Haaretz
weekend magazine published a cover story on allegations of medical
malpractice in the treatment given to the wife of a senior
physician at the hospital at which he worked. The incident
was followed, he claimed, by a series of cover-ups and attempts to
silence discussion of what had happened.
These incidents are representative of a broad problem that
extends beyond the scope of individual misconduct or
negligence. They are indicative of the absence of effective
channels of communication within these institutions—a deficiency
which, in turn, fosters misunderstandings and mistakes, escalates
conflict, encourages defensive treatment of complaints, and masks
incompetence and wrongdoing. In Israel, this “organizational
ailment” is further complicated by an industry in which the
operator of the major hospitals—the Ministry of Health—is also the
regulator and monitor of their functioning.
The American experience with internal dispute resolution (“IDR”)
or “conflict management systems”—that is, the development of an
internal, systemized capacity for handling conflict within
organizations—has proven that, in certain cases, these mechanisms
can be instrumental in remedying organizational ailment. This
paper suggests that a particular IDR model, which the author refers
to as internal transformative resolution (“ITR”), could provide
more satisfactory, often speedier, and less costly resolutions to
individual complaints as well as help organizations function in a
healthier manner by facilitating the engagement of ongoing dialogue
with the various stakeholders, and the proactive addressing of
problems.
To date, the Israeli dispute resolution landscape has not made
any significant strides with respect to IDR. This paper
demonstrates, through a case study of hospital disputes, the
benefits of ITR systems and the ways in which this particular model
can better address some of the perils associated with IDR.
The paper begins with some background on dispute resolution in
Israel, the forces that have shaped the dispute resolution
landscape there, and the reasons for the dearth of IDR in
Israel. The article then turns to the ITR model and explains
the ways in which it can help organizations handle disputes more
effectively than other routes for dispute resolution, both on an
individual and organizational level. Then, in light of the
benefits offered by ITR systems, the article addresses why
hospitals have refrained from adopting these systems
voluntarily. Finally, the paper concludes that the
institutional and legal environment actively discourages any effort
for information gathering, quality control, and learning in the
medical arena—the driving force behind ITR systems—and offers some
thoughts on changes in the legal environment that would provide
incentives for hospitals to develop ITR systems.