At a time when it can least afford it, Canada's health-care system may be facing a new drain on resources.

"Systemic errors are increasing dramatically because of things like overwork and stress among practitioners," says Jan Ahuja.

Ahuja is co-director of Mediate.calm, an Ottawa-based firm that tries to find collaborative resolutions to health-care disputes.

Non-medical internal disputes among practitioners or staff within institutions can cost thousands of dollars in legal fees to resolve. Statistics are hard to come by, but Ahuja says the number is rising in Canada.

Jan Ahuja

Without a way to resolve the conflicts before they swerve into lawsuits, Ahuja says, health-care delivery will become even more difficult.

Ahuja, who is also an emergency-room doctor in Orleans, has more than two decades of experience as a medical insider and has watched minor problems fester into major conflicts, such as physician-nurse disagreement.

"Health care in general is finding itself embroiled in tons of conflicts over access, resources, even job satisfaction, and the only common recourse tends to be through the legal system, " Ahuja says.

"Parties get entrenched in their positions and don't see the issues of other parties, even though everyone agrees they're working toward the same goal. Mediation allows us to break this pattern," he says.

Mediate.calm (whose domain name is actually www.mediate calm.ca) is the only health-care mediation company in Canada run by physicians.

Ahuja's partner is fellow emergency-room doctor Rob Robson, who lives in Winnipeg. Ahuja received his mediation training at the University of Windsor's law school, while Robson received his at Harvard's law school. Clients tend to be large institutions where problems can have a cascading effect.

In one case, a senior physician at a major hospital did not fit in with the established environment.

While he was not making mistakes, his confrontational attitude was costing the hospital thousands of dollars in lost productivity, such as stress leave for nurses. For less than $10,000 Mediate.calm negotiated a solution by bringing all the stakeholders together to clarify how each player's actions affected the others, Ahuja says.

The company's work also has been as simple as spending three hours helping three doctors decide on the length of an office lease.

"For some reason they just couldn't decide," Ahuja says. "But this is how mediation works. It gets people telling their stories and in turn seeing how they impact on others in the team. It's all about understanding and accepting that we can't solve all our problems by ourselves."

"Health care, however, is particularly tough because it has a very established hierarchy," Ahuja says.

In the past, physicians and other practitioners were seldom questioned about styles and decisions. The current situation requires more balancing of competing philosophies, training and resource allocation.

Patients also are increasingly seeing themselves as health-care consumers and are more likely to say something if they believe they are being treated unfairly.

"Practitioners find they have to be part of a team now where individual weaknesses come out quickly," Ahuja says. "It's a different playing field and everyone has to find out where they fit in without getting at each other's throats when communications go sour."

At a time when the health-care system is trying to increase efficiencies, personnel conflicts inevitably interfere with hospital teamwork.

"The emotional nature of the work creates huge pressures, especially when resources are dwindling," says Anne Grant, a dispute-resolution professional with Mediated Solutions Inc. in Toronto. "The staged approach can save money because disputes get resolved quickly and outcomes are more sustainable."

One of Canada's oldest private mediation companies, Mediated Solutions was started in 1989 when commercial and labour disputes were left almost exclusively to the courts.

It has three directors, including Grant, who is a qualified mediator and lawyer. It also has four affiliated professionals handling mediation and arbitration.

A natural offshoot of Mediated Solutions' conflict work is facilitation, which deals mainly with restructuring and strategic planning, but Grant says the company's process is highly integrated.

"So many disputes create a poison work environment, so it has to be built back up after some sort of resolution is arrived at," Grant says. "We've found, especially in health care, that the best solutions happen as close to the source (of the problem) as possible."

Without facilitated help, dispute resolution often gets shuffled from desk to desk until it explodes.

"I spend about a quarter of my time dealing with conflicts, almost always about something that could easily be fixed if a trained mediator could just sit down and get (the parties) to talk about it," says an administrator at one of Ottawa's hospitals, requesting anonymity.

In 2000, 7.5 per cent of 2.5 million hospital visits resulted in an "adverse effect," which is a medical mistake, and almost 40 per cent of those were "potentially preventable," according to the Canadian Medical Association Journal.

Most were minor incidents, but Ahuja sees dangerous potential for conflict if there isn't a system established to bring all the parties together to discuss what happened, and why.

"Some level of transparency allows everyone to understand what happened and then what has to be done to fix it. So much conflict can be avoided by patients getting a simple explanation from doctors," he says. "Never underestimate the power of an apology."

The federal government now mandates alternative dispute-resolution sections in each department. Ahuja believes the health-care system should take note.

"The longer a conflict remains unresolved, the more expensive it becomes and the more it heads toward the kind of winner/loser scenario that lawyers and the legal system love to get their hands on," Ahuja says.

(Mike Levin can be reached at levin@businessedge.ca)