Review of Mediation Services/Approaches

in NHS Scotland

Report for

NHS Dumfries and Galloway

Contents

Section Title Page Number

1: Introduction 3

2: Our Approach 6

3: Findings – Mediation in Practice 9

4: Findings – Emerging Themes 18

5: Conclusions & Recommendations 34

Appendix 1 Assessment Criteria 46

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1 Introduction1.1 Context

Conflict in the workplace can have a massively disruptive effect on individuals, their colleagues and the services that they provide. When conflict is not nipped in the bud, it can lead to high levels of stress, long term sickness absence and a diminished service to patients. Even when formal procedures are initiated, resolution can be slow and the time and cost implications enormous.

The NHS environment has plenty of scope for conflict, personality clashes and challenging behaviours; perhaps more so than many other organisations and sectors. The multi-professional, multi-disciplinary nature of the service can create tensions and misunderstandings. Most NHS staff are values-centred and come to work for more than economic gain, therefore they bring their hearts and souls to work; this also creates potential for emotional investment, and conflict arises when their values are not seen to be recognised.

Mediation offers the possibility of resolving conflict quickly, before it descends into an intractable problem from which the individuals involved cannot recover. In addition, it may save the service money and help teams move forward productively.

The national Dignity at Work project was established to promote a positive working culture and behaviours that would reduce the perceived or actual levels of bullying and harassment felt across NHS Scotland. It is funded by the Scottish Government Health Directorates and hosted by NHS Dumfries and Galloway. Part of its remit is to:

establish current activity across NHS Scotland to promote Dignity at Work

share best practice promote effective methods of improving culture and tackling bullying

and harassment

Mediation is increasingly being adopted by NHS Scotland organisations, as a means of tackling relationship breakdowns and conflict in the workplace. Inevitably, different organisations use different approaches, and the Dignity at Work project wanted to:

build up an accurate picture of how mediation is being used across NHS Scotland

find out what has worked well and what hasn’t worked so well ensure that all parts of NHS Scotland could learn from the experiences

of ‘early adopters’ inform the further development of mediation

Brightpurpose Consulting was therefore commissioned to undertake a review of mediation and approaches to informal resolution in NHS Scotland.

1.2 Scope of the review

Seven NHS Boards volunteered to be part of the review:

NHS Forth Valley NHS Grampian NHS Health Scotland NHS Highland NHS Shetland

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NHS Tayside Scottish Ambulance Service

This provided a good spread of special and territorial boards, urban and remote and rural boards, small and medium-sized boards. The volunteer boards were not all ‘early adopters’ of mediation. Some had established mediation services; others had not yet introduced a mediation service. Some were providing facilitated resolution rather than mediation per se.

1.3 Definitions1.3.1 Mediation

The definition of mediation used by the Dignity at Work project is as follows:

A process:

that is voluntary for all participants that involves the services of a skilled mediator who is neutral, impartial

and independent where the outcome/decisions reached are reached by the participants

not the mediator where the decisions reached are not legally biding where equality and collaboration are central to the process where information shared in the mediation process is privileged and

confidential

In addition to seeing a number of boards that offer or are planning to offer mediation according to this definition, our review also identified the existence of a second model that is similar in many respects but might be better defined as facilitated resolution. Whilst many of mediation’s defining features were present in this model, they exhibited one or more of the following important differences:

delivered by staff who, whilst skilled in a range of organisational development, coaching and facilitation skills, were not necessarily skilled mediators – they had taken on ‘mediation’ without additional training

the ‘mediator’ had an influential role in determining outcomes and/or enacting their implementation

some of the outcomes or content of the discussion were shared with the line manager or referring manager

We often heard the terms mediation and facilitation used interchangeably during the review. However, for the avoidance of doubt, in the report we have only used the term mediation to refer to interventions that fit with the Dignity at Work project’s definition. We have used the term facilitated resolution throughout the report to refer to interventions as described above, even when interviewees referred to them as mediation.

In addition to these two terms, we also refer in the report to informal facilitation. In other words, facilitated discussions between two parties in the early stages of conflict. These discussions might be facilitated by the line manager ‘on the spot’ when they become aware of a problem, or by another colleague who has been asked to facilitate by the line manager. Whilst in an ideal world, informal facilitation should simply be a part of line management, in reality some managers do not currently take on this role; for a variety of reasons including lack of confidence, lack of know-how and organisational cultural barriers.

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1.3.2 Models of mediation

There are a number of different models of mediation practiced by the mediation community, some of which are more suited to the workplace than others. Experienced mediators often use more than one model, sometimes switching between models during a mediation to suit the needs of the situation. Whilst there are many different models, and research and practice continues to develop in mediation, Boulle’s1 definitions offer a helpful framework for distinguishing between approaches:

settlement – the mediator encourages incremental bargaining towards a central point between the two parties' positions, bringing the parties to a compromise

facilitative (sometimes also referred to as problem-solving) – the mediator focuses on helping the parties identify and express their interests and needs, assuming that this will reveal common ground and highlight areas for trade-offs and compromise

evaluative – the mediator tries to provide disputants with a realistic assessment of their negotiating positions, according to legal rights and entitlements and within the anticipated range of court outcomes; a style that is common where parties are in conflict over a single issue – such as money

therapeutic – the mediator focuses on dealing with the underlying causes of the problem with a view to improving future relationships between the parties

In the report, we use these definitions to describe the models of mediation being used by different boards.

1.4 Acknowledgements

We are grateful for all the inputs and support we received to conduct the review. In particular:

the staff we interviewed in the boards we visited – they were generous with their time, information and ideas

the administrative staff who helped arrange our visits to their boards – they provided invaluable logistical support and made it possible for us to conclude this review in a relatively short timeframe

the staff who participated in the ‘expert panel’ – they provided their real-world experience of mediation in the NHS and ensured the assessment criteria were realistic and meaningful

the individuals who were willing to share their stories of participating in mediation – they brought the review to life, in terms of the impact mediation can make

1 Boulle, L. Jones, J. Goldblatt, V. (1998), Mediation: Principles, Process, Practice (New Zealand Edition), Wellington, Butterworths.

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2 Our ApproachOur approach to this assignment is shown in the diagram below. Key aspects of the methodology are then described in more detail.

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Service reviews

2.1 Developing the assessment criteria

In order to review each service on a broadly comparable basis, we needed to develop a set of common assessment criteria that we would apply to each board that was part of the review. We drafted these based on:

the requirements set out in the brief our own past experiences the findings of a desk review

They were then tested and refined by an ‘expert panel’ that included:

HR Directors HR Managers NHS board in-house mediators the Dignity at Work project manager

Following the development of the assessment criteria, we designed a detailed research framework including interview and focus group proformas for the service reviews. It is important to note that the data sought against each criterion were adapted slightly to reflect the varying extents to which boards had established mediation services already. However, the core criteria were designed to cope with these variations, and remained the same regardless of the maturity of a board’s mediation service.

The assessment criteria are shown at Appendix 1.

2.2 Service reviews

We visited six NHS boards that had volunteered to be part of the review. We received a detailed written report from the other2.

The service reviews took the following format:

stakeholder interviews mediation team interviews/focus groups service user engagement review of documentation

2.2.1 Stakeholder interviews

We interviewed a range of stakeholders, depending on their availability. These included:

HR Director Employee Director staff side representatives front-line managers Organisational Development (OD) manager other senior managers Learning and Development manager

2 Delivering Mediation at Work in NHS Grampian: An overview of NHS Grampian’s Workplace Mediation Scheme (August 2009)

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In addition, we provided updates to area partnership forums by written briefing, and in one case by presentation at their meeting.

2.2.2 Mediation team interviews/focus groups

Where mediation or facilitated resolution was in place, we interviewed staff involved in delivery. Where possible we also conducted focus groups with mediators. We also spoke to one external provider of mediation and mediation training.

2.2.3 Service user engagement

In two boards we were fortunate to be able to speak to staff who had participated in mediation. The interview process was entirely voluntary, with the board emailing individuals only to explain the review and offer them the opportunity to contact the review team directly if they wished to participate.

We were very conscious of the potential distress to individuals arising from recounting their experiences of mediation, and these meetings were handled very sensitively.

2.2.4 Review of documentation

All boards provided us with a range of documentation relating to their approaches to mediation or facilitated resolution. We reviewed all of these.

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3 Findings – Mediation in Practice In this section we provide a short case study of each Board’s approach to mediation.

3.1 NHS Forth Valley

NHS Forth Valley does not have a formally established mediation service, but delivers facilitated resolution, sometimes also referring to it as ‘informal mediation’. This has developed in an iterative way, rather than from a deliberate decision to introduce the intervention. A small number of cases are dealt with by external mediators.

