Mankind always sets itself only such problems as it can solve; since, looking at the matter more closely, it will always be found that the task arises only when the material conditions for its solutions already exist or at least are in the process of formation."
- Karl Marx

Karl Marx was an astute social critic: he suggested that problems do not tend to be noticed or taken seriously until the possibility for their resolution is also available. Now, while it may be true that a variety of solutions exist for the resolution of a whole range of disputes, many people need help in fitting and fashioning those solutions to the disputes in hand.

Traditionally, people have turned to the law as the favoured forum and lawyers as the preferred players. However, participants often become disillusioned with lawyers and the cost of legal services and have sought alternatives. The use of more appropriate methods of dispute resolution (mediation facilitation) has been well received in many fields such as family law, commercial disputes and even criminal law. In healthcare, the use of appropriate dispute resolution (ADR) has been slow to take hold; however, there are some positive signs on the horizon. A number of programs and processes are in place and others will surely follow.

The simple answer is found in the recognition that the conflict resolution methods used to date have largely failed. By and large, these methods have been variations on an adversarial theme, with the result that many parties, including patients, have been left out of the process.

Most healthcare facility risk management efforts adopt the classical "selfprotective" stance encouraged by the insurance industry. While concern with the institution's "bottom line" is not unreasonable, in most cases this approach results in practices that alienate patients and their families, creating major barriers to effective communication.

Multiple avenues to make formal complaints exist for those unhappy with their experiences in the healthcare system. These processes are often agonizingly slow, generating more distrust and skepticism. It is cold comfort to a patient to learn many months or years after the fact that a regulatory body finds some credence in their complaint.

Finally, there has never been evidence to support the concept that medical malpractice litigation can serve as a positive force to improve care. On the other hand, there has been ample documentation of the slow, costly and uneven nature of justice at the end of a lawsuit relating to healthcare outcomes. All is not lost! Some hospitals have consciously adopted the so-called "humanistic" approach to risk management, and others have given real power to in-hospital ombud positions.

Gradually, healthcare facilities are learning about the advantages of using trained mediators. Some liability providers have even "experimented" with "early intervention ADR" in potential litigation situations. The problem with most adversarial methods for dealing with conflict in healthcare is that they ruin relationships. In order for the healthcare system to work effectively, strong and respectful relationships must be developed and nurtured between providers and patients and their families. As well, most care is now provided by multidisciplinary teams, whose optimal functioning requires fair treatment of all team members and solid relationships based on mutual respect.

There are several characteristics specific to healthcare that help to generate misunderstandings and conflict. Healthcare is a classic example of a complex adaptive system (CAS). Such systems are prone to generate errors on a regular basis; they are also capable of achieving innovation if the correct conditions are created. Since the type of service that healthcare systems provide involves the health/sickness of individuals, it is essential to understand the systemic causes of error to prevent and respond to it whenever possible. Secondly, the complexity of the healthcare system means that misunderstandings and conflict usually occur