Prostate Cancer Screening Update

In 2013, TMG was hired by Roger Luckmann, MD to facilitate a process where a multi-stakeholder panel created a clinical practice guideline (CPG) for prostate cancer screening. A CPG guides doctors and their patients in making medical decisions based on the best-available scientific evidence with values choices are clearly articu- lated. The goal of the project was two-fold: to develop a process whereby patient representatives had a voice in creating the guideline, and to provide guidance to Massachusetts men and their health care providers considering prostate cancer screening. We concluded the process in May 2013 with the first goal attained: our process involved the voices of patient representatives and PCPs and we had unanimous support for the guideline. The second goal was reached earlier this year.

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No One Speaks First: Resolving Heated, Many-Sided Conflict in Organizations

Conflict in organizations is often more than him against her. There are likely at least as many “sides” to contentious organizational issues as people involved and with lots of parties embedded in a complex organizational structure, a normal mediation model where one “side” speaks first might not work. In these kinds of situations, I have found it helpful to create a process where no one speaks first and where brainstorming kicks off the process.

In a typical mediation, the first party to speak often frames the conflict, defining the playing field to a significant extent. This pushes the next speaker to respond to the original frame. If the second party sees the situation – or defines the problem – differently, he must change a definition already established, a more difficult task than simply presenting a view where none is yet at the table. In emotional and value-laden situations, I am concerned even more about that possibility. Whoever speaks first might define “the problem” in a way that significantly affects the outcome.

One way to adapt the mediation model is to allow everyone to speak at once by brainstorming the definition of the problem confines each speaker to a brief statement of the issue. This will create space for a wide range of perspectives simultaneously, allow the group to quickly see how many different perspectives there are, and accommodate the wide range of problem definitions. This avoids some of the polarizing effects of taking sides.

By proceeding from brainstorming to integrating the various definitions into a single, mutually-acceptable definition, the group may naturally transition from exploring issues to finding solutions. That is, the group has established a mutually-acceptable definition of a problem everyone had a stake in solving, which is considered key to many constructive conflict resolution approaches. If the parties can agree on a shared definition of the problem, and commit to solving it, then they are more likely to work collaboratively towards a mutually satisfying solution.

Finally, by using a brainstorming approach to defining the problem, we might avoid much of the contentious argument that can take place in the earlier stages of mediation. Such argument can often be useful; but in this case – with limited time and so many parties – it would be difficult to manage productively.