The purpose of offering facilitated resolution is to:

provide an alternative to a formal process make an early intervention to improve relationships, rather than

relationships becoming further strained by using a formal route

It is also seen as supportive of the workforce modernisation strategy, which aims to create a culture of risk-taking and asking challenging questions.

The need for facilitated resolution generally arises from poor working relationships or personality conflict; in turn these have often stemmed from the introduction of change or attempts to tackle underperformance.

The vast majority of cases are dealt with in-house. External mediation for a small number of cases has been by either Core Solutions Group or Catalyst. The decision to use an external provider is usually taken by a Director or General Manager in conjunction with the HR Director. This is based on a range of factors including:

seniority of the personnel involved the skills and competencies of the participants to handle mediation the need for advanced mediation skills the costs involved so far (time, effort) the projected costs (possible Employment Tribunal, compromise

agreements, time and effort)

Two senior HR staff are trained as mediators. However, the nature of their roles means that they do not conduct mediation. Core Solutions Group provided the training, which was between 5 and 10 days in length, and was certificated based on passing an assessment at the end of the training.

In addition, there are approximately seven other HR advisors, three OD staff, the Chief Operations Officer and potentially an undetermined number from the medical workforce who conduct some sort of facilitated resolution.

NHS Forth Valley plans to introduce a formal mediation framework in the future, which would include identifying who should be a mediator. Separate to this, the board is planning to introduce in-house training, adapted from the Employee Counselling Service training, called ‘Nip It in the Bud’. This will be offered to the HR advisors and the staff side reps and will cover the skills and tools to have difficult conversations and provide the basic skills to resolve conflict.

Currently, the staff providing facilitated resolution use approaches based on their background – eg coaching, facilitation, training, mental health – and one focuses on wider team culture issues. As most of the individuals are also coaches, they use their coaching supervision as a support system. In addition

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the Head of OD supervises her OD advisors as they facilitate individual cases. However, there is no formal supervision or continuous professional development.

Whilst there is no co-ordinator for facilitated resolution, impartiality and neutrality are seen as priority issues. The HR team informally discusses who is the best person to get involved in a particular case; however, they recognise that it can be challenging to ensure impartiality due to the size of the team.

Confidentiality is seen as a key priority and if a case uses an external provider then a confidentiality agreement is signed. Internally there is a mixed practice, with some facilitators requiring individuals to sign a confidentiality agreement, and others not. Also some facilitators require the participants’ line managers to attend the meeting whilst others do not. Some would report the outcomes of the discussion to line managers who were not present, others would report on the content of the discussion.

In terms of responsibility for actions and outcomes, the facilitator can play a strong role in suggesting outcomes, and HR and the line manager can hold significant responsibility for ensuring the outcomes are delivered.

There has been no formal cost benefit analysis. However, there is an instinctive view that there is a saving in terms of time.

Due to the iterative way in which the service has grown, and the ad hoc nature of it, most staff would be unaware of it as an option. The HR team, working with line managers, become aware of issues and liaise to identify whether facilitated resolution is an appropriate route.

Some facilitators evaluate the intervention via a questionnaire 2-3 months after the meeting, to assess progress and whether further support is required. There is a general view that issues don’t go away totally, but they either become more bearable or they resurface in another guise.

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3.2 NHS Grampian

NHS Grampian introduced mediation in January 2008, following a scoping exercise and stakeholder consultation to assess the organisation’s needs in relation to Dignity at Work. This revealed concerns about the formal Dignity at Work processes, around:

perceived independence lack of confidence in the process time taken employees’ ability to influence the outcome of the process

Mediation was identified as a possible solution. At the same time, conflict management training was introduced, which would equip staff to handle challenging situations ‘on the spot’. Initial funding for both was provided by the Grampian Area Partnership Forum (GAPF). Funding in the second financial year came again from GAPF with gap funding from the HR budget.

The majority of mediation is provided in-house, with a very small number of cases being referred to external mediators. External mediation is used where in-house mediation cannot offer sufficient independence or where the situation calls for advanced skills.

Mediators are recruited using a selection and assessment process open to all employees that includes advertisement, briefing/information session, role description and person spec, application form, psychometric test (using the Occupational Personality Questionnaire – OPQ) and a one-day assessment centre, including interview.

There are 15 trained mediators, including a recently trained second cohort. They are drawn from a range of professional groups: administration, allied health, library, management, nursing, public health and sterile services. All have been trained by Conflict Management Plus UK Ltd (now trading as CMP Resolutions), attending a six day certificated training programme accredited by OCR that culminated in an assessed role play mediation. Only after passing the assessment and successfully completing an independently-marked study pack can trainees work as mediators.

Conflict Management Plus UK (CMP Resolutions) provides ongoing mentoring to the mediators, and CPD is arranged locally in the form of an annual practice day and quarterly CPD sessions.

All mediators commit to a minimum of 4 cases, equivalent to 8 days, per year. This commitment is agreed with the mediator’s line manager when they apply to become a mediator, with the manager signing a release form agreeing to that effect. All mediators work to a code of practice which sets out the values and principles of mediation.

Mediation is delivered by pairs of mediators co-mediating. This models equality and promotes balanced practice and impartiality. It builds confidence, allows mutual feedback and enables less experienced mediators to be paired with the more experienced and provided valuable peer learning Mediation also requires stamina and is demanding both physically and mentally. Co-mediation permits this load to be shared in a mutually supportive way by two mediators.

The Dignity at Work Manager, as manager of the mediation service, collects monitoring information on the individuals participating in mediations. Between April 2008 and July 2009 there were eight cases dealt with by internal mediators and two by external mediators. A number of other cases started, but did not

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proceed to mediation because the issue resolved or one party did not wish to continue. All parties are sent a follow up evaluation questionnaire by email, but completion is on a voluntary basis. At present there is no facility to track trends in mediation uptake against Dignity at Work complaints and formal grievances, although this is an area already identified for development.

Central to NHS Grampian’s mediation approach is the role of Dignity at Work Manager as ‘gatekeeper’. This case management role includes:

case intake and initial liaison with parties assessment of issues risk management allocation of cases to mediators to ensure independence, impartiality

and neutrality

Mediation is available to all staff in NHS Grampian, although it is not an ‘on demand’ service. The gatekeeper assesses every case and determines whether it is suitable for mediation. If not, she then signposts to alternatives.

To help managers and staff understand mediation, NHS Grampian has developed a booklet: ‘Mediation in NHS Grampian – A Short Guide to How it Works’. This explains what mediation is, the benefit it offers, and how the process works. It also explains the conditions in which mediation is (and is not) appropriate. The mediation service was launched in January 2008, with an event that included a live mediation. This was videoed and continues to be used at promotional roadshows and staff development events.

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3.3 NHS Health Scotland

NHS Health Scotland has not yet launched a mediation service; however the board has recently been awarded funding to introduce mediation from the ‘Working Well Fund’, in a joint bid with NHS Quality Improvement Scotland and NHS Education Scotland. This funding will be used mainly for mediator training by a recognised provider. The mediation approach and the selection of mediators have yet to be decided, and this review will inform those decisions.

In the meantime, NHS Health Scotland has one person (the head of OD) who has provided facilitated resolution on three or four occasions over the last two years. The facilitation predominantly uses a coaching framework, exploring the impact and intent of behaviours. A conscious decision on the approach has not been taken; it has developed as a result of the existing skillset of the facilitator. There is a recognition that the use of a broader range of approaches would be helpful, in particular, the ‘settlement’ or ‘evaluative’ end of the mediation spectrum.

The need for facilitated resolution has arisen from performance management interventions and the introduction of change, leading to strained relationships and conflict. Facilitated resolution has tended to be used when there has been a significant breakdown in relationships, rather than as an early intervention.

All cases have been dealt with in-house. The head of OD has not received any formal training. She does not have any formal supervision or CPD for her role in facilitated resolution, although she does have supervision and CPD for her coaching role. She also receives support from the head of HR.

As only one member of staff currently provides facilitated resolution, and she only works two days per week, access and neutrality are both recognised as issues. However, there is a general view that the ‘service’ is currently seen as impartial and neutral due to the reputation of the head of OD. Confidentiality is seen as a key priority although there are no formal processes to establish confidentiality, such as written confidentiality agreements.

The head of OD evaluates the intervention verbally with parties, to assess progress and whether further support is required. In one case she has provided regular follow up sessions for both parties, to ensure the solutions are durable.

There has been no formal cost benefit analysis, either for the current approach or for the service that will be introduced in future. However, there is an instinctive view that:

there is a saving in management time it can improve employee relations it will reduce absence that would occur if a more formal and protracted

investigation was completed

The board has doubled in size since 2005. When the organisation was smaller, processes were more informal. There is a recognition that the scale of the board now requires more formality, and the new mediation service will need to be aligned with formal routes, demonstrating to staff a cohesive range of options.

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3.4 NHS Highland

Mediation was introduced into NHS Highland about two and a half years ago. The purpose is to offer early intervention; ie to provide a support mechanism to attempt to resolve conflict at an early stage, hopefully reducing the need to move to a formal process. The belief is that this will also positively change the culture by reducing interpersonal conflict.

Currently, all mediation is provided in-house. There has not been a need to appoint external mediators. This would only be required if there was conflict at a very senior level, for example, between two Directors, where there may be significant reputational risk or in particularly challenging circumstances.

There are ten trained mediators all of whom are from the HR Department with the exception of one person from the Health and Safety team. The training was provided by Jan Pye. Jan had previously delivered high quality training for NHS Highland and has extensive experience in mediation. The training was intensive and was delivered over five days with some time to practice skills and then with a follow-up three days. Jan also provided telephone support when required.

As a follow up to the training, the mediators developed a resource pack. Currently the volume of mediation is quite low, and the pack therefore ensures that there is a consistency of approach.

The group of mediators offer each other peer group support by confidentially reviewing and giving each other feedback on their approach to cases. This is done for development purposes. There is no formal supervision or continuous professional development. The team of mediators are conscious of this and are investigating opportunities to address the gap.

Each mediator allocates one day per month to provide mediation, although on average each mediator will only deal with a case every two to three months. There is a dedicated mediation co-ordinator who allocates cases on the basis of availability. However, confidentiality, impartiality and neutrality are priority issues and for this reason the mediators are appointed to cases outside their normal geographical work area. Given the geographical spread this has worked well.

Data on the number of cases is collated by the mediation co-ordinator. It is too early to see the impact that mediation is having on the number of Dignity at Work cases and also the success of mediation in resolving the conflict.

There has been no formal cost analysis; however, there is a strong view that there is a saving and as the HR team conduct mediation as part of their role the organisation achieves value for money. There is currently no evaluation in terms of quality of process or outcome. This too is being considered as an enhancement of the service.

NHS Highland offers mediation to all staff and there is a strong desire for staff to tap into the mediation rather than it being offered to them. To achieve this they had a very successful launch which included, for example; sponsorship from the CEO and leadership team, distribution of leaflets and information on the intranet. This created a high level of awareness. They believe this to be important and a refresh of the launch is planned in the coming months.

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3.5 NHS Shetland

NHS Shetland is just in the process of introducing internal mediation. The purpose of offering mediation is to provide for staff welfare, reduce the number of formal cases and to create a culture of dealing with issues productively and respecting difference.

NHS Shetland has used an external mediator on one occasion in the past, after a formal grievance was not upheld, to support the complainant and their manager to rebuild a working relationship. There is currently a request for internal mediation for a similar situation, but NHS Shetland also intends to use mediation as an early intervention before cases reach the formal stage. They see equal value for both uses, especially given the unique circumstances of an island board; there are few alternative employers and staff generally do need to return to work after a grievance, often into a workplace where their relationships have been badly damaged.

Whilst the HR team has been finalising the strategic framework for mediation in NHS Shetland, seven staff have undertaken mediator training. This was a two-day, non-certificated course run by ACAS that included theoretical input and several opportunities for practice. The seven mediators are drawn from: allied health, human resources, midwifery and health improvement, with four of the seven working in allied health.

As NHS Shetland is currently finalising its approach and strategic framework for mediation, they are still wrestling with some of the challenges that more experienced boards have worked through; they were keen to participate in the review to learn from other boards’ experiences. The most pronounced challenge is that of assuring impartiality, neutrality and confidentiality. This is difficult in all remote and rural boards, but the difficulties are magnified in the island setting: many people know each other in their close-knit communities, many are related to each other and everyone is a user of the health service. In addition, most staff ‘wear more than one hat’, so are known to even more people through their multiple roles.

Finding a mediator that doesn’t know either party is therefore particularly difficult. To maximise the possibility of finding an impartial mediator, it is likely that NHS Shetland will need as many mediators as a larger board; this presents resourcing issues in a board with a workforce of only 760 including bank staff. One of the options discussed during our visit was the possibility of pooling resources with another large employer such as the local authority and/or college.

Mediation will be promoted to managers during the Dignity at Work module of NHS Shetland’s management development programme. Requests for mediation will be made to the Head of HR, who will assess the suitability of the case and then match with a mediator.

Given the close-knit nature of the NHS Shetland ‘family’, mediators and the HR team are very mindful of the pressures associated with the first few internal mediations. If they go well, then mediation is likely to be accepted by staff; if they don’t go well (and word gets around on the inevitable grapevine) it is unlikely that staff will be willing to try mediation.

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3.6 NHS Tayside

NHS Tayside is currently in the process of developing an approach to mediation and conflict resolution. The Dignity at Work workplan includes introducing mediation, but how this will be developed is still under discussion. The purpose of introducing mediation is to reinforce the organisation’s commitment to dealing with issues as they arise and to reduce the number of cases progressing to formal process. There is a recognition that nobody ‘wins’ in a formal cases, even when their complaint is upheld; such is the emotional impact of participating in a lengthy and adversarial process.

The organisation has identified the need for both informal facilitation and mediation. How mediation will be delivered (internal, external or both) is still being discussed by the Dignity at Work steering group. It is likely that the first step will be the introduction of informal facilitation training for up to 100 staff, including staff-side representatives, human resources and managers from a range of disciplines. This will be funded by Area Partnership Forum funds. Informal facilitation and facilitated resolution is provided by some managers already, either as part of their organisational role (such as OD) or in their roles as departmental or line managers. Therefore the informal facilitation training will build on this and encourage more managers to take this proactive approach to nipping issues in the bud.

Alongside informal facilitation, there will be a model for providing independent mediation, either by internal staff or external mediators. A robust business case and cost-benefit analysis will be needed to justify any investment in creating an in-house service.

NHS Tayside currently uses a range of external mediators for a small number of high risk cases. These include commercial providers and the local Occupational Health and Safety Advisory Services (OHSAS). Three cases have been mediated by commercial providers in the last year. It is likely that more cases would be referred for mediation if NHS Tayside had an in-house service.

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3.7 Scottish Ambulance Service

The Scottish Ambulance Service (SAS) recognises that mediation is one of a number of ways to resolve conflict. They view it as part of a five level model:

1. Advice and Support – provided by line manager, colleague or staff side representative

2. Facilitated meeting – provided by someone with appropriate skills; typically one of the personnel team

3. Internal mediation – provided by a trained internal mediator4. External mediation – provided by Core Solutions Group5. Management review – provided by an appropriate manager

The priority is to identify conflict at the earliest opportunity; ideally when it is identified by the line manager. In so doing, it is believed that there will be, for example, a reduction in absence and an increase in performance. This should also result in a reduction of the number of conflict cases as they will be resolved at source. To achieve this it is necessary to develop the line management population in mediation skills. The intention is to include mediation skills as a core module in the forthcoming leadership training.

Facilitation or mediation can be at the request of an employee or manager or can be offered by the Personnel Team. The decision on provision of internal or external mediation is made by the Personnel Team. Mediation is entirely voluntary and is only provided if all parties are in total agreement.

As part of the mediation, the parties are asked to sign a contract indicating their commitment to the process and also agreeing to the conditions of confidentiality. The parties involved in the mediation may, if they wish, be accompanied at the mediation meeting by a union representative or work colleague. To minimise operational impact, mediation is typically conducted over one business day. To aid preparation, the parties normally provide the mediator with a brief summary of the issues. The agreed resolution is signed by both parties. The purpose of this is to reinforce the joint responsibility for the outcome. There is no follow-up unless either of the parties requests it at a later stage or alternatively a formal process is invoked.

Internal mediation is provided by one of three trained internal mediators all of who are within the Personnel Department. They have been trained by Core Solutions Group and are accredited to Level 4. The mediation training is of five days duration followed by three days of assessment. Core Solutions Group also acts as the external mediator and was selected because of their reputation and expertise.

To date there has been a small number of mediation cases and currently there is no data collected. There is a confidence that the mediation that has taken place has been successful and has been a very cost effective way of remedying conflict.

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4 Findings – Emerging ThemesThe following themes emerged from our analysis of the findings from interviews with mediation practitioners, stakeholders and staff that had used mediation. Throughout this section we provide vignettes of current practice, lessons learned and ideas for future improvement.

4.1 Uptake

Even in boards with established in-house mediation services, annual uptake of mediation is in single or low double figures. Given the size and complexity of the organisations, this seems surprising and may suggest that:

promotion activities have not yet become fully effective in engaging all constituents

mediation is not seen as relevant to those in the midst of conflict organisational culture does not support mediation or other informal

resolution processes

Boards also reported that uptake tended to be at band 6 or above. Whilst we explore this later in the report, we note here our concern that this represents substantial strata of the organisation that do not engage with mediation at all. Where boards have taken the decision to embrace mediation, the opportunity needs to be proactively extended to all staff groups.

4.2 Definitions and purpose of mediation

4.2.1 Purpose

Boards had varying reasons for introducing mediation. These tended to fall into one or more of the following:

changing organisational culture to one of ‘nipping it in the bud’ – early intervention in conflict and personality clashes

reducing duration of absence associated with conflict and personality clashes

reducing HR workload in managing formal cases helping parties return to a productive working relationship after a

formal complaint, grievance or disciplinary investigation further developing the skills within the HR team and providing job

enrichment

4.2.2 Strategic foundations

Mediation was universally considered an important and valuable intervention by the boards we visited. However, some of the boards had introduced or were about to introduce mediation without having made strategic, considered decisions about:

the definition of mediation that the board would work with the type/model of mediation to be used how mediation would fit with the needs of the organisation the numbers of mediators required, to balance speed of availability

against the need for regular practice and the professional diversity of the group

how mediation would be adapted to meet the needs of individual cases

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In some cases, there was a tendency to build on the skills and capabilities already available within the board, such as human resources, coaching, facilitation and organisational development skills, rather than conducting a needs analysis and then acquiring the skills that would meet the organisation’s needs.

Whilst the outcome may be an effective mediation service, this is not guaranteed unless founded on a thoughtful consideration of organisational need.

4.2.3 Business case

Intuitively, mediation is ‘a good thing’ – an alternative to lengthy and distressing formal processes, and potentially a lever for behavioural change. Boards’ business cases for introducing mediation were generally based on these qualitative benefits of mediation, but did not include a robust cost benefit analysis. Given the increasing budgetary constraints on the NHS, this lack of financial analysis could present a risk to the sustainability of a mediation service. All the boards we visited believed that mediation had or would save money, but had not been able to calculate the financial value of the service.

4.3 Delivery models

4.3.1 Mediation and facilitation

We saw and heard about three types of intervention during our board visits:

mediation facilitated resolution informal facilitation3

In most cases the boards made a clear distinction between mediation and informal facilitation, and offered each for different situations. However, on occasion we saw either facilitated resolution or informal facilitation being used under the title of mediation.

Informal facilitation offers an excellent option for parties who have not reached the point where mediation is needed, and most boards used it as part of a continuum of interventions for addressing conflict at work. For some boards, the only difference between this and mediation is that the parties could be represented/accompanied during the meeting.

We noted that the terms facilitation and mediation were often used interchangeably, and stakeholders and managers often did not understand the difference. Therefore they sometimes used the term mediation when they were referring to facilitated resolution or informal facilitation. There is therefore a need to ensure managers understand the difference between the different approaches, and when each might be an appropriate intervention.

4.3.2 Mediation models

All boards that are currently offering mediation used the facilitative model exclusively, including in their external mediations. For most, this is not a conscious decision; based upon the description of their approach we have assumed it to be the facilitative model. With the exception of one board, staff that had been trained as mediators tended not to have knowledge of other

3 Definitions of all three are provided in section 1

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models, such as the evaluative model, and indeed were often unaware that other models existed.

When we discussed cases where the facilitative model had not been successful, it often emerged that another model would have been more appropriate to the case in question.

The approach to mediation varied from a purely problem-centred approach to a more systemic approach that focused on the relationships and context that had led to the problem.

Whilst a problem-centred approach can offer a rapid resolution, it may only act as a sticking plaster as it fails to deal with the underlying issues. These issues may surface again later in new conflicts between the same or related parties. A more diverse toolkit of models may be more appropriate for in-house mediators, so they could select the appropriate model(s) as the mediation progressed. However, given the small number of cases currently being mediated even by established services, we would question whether mediators would have sufficient opportunities to become fluent in moving between models.

There is no evidence of checks being in place in any board, to:

ensure that the mediation provided a sustainable solution rather than a sticking plaster

find out why the solution has been successful (or not)

4.3.3 Co-mediation

NHS Grampian’s internal mediators work in pairs to co-mediate. This appears to be good practice for a number of reasons:

it provides a safer environment for new mediators to begin their practice, alongside a colleague

it offers a development opportunity for less experienced mediators, by pairing them with more experienced colleagues who can act as mentors

it offers peer learning opportunities and peer-based quality assurance it offers the potential for a blend of different styles from the mediators

to meet the preferences and needs of the parties in cases where one or both parties become upset or need to withdraw

temporarily from the mediation, there is a mediator available to support each party

However, these benefits must be balanced with the additional resources required by a co-mediation model:

double the ‘hidden’ staff costs – each mediation takes two mediators away from their other roles, and a larger pool of mediators requires more staff to be away from their other roles for CPD

greater difficulties in assuring neutrality and impartiality – boards told us it was often hard enough to find one mediator that neither party knew

increased training costs – to staff a co-mediation model requires more mediators to be trained

4.3.4 Criteria for accessing mediation

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These varied widely from board to board. Some boards had clear criteria and guidelines for the types of cases that are suitable for mediation, whilst others offered mediation for any kind of conflict, including bullying and harassment, and issues that may represent misconduct.

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Current practice – NHS Grampian

NHS Grampian’s booklet ‘Mediation in NHS Grampian – A Short Guide to How it Works’ includes a set of criteria for when mediation is appropriate. It also sets out when mediation would not be appropriate. The guide is available to all staff, to allow them to make their own assessment, but the criteria are also used by the gatekeeper to ensure mediation is used appropriately.

We would have concerns about the appropriateness of mediation being offered where there was an imbalance of power between parties, although we recognise that skilled and experienced mediators can deal very effectively with power imbalances caused by hierarchy. We would also have concerns about the use of mediation for cases where there is potential misconduct. Mediation could be a useful intervention for certain cases, but should not be considered a panacea for all conflicts.

4.3.5 Co-ordinator role

A number of boards have a member of staff who acts as the co-ordinator (or gatekeeper in NHS Grampian’s case) for accessing mediation. They handle requests for mediation, assess suitability and then match cases to mediators. The role is fulfilled by different departments/staff in different boards:

Dignity at Work Manager HR team named member of HR team

We see this as an important role that can facilitate consistency of approach, equity of access, appropriate case matching and effective monitoring and evaluation. However, we recognise that this represents an additional hidden cost of offering in-house mediation. In those boards that have a co-ordinator, the role is combined with another role, rather than being a separate member of staff. For instance the Dignity at Work Manager, Head of HR, Head of OD. Current practice – NHS Highland

NHS Highland has a dedicated mediation co-ordinator. The purpose of the role is to match the mediator to each case, ensuring that the appropriate mediator is appointed in a way that ensures confidentiality and neutrality. The co-ordinator acts as the point of contact for all parties and collates data for future analysis.

Current practice – NHS Grampian

The Dignity at Work Manager acts as the gatekeeper for Grampian’s mediation service. She provides a case management role, managing intake, assessing suitability of cases, liaising with parties and selecting appropriate mediators. Following the mediation, she debriefs with the mediators and also follows-up with parties by email.

4.3.6 Mediation as one of a number of options

In some boards, mediation is offered as one of a number of options to address conflict in the workplace. We have already mentioned the option of informal facilitation in previous sections. Some boards also offer management review, team-based organisational development interventions and informal discussions

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and advice with managers as part of a suite of options. All, of course, also offer formal Dignity at Work, grievance and disciplinary processes.

Confidential Contacts are also an important part of the picture. They can offer a listening ear and sounding board to staff in difficulties, and advise them on the options available to them. However, some do not feel well-informed about: all the options available; how they differ; and what each might be appropriate for.

It is important that mediation is explicitly presented as one of the options available to staff. If not, it lacks the legitimacy of other interventions, and staff may avoid it for fear of the issue being ‘swept under the carpet’.

Current practice – Scottish Ambulance Service

Conflict resolution is a priority to SAS. The likelihood of success is increased the earlier the conflict is identified and addressed. SAS has developed a 5 level model aimed at dealing with conflict in an appropriate way depending upon the severity of the situation.

Given that mediation is not a panacea for all conflict situations, it is essential that it is offered within a range of options. If not, then it cannot be considered voluntary, and may be used for inappropriate cases.

Whilst we recognise the need for options, we also acknowledge the potential resource implications of implementing a range of in-house resolution options. For example NHS Tayside’s proposals to provide informal facilitation training to a range of staff, and to introduce in-house mediation, means they must bear the training costs of introducing two different interventions. In such cases, there needs to be a clear business case and demand for introducing both on an in-house basis.

4.3.7 Voluntary nature of mediation

Whilst all boards are committed to mediation being voluntary for all parties, in reality individuals sometimes feel they do not have other options. For example:

mediation being offered as an alternative to formal process, with the implications of going down a formal route being painted in very stark and unappealing (although probably accurate) terms

mediation being recommended as an outcome after a formal grievance process, to help both parties return to a working relationship; it may be difficult for some individuals to feel able to refuse the recommendation of a formal investigation

We spoke to a number of staff who had used the mediation service, and all said that they had been willing to give it a try. However, they also highlighted that they felt that there were few or no other options to consider. This raises questions about what ‘voluntary’ actually means in practice. A single option is no choice at all, two options presents a dilemma, three or more options offer real choice. We see an important distinction between:

genuinely voluntary – mediation is one of a range of options available and suitable for the case

semi-voluntary – mediation is entered into willingly, but seen as the only available option or the only palatable option in a choice of two

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In reality, some cases will only be appropriate for mediation or formal process, but in these cases individuals need support to weigh up the pros and cons in a rational and unbiased way.

4.3.8 Selection of internal mediators

The process for selecting internal mediators varied between boards:

role or skill-based – staff in HR, management or OD roles coalition of the willing – those who come forward for training hand-picked – invited by HR to participate in training and become

mediators open selection – advertised throughout the organisation, staff invited to

attend briefings, complete application forms and psychometric testing

With the exception of the open selection process, these approaches present a number of risks:

assumption of capability – many assume that managers and OD/HR staff have an underlying capability on which to build mediation capability; this may not always be the case

lack of diversity – if all mediators come from a similar discipline or role, it becomes difficult to ensure impartiality and neutrality for every case; it also limits mediation’s accessibility and perceived relevance to a diverse range of staff groups

opportunity cost – the time that staff spend on mediation is time they cannot spend on other roles and functions, so if all are drawn from a particular role or function (such as OD) then the core capacity of that function is diminished; drawing from a wider functional/disciplinary base spreads the load

potential conflict of interest for HR/OD staff between their substantive post and their role as mediator

4.3.9 Selection of external mediators

None of the boards we visited had explicit criteria for determining when external mediators or facilitators would be used. External providers tended to be called upon in the following cases:

where the case carried significant reputational risk for the organisation where the case carried significant financial risk for the organisation (eg

cost of sickness absence and cover for medics) where one or more of the parties were very senior in the organisation where one or more of the parties was in a ‘high value’ role in the

organisation, such as consultants or senior nurses where in-house capacity or capability was not present where privacy and independence could not otherwise be guaranteed

External providers tended to be selected based on:

past work with the board (in some cases this included non-mediation work as well as mediation assignments)

recommendation from a colleague, other board or partner organisation perceived reputation and expertise in mediation

The need for a rapid response precluded a competitive process, and we did not see evidence of boards checking the credentials of external providers before engaging them. However, some boards were using recognised specialist

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mediation providers for the work, which does offer some level of quality assurance.

Likewise, we did not see evidence of an explicit contracting process between most boards and their external providers. There appears to be an assumption that external providers will come in and ‘do mediation’, based on a general briefing, and that the board does not need to set boundaries around the model, outcome and approach. It would be more appropriate to have an explicit contracting conversation between the board client and the external provider, to ensure appropriateness of approach. There also seems to be little onus placed on the provider to evaluate the sustainability of the intervention or provide follow up support. It could be useful to compare data on sustainability of outcome between external and internal mediations.

We would have concerns that external providers who also do other non-mediation work for a board may risk conflicts of interest.

We also note that the lack of competitive selection process presents some risks:

inconsistent quality and approach lack of quality assurance lack of cost control

4.3.10 Staff perceptions of mediation

Some of the staff-side representatives were very positive about mediation; however they felt that they could have been more involved from the outset. Some also told us they were concerned that staff might perceive mediation as:

a whitewash – ‘management’s’ attempt to deny staff their right to due process

an HR intervention – therefore only focused on getting staff back to work quickly

a management intervention – with the balance of power in the manager’s favour

Some stakeholders also reported concerns that managers may perceive mediation as a restriction and interference to their freedom to manage.

Some managers reported that mediation was not suited or relevant to lower grades of staff, as they tended to want to pursue formal process; to ‘have their day in court’. There was also an implication in their comments that lower grade staff tend to lack the emotional articulacy to value a ‘talking’ intervention. As uptake of mediation has tended to be amongst staff above band 6, and therefore the service users we interviewed were in the higher staff grades, this is a difficult assertion to test without a large scale staff survey.

These perceptions may impact on the extent to which staff consider mediation an appropriate intervention for their difficulties, and the extent to which they would be genuinely willing to engage with the process. This raises challenges for promotion and accessibility.

4.3.11 What matters to staff?

We asked staff-side representatives, managers and staff who had used mediation what, from their perspective, were the most important characteristics for a mediator to have. The following three factors were all seen as equally important:

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Knowledge of the board and/or the NHS was not seen as particularly important.

4.3.12 Impartiality, neutrality and confidentiality

Although all boards and mediators expressed a strong commitment to providing impartial, neutral mediators, in some cases organisational or local context makes this difficult:

remote and rural boards – they employ large proportions of the local population, who tend to live in close knit communities where people know or are related to many others, making it difficult to find a genuinely neutral mediator; this is especially pronounced in the island boards

boards with larges bases in small towns and small cities – again they are significant local employers in close-knit communities, making it difficult to find a mediator that is not known to one or other party

boards where mediators are all drawn from similar roles or functions – if this function or group of staff is well known throughout the organisation (such as HR), then it will be difficult to provide impartial, neutral mediators

Current practice – NHS Highland

Confidentiality and neutrality are paramount in conducting effective mediation. NHS Highland appoints internal mediators who work in a different geographical area from both parties. This means that they are not known by the parties and the content of the mediation can truly be confidential.

In addition, whilst boards and mediators are strongly committed to confidentiality of process and outcome, staff do not always believe this will be the case and can be put off entering a mediation process for fear of being labelled a trouble-maker.

There are solutions to the problem of finding impartial, neutral mediators. These include:

drawing internal mediators from a diverse range of staff groups, roles and functions

pooling mediation resource with other boards or with other local partner organisations (such as local authorities, higher and further education institutions)

Thoughts for the future – NHS Shetland and NHS Tayside

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Both boards face the challenge of being large employers in relatively small communities, and are thinking about how to ensure impartiality and neutrality in mediation. Both are considering pooled resources with local partners: Dundee University in Tayside and Shetland Islands Council on Shetland. NHS Tayside is also considering scope to pool resource with neighbouring boards.

The problem of perceived confidentiality is more complicated to solve, as it is a result of perceptions rather than reality. It needs to be taken into account in the promotion of mediation and in the information provided to staff who are considering mediation.

It is also important that all internal mediators in a board handle the communication of confidentiality in the same way. In one board we visited, we identified a range of practices, with some staff sending a confidentiality agreement to be signed and others not. Also there were differences in how much information was communicated to line managers.

Current practice – NHS Grampian

NHS Grampian has adopted a Code of Conduct, by which mediators must abide. It sets out the values and principles of mediation in NHS Grampian, to ensure consistency and quality. It also enables staff accessing mediation to see what standards they can expect from their mediators.

Current practice – NHS Highland

NHS Highland has created a pack for mediators ensuring that there is a consistency of approach. This pack includes a series of letters one of which confirms to both parties the outcome of the mediation and reinforces their shared responsibility for the agreed actions.

4.4 Impact

None of the boards have conducted systematic evaluation that assesses the impact on the individuals using mediation or on the organisation. However, our interviews revealed a number of impacts and also some issues that might hinder the achievement of maximum impact.

4.4.1 Impact on service users

We interviewed a number of individuals who had participated in mediation to resolve conflicts with a colleague. All reported at least partial resolution as a result.

Some reported that the specific problem had been resolved but that the relationship between the parties remained difficult. This represents a missed opportunity to deal with the underlying relationship issues, as discussed previously in section 4.3.2.

Service users, and some managers and staff-side representatives, reported that individuals didn’t always understand what to expect from mediation, so didn’t really know what they were getting into, in terms of:

process – as mediation is informal, staff may assume it is a softer option than a formal process; in reality it can still be emotionally gruelling and staff may be unprepared for this

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purpose and outcome – staff do not always understand what might be the possible outcomes, and may have unrealistic expectations

responsibility – staff sometimes do not realise that implementing the outcomes will be their responsibility, and therefore are left with a feeling of ‘is that it?’ at the end

This indicates that some pre-mediation support and preparation is required. Whilst some boards do provide leaflets and information in advance of the mediation, this might need to be supplemented by human support, for example from the mediation co-ordinator or from staff-side colleagues, but not the mediators.

Current practice – NHS Health Scotland

There has been an initiative to train all staff on Steven Covey’s ‘7 Habits of Highly Effective People’; so far 70% of staff have received the training. Two of the habits have particular applicability to mediation and facilitated resolution, and parties are reminded of them in their preparation for the intervention. The two habits parties are encouraged to demonstrate during the intervention are: Habit 2 - ‘beginning with the end in mind’ – to become more outcome focused during the meeting. Habit 5 – ‘seek first to understand, then to be understood’ – actively listening to the other person’s perspective. The habits are then used as a point of reference during the intervention. Staff have practised the habits during their training, which helps them to demonstrate them during the actual facilitated resolution.

Lessons learned – NHS Highland

Some of the mediators in NHS Highland found that if they spoke to the parties by phone prior to mediation starting there was often a desire by the parties to talk about the case. The mediators agreed that the best way to avoid this happening was to communicate by email.

As mediation is a privileged and confidential process, most boards do not provide follow-up or support after the mediation. Some service users, staff-side representatives and managers reported that this can leave service users feeling vulnerable post-intervention.

Thoughts for the future – NHS Tayside

Staff-side representatives and managers in NHS Tayside reported that staff entering a mediation often did not really know what to expect, even if they had been briefed. They felt there was a need for additional support and preparation, so that parties could get the most out of the mediation by knowing what to expect.

There can also be an assumption that the mediation will lead to an immediate return to ‘normal’, when in reality it can take a long time to rebuild working relationships even after a successful mediation intervention. Some of the users of mediation also described difficulties in coming to terms with the overall experience, and that this also limited their ability to get back to ‘normal’.

It is possible to preserve the confidential nature of mediation whilst also providing post-intervention support, and this could be very valuable in helping mediation parties move on positively, both individually and together.

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Current practice – NHS Health Scotland

The head of OD has provided a successful combination of informal evaluation and ongoing support in one case, which has led to sustainable outcomes and has increased the parties’ capability to deal with similar conflict issues in the future.

The head of OD has established six-monthly follow-up meetings with both parties (in a joint meeting). The purpose of the meeting is to establish progress made and any further support they need from the board. In addition, the parties also meet together every two months without the head of OD, to discuss their progress.

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4.4.2 Organisational impact

NHS Highland has collected data that show a correlation between an increase in mediation cases and a decrease in formal Dignity at Work complaints. However, these data represent early findings and NHS Highland has not examined causality. None of the other boards we visited had assessed organisational impact beyond the anecdotal.

In boards with established mediation services, stakeholders reported that intuitively they believed that mediation was creating a culture of early intervention and ‘nipping things in the bud’.

None of the boards had attempted to calculate cost-benefit, but stakeholders again intuitively felt that mediation was saving their boards money (or would save them money in the case of those that had not yet introduced mediation).

A number of boards reported that introducing mediation had provided a personal development opportunity for staff who had trained as mediators. Mediators confirmed this and reported that the skills they had developed through mediation were also useful in other aspects of their work. However, the cost of mediation training is significant, and therefore the personal development gains should be considered only as a secondary benefit of introducing mediation, rather than a reason to do so. Other personal development opportunities may be available at lower cost, should that be the primary driver for considering introducing mediation.

Stakeholders in one of the boards that was just about to launch an in-house mediation service reported concerns that, if the first two or three mediation cases did not go well, it would cause mediation to lose credibility with staff. This points to the need for thoughtful consideration of how the service is introduced and the promotion and support that goes around it. If the risks are significant, then the time and investment needed to mitigate those risks may also be significant.

Some stakeholders also reported concern that the introduction of mediation may have an impact on managers’ roles, with managers seeing mediation as an alternative to them managing staff effectively. Managers managing well is a critical part of an organisation’s portfolio approach to addressing conflict. It is important that this is made clear to managers when explaining the range of options for resolving conflict. The managers’ role should be paramount, not undermined.

If the organisation has a culture of accepting poor management performance then mediation cannot reach its potential:

if managers abdicate reasonability for managing well, cases that should have been nipped in the bud by the manager end up escalating to mediation, thereby swamping the service and reducing its availability for genuinely appropriate cases

many cases will probably arise from ineffectual management, which could have been avoided if managers operate effectively and with the right training support

Current practice – NHS Forth Valley

In some cases, the need for facilitated resolution has acted as a trigger to consider the root causes of the problem, eg the prevailing team culture, not just between the two participants. Following the informal resolution, a departmental cultural diagnostic has taken place, which subsequently led to a systemic

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organisational development intervention (coaching and training) with the team affected; this offers the potential for a wider impact on team relationships and effectiveness.

4.5 Cost of mediation

We estimate the cost of an in-house mediation intervention to be:

Item CostAbsorbed costs of mediation training £750Wage costs for mediator(s) £298 to £596Wage costs for 2 staff members to participate in mediation

£298

Cost of mediation intervention £1,346 to £1,644

We also know from our interviews that the cost of an external mediation is usually in the range between £2,000 and £5,000 per case.

The start-up costs are relatively high, in terms of training and staff time, and it can be harder for boards to justify the cash expenditure on a training course than the continued ‘hidden’ cost expenditure of wages and staff time in resolving formal processes. As previously mentioned, mediation is not the solution for all conflicts, therefore an investment in mediation does not eliminate all the costs of grievances.

4.6 Sustainability

4.6.1 Cash costs

The set-up costs for the majority of internal mediation services have been funded by partnership or endowment funds, with some additional funding from HR budgets. Costs of external mediators tend to be funded by the departments requesting the mediation.

Once an internal mediation service is up and running, the cash costs are limited to training further cohorts of mediators and continuing professional development (CPD) for trained mediators. In most of the boards, ongoing training and CPD is not provided, so there are no ongoing costs unless they decide to train up more mediators. We will discuss the need for CPD in section 4.8.3, but would recommend it for all in-house mediation services. Therefore, in future, there may be cash costs associated with this.

Endowments are under severe pressure during the current economic crisis. As the Bank of England base rate is close to zero, endowments are attracting very little interest at present. It is the interest that is used to fund development initiatives such as mediation.

4.6.2 Hidden and opportunity costs

In addition to cash costs, there are ‘hidden’ costs (staff time) and opportunity costs associated with staff delivering mediation. Whilst these are less easy to account for, they are important.

We did not see evidence of boards considering the opportunity costs, especially those associated with only using particular staff groups or roles for mediation (such as OD and HR). These opportunity costs represent the time that staff

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spend away from their ‘day job’ when they are involved in mediation. When the mediators are all drawn from a single staff group, this can significantly reduce the capacity within that group.

4.6.3 Sustainability and reputation

Boards recognised the crucial link between reputation of the mediation service and its sustainability. If even a small number of mediations are unsuccessful, there is a risk of word getting around and staff being unwilling to engage.

Conversely some boards report concerns that, if they advertise mediation widely and it appears successful, they will be deluged with demand. NHS Highland’s experience is instructive here, as the board did not experience unsustainable demand when it promoted its service widely.

4.7 Accessibility, inclusivity and promotion

The boards we visited had different approaches to promoting mediation:

widespread promotion to all staff – advertised as something for everyone, aiming for staff to ‘pull’ the service rather than HR ‘pushing’ it

promotion to managers only no promotion at all – HR offer mediation when they believe a case is

appropriate

Despite these different approaches, boards told us that mediation tends to be taken up by staff at Bands 6 and above, although none of the boards collected diversity data on mediation participants. This suggests one or all of the following:

mediation is not seen by lower grades as a realistic option even if it is promoted to them – this was reinforced by some of our discussions with managers, who indicated that staff in lower grades tended not to be attracted to mediation and generally wanted ‘their day in court’

promotion activities do not communicate mediation and its benefits effectively to lower grades, in formats and styles that appeal to them

those promoting or suggesting mediation (managers, HR professionals, mediation co-ordinators) make assumptions (consciously or unconsciously) about staff in lower grades’:

o ability to engage with and/or benefit from mediationo interest in pursuing an informal resolution such as mediation

This raises serious concerns about equity of access and the possibility of bias. If a board determines that mediation is an effective component of their conflict and dispute resolution portfolio, then it should be available on equal terms to all staff groups. If the assertion that staff in lower grades prefer to follow formal process, then this represents a high cost to the organisation, and the potential for improving the acceptability of informal resolution (whether mediation or other models) needs to be explored.

In terms of how mediation is promoted, we would have concerns about anything other than widespread promotion, as selective promotion or selectively offering

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mediation both imply assumptions about who mediation is suitable for, rather than letting staff make that decision for themselves.

To be effective, widespread promotion needs to be segmented with messages and channels adapted to the needs of many different audiences, to ensure mediation appears relevant to different staff groups. It is also worth bearing in mind that one-off promotion, either at induction or at a launch event, is probably insufficient; people tend not to absorb promotional information until they have a need for the product or service being offered. Therefore ongoing promotion or awareness raising is probably needed.

It is important that the promotion is done using a partnership approach, so as to counteract any suspicion of it being an ‘us and them’ intervention. It also needs Chief Executive endorsement.

4.8 Training

4.8.1 Selection of training providers

Selection of training providers to deliver mediator training has not usually been through competitive tender, although some boards have been through a research process to identify one or more suitable providers before inviting cost estimates.

4.8.2 Training courses

Training courses have ranged from 2-day non-accredited courses to 10-day accredited or certified programmes. The boards with more established mediation services have gone down the more intensive training route, with programmes lasting between 5 and 10 days. All training programmes include a high proportion of the time dedicated to practice.

Given the level of difficulty that mediation entails, we would have concerns that the shorter courses do not adequately prepare staff to run an effective mediation intervention. With the best will in the world, two days doesn’t give very much time to practice, nor does it provide the opportunity for anything more than superficial input on theory, models or how to handle some of the difficulties that might arise during a session.

In some boards, staff have not had the opportunity to practice for some time after their training course, which could leave them rusty and lacking confidence before they even start.

Current practice – NHS Grampian

Mediators work in pairs in NHS Grampian. This co-mediation approach offers more opportunities for practice, as well as peer learning and informal mentoring. Since a second cohort of mediators has been trained, new mediators are paired with more experienced colleagues.

It is important to ensure mediators have sufficient practice time to keep their skills current.

4.8.3 CPD and Supervision

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Continuing professional development (CPD) is an important component of keeping mediators’ skills up to date and fresh. Whilst dedicated mediators will undoubtedly seek opportunities for self-directed learning, there is value in providing a programme of CPD for mediators to participate in collectively. This could address the need for additional practice, as well as offering opportunities to learn new techniques, models and approaches. Only two boards currently offer collective CPD opportunities for mediators:

Current practice – NHS Grampian

As well as annual practice days, mediators in Grampian have recently agreed to have quarterly group CPD sessions. They are also provided with mentoring by an experienced mediator from Conflict Management Plus (CMP Resolutions) and also by the NHS Grampian Dignity at Work Manager

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Current practice – NHS Highland

NHS Highland currently has no formal CPD arrangements in place for mediation. They do, however, regularly conduct confidential peer reviews. This reflective process allows them to understand how colleagues work, what works well and what could be done better, thereby supporting personal development.

One of the boards provides supervision to mediators, albeit on an informal, mentoring basis rather than formal supervision. This is provided by the mediation co-ordinator and the external training provider. In another board staff involved in facilitated resolution receive support from their line manager and/or their coaching supervision group.

4.9 Monitoring and evaluation

4.9.1 Monitoring

Most of the boards we visited collect basic monitoring data on mediation, such as volume of cases. We did not see evidence of diversity data being collected on mediation participants. As Dignity at Work complaints and formal grievances must already be monitored, then extending that monitoring to include mediation cases doesn’t appear to present a major workload increase.

4.9.2 Evaluation

Notwithstanding from the need to quality assure an in-house service, evaluation is essential given the increasing pressure to justify the value and impact of all non-patient-facing activity. Only one board currently undertakes consistent evaluation and this is only done immediately after the intervention. In another board, it is done by some of the facilitators but not by others. In one board, one case is being evaluated qualitatively through a series of follow-up meetings between the mediator and the parties.

To be robust, evaluation needs to:

take place consistently across all cases, including external mediations be carried out by someone other than the mediator (eg the mediation

co-ordinator) focus on both the process (how the mediation worked for them) and

the content (outcomes and sustainability) include immediate post-intervention follow-up include follow-up at least six months after the intervention to assess

whether the outcome has been sustained

This would represent additional workload for the mediation co-ordinator, however it is an essential component of a quality service. It may be possible to identify opportunities for Masters students (from within the organisation) to become involved in the evaluation process for their project work. This would of course require them to sign up to treat all data confidentially.

There is a perception that evaluation is incompatible with the principles of confidentiality that are central to mediation. We would disagree, provided that:

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participants are advised of the evaluation process after they agree to enter the mediation process, and they are then given free choice whether to participate (if they are asked before entering the process, they may perceive that access to mediation is contingent on their agreement to participate in the evaluation)

the evaluator focuses on the participant’s experience without going into the specifics of the case

Current practice – NHS Forth Valley

Some of the facilitators in NHS Forth Valley use a comprehensive evaluation questionnaire, which is sent to participants after facilitated resolution. It covers the process, the success and sustainability of the outcomes and feedback on the individual facilitator. As well as offering a rating scale for most questions (1-5), there is room for comment after each question. If more consistently applied, this could offer the board an opportunity to measure impact and provide CPD guidance for individual facilitators.

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5 Conclusions and Recommendations 5.1 The argument for mediation in NHS Scotland

The Dignity at Work Steering Group is tasked with answering the question ‘is mediation a worthwhile intervention?’. This review sought to examine the experiences of NHS boards to support the steering group in answering the question.

It is not possible to come to a definitive conclusion on the worthwhile nature of mediation based on our findings for the following reasons:

5.1.1 Low uptake

So far, mediation has touched a very small number of staff in NHS Scotland. Whilst on paper the intervention appears to be cost-effective (albeit based on limited data), it can only become a viable investment option when there is sufficient uptake to recoup the start-up costs.

5.1.2 Limited data on service user experience

Of the small number of staff that have accessed mediation, we only had access to a small sample. Therefore any assessment of individual impact is limited. Those that we met reported at least partial resolution of their issues as a result of mediation, but they also raised some legitimate concerns and issues about the process, including:

the extent to which their participation was genuinely voluntary their level of preparedness for the realities of mediation the lack of support available post-mediation to help parties rebuild

their working relationship

We address these issues in more detail in other sections.

5.1.3 Lack of evaluation evidence

None of the boards are conducting effective evaluation that would enable a balanced assessment of the individual and organisational impact of mediation.

5.1.4 Conclusion

We do not doubt the worthwhile and appropriate nature of mediation as an alternative to formal process, provided the process supports parties and enables them to avoid lengthy and expensive formal processes. However, the question of whether in-house mediation is worthwhile is less straightforward to answer. The start-up investment for NHS organisations is significant, in a climate of increasing budgetary pressures, and needs high levels of uptake to deliver the cost-benefit. Boards also need to recognise that much of the ‘saving’ associated with in-house mediation is in ‘hidden’ costs rather than hard cash. Saving staff time is not unimportant, but it is harder to account for financially.

Those boards with established in-house services believe that their organisations and staff benefit, but those considering introducing mediation may obtain better value for money from a collaborative approach to mediation, such as pooling resources with other boards or local partners.

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The remainder of our conclusions and recommendations provide guidance to boards and national NHS organisations on the development of mediation in NHS Scotland.

5.2 A strategic foundation for mediation

With increasing pressure on boards, both in terms of financial constraints and demands on service delivery, any new initiative needs to be based on a solid, strategic foundation. Whilst mediation is widely recognised as a potentially useful tool for conflict resolution in the workplace, it has a much stronger chance of delivering its full potential and becoming sustainable if it is based on a robust needs analysis and a deliberate, thoughtful design process.

Boards that wish to introduce mediation should consider the following preparatory stages in designing their service:

Needs analysis o what are we trying to achieve? o what are the issues in this organisation? o what do we already have in place? o where are the gaps?

Strategic frameworko what options would meet our identified needs?o what appetite do stakeholders have for each of these options?o what are the pros and cons of each option?o what are the right models and approaches to meet our needs?

Robust business case o qualitative benefits of the chosen optiono cost-benefit estimates over the immediate and medium term

5.3 Mediation as one of a range of options

Mediation should be one of a range of options for conflict resolution in the organisation, with each option being used for appropriate cases. Having a spectrum of interventions, from effective line management through to formal processes when necessary, helps move the culture of the organisation from one of adversarial conflict resolution to one of early intervention and adult-to-adult discussions about relationship difficulties.

There is a risk that, if mediation is introduced in isolation, it simply shifts problems from the formal process into mediation, rather than genuinely shifting culture to one of early intervention. By placing mediation within a range of options, there is the potential to push the resolution of relationship difficulties and conflicts downstream, into line management and informal facilitation. In this scenario, mediation would eventually become a ‘last resort’ along with formal process, with managers and staff being more willing to discuss difficulties at an earlier stage.

It is also important to stress that mediation should not be considered a soft option, even though it is less formal in nature than traditional formal processes. It requires considerable emotional resilience on the part of each party, and a willingness to discuss differences openly with each other. It may not drag on as long as a formal process, but can still be a gruelling process for the parties involved. It is essential that boards make this clear to participants, and prepare them for the reality of mediation in advance.

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5.3.1 Options for conflict resolution

The diagram below shows a possible range of options for conflict resolution.

We would recommend that boards consider:

introducing informal facilitation alongside mediation the development needs of managers, to ensure they can play their part

in resolving conflict and personality clashes as they emerge

In addition, Confidential Contacts will need development, to ensure they can provide informed advice to staff on the various options available to them.

5.3.2 Criteria

As mediation is not suitable for all cases of conflict in the workplace, it is important to have a set of criteria that describe the conditions and circumstances in which mediation is appropriate (and those in which it is not). They should be informed by the board’s strategic framework described in section 5.2.

The guide used by NHS Grampian, and shown below, offers a good example of a flexible set of criteria on which to decide whether mediation is appropriate. Flexibility is essential in applying the criteria, which is why a dedicated mediation co-ordinator role is important. For example, it would not be appropriate to say whether mediation is (or is not) appropriate for bullying and harassment cases: there may be instances where an accusation of bullying or harassment has been made, but the parties are willing to work together in mediation to resolve their differences; there may be other cases where an individual who has complained of bullying feels too vulnerable to be in a facilitated process with their alleged bullier. Deciding whether mediation is appropriate to a case requires the application of judgment and sensitivity, rather than a simple algorithm. For this reason, we highlight the NHS Grampian criteria as a useful model, however with the caveat that a dedicated co-ordinator is

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required to ensure that the criteria are applied flexibly, safely and appropriate across all cases.

“Mediation may be possible when:

both parties are willing to work together to resolve the issue there is a workplace complaint, dispute or allegation the problem has to do with something that the parties themselves can

change

However, mediation is not possible if:

either party is unwilling the law has been broken or legal processes are involved formal processes such as Disciplinary or Grievance proceedings are

underway violence or aggression may have taken place there is an unbridgeable imbalance of power the parties do not have the power to agree a solution health issues prevent full participation”4

These could be further expanded to include criteria for when other options are appropriate and not appropriate.

5.4 Co-ordinator role

Our review has revealed that in organisations with an in-house mediation offering, it is very important to have a mediation co-ordinator. This does not need to be a full time role, and can be combined with other compatible roles, such Dignity at Work manager, HR manager, etc.

The role is essential to the effective running of the mediation service. It includes a number of functions:

acting as first point of contact for those requesting mediation for themselves or their staff, to provide information on mediation

assessing the presenting issues and determining whether mediation is the appropriate intervention

advising on the range of options available and supporting the decision whether or not to proceed with mediation

preparing individuals for participating in mediation – explaining what to expect

following up with parties post-mediation, to provide support and monitor effectiveness

supporting mediators with mentoring, debriefing and supervision quality assurance of the mediation service co-ordinating CPD and supervision for mediators collecting monitoring and evaluation data on mediation managing external mediators deciding on the appropriate style of mediation and therefore assigning

an appropriately skilled mediator

Boards wishing to introduce mediation should consider including a co-ordinator role as part of the service.

4 Extract from “Mediation in NHS Grampian – a Short Guide to How it Works”

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5.5 Selecting internal mediators

There are significant advantages to having a diverse mix of staff trained as mediators:

improving the chances of finding impartial and neutral mediators for all cases

signalling the relevance of mediation to different staff groups minimising the opportunity cost and time commitment on any

individual staff group or function

Given our findings that mediation is rarely accessed by staff below band 6, there is a need to consider how staff from these lower grades could be attracted to become mediators; this would:

encourage their peers to see mediation as a relevant option for them reassure staff in lower grades that they would be able to access

mediation by someone who was a peer, thereby eliminating the risk that more ‘senior’ mediators are intimidating to staff in lower grades

An open selection process is the most effective way to achieve a diverse mix of mediators, as can be seen in NHS Grampian where mediators are drawn from many different occupational groups.

We would advise that the process includes:

briefing or background information on the role before application application form interview

The use of a psychometric tool can be a useful supplement to this process, and has been used to good effect in NHS Grampian. It can provide useful insights on personality preference, to explore at the interview stage. Using a psychometric tool has cost implications, but many boards have in-house capability to administer such tools; therefore the only cost would be test license fees for each individual (usually around £30 per head) and the time taken to analyse the results and give feedback (approx 2 hours per person).

5.6 Training internal mediators

Mediation is not a soft option. It can be hard work for the participants and the mediators. Conflict situations can be complex to resolve and issues can ‘blow up’ during the intervention. Therefore, mediators need to have had appropriate levels of training and practice to be able to handle a difficult, dynamic and potentially draining process. Ongoing support and supervision is also necessary to ensure they maintain and develop their skills.

5.6.1 Training

To provide sufficient theoretical and practical input, we recommend that internal mediators receive around 5 to 8 days of initial training. This should conclude with an accreditation or certification based on assessment of observed practice in a role play situation. Successful completion of the assessment should be a pass/fail criterion: individuals should not become internal mediators until they have passed the assessment.

5.6.2 CPD programme

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Continuing professional development is important for internal mediators. They need opportunities to:

reflect on their practice continue to develop their skills and toolkit practice in a safe environment

We recommend that boards adopt a minimum standard for mediator CPD. These should include:

individual reflection on cases quarterly or 6-monthly group sessions, including

o skill building – eg inputs on other models and approaches, tools and techniques

o opportunities for observed practice and feedbacko peer review of cases (within the bounds of confidentiality)

mentoring or buddy-pairs

5.6.3 Supervision

Supervision is of critical importance in the helping professions, and fulfils three distinct roles:

formative – supporting the professional to improve their practice normative – ensuring quality and ethical standards are being met restorative – providing support for the professional to sustain their

energy and confidence levels in a solitary role

We would see mediation as being a profession/role that requires supervision, in either a group or one-to-one setting.

There is an opportunity to provide supervision training at a national level, offering each board a place for one member of staff (probably the mediation co-ordinator). These supervisors could then provide group or individual supervision to their local colleagues.

5.6.4 Maintaining competence

Cases requiring mediation do not occur frequently at present. Even in boards with established in-house services, the uptake in a year might be 10 or fewer cases. This may change in future, as mediation becomes better understood and accepted, and if lower staff grades begin to engage with mediation more. In the meantime, this low uptake presents a challenge, as mediators need to maintain their competence levels in between cases, to ensure they are fresh and effective for every case they mediate.

Based on the current levels of uptake, we would recommend that all mediators must mediate at least one case per year. If not, it would be appropriate to require them to do a refresher training course. We would prefer to recommend a higher number of cases per year, but must be pragmatic about the current level of service provision. We would therefore recommend that additional practice time is obtained through:

observed role-play practice at CPD sessions offering mediation to other boards or partner organisations

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5.7 Selecting training providers and external mediators

Each board should have the opportunity to select their training providers and their external mediators to suit local circumstances. However the current arrangements, where each board selects their own based on their own research or on the basis of recommendation, carry the following risks:

cost-effectiveness – limited competition means that providers may not be charging the most competitive rates, and may not be charging the same rates to all boards

time-effectiveness – all boards must go through their own procurement process, which takes time and effort

quality assurance – boards’ processes for selecting and checking the credentials of external mediators and training providers vary

choice and diversity – most boards know a small number of providers, so go with the same ones without knowing what else is available

effectiveness of approach – providers may use only one mediation approach, and this may not be appropriate to all cases

There is scope to develop national preferred provider framework contracts for:

external mediators mediation training

Providers would participate in a competitive tendering process to be included on a preferred provider list that boards could select from. This offers the following advantages:

Cost control a national tendering process generally delivers more competitive prices

from suppliers than local tendering, semi-competitive or non-competitive processes

successful tenderers would offer consistent rates for all boards

Time saving a single national procurement process would take only a little more

time than each board’s individual procurement process, as the total value is unlikely to be above the threshold requiring a lengthy European procurement process

when a board wanted to use an external mediator or mediation trainer, they would be able to select one quickly, without having to rely on ‘the usual suspects’

Choice and diversity a wider choice of quality-assured providers for boards to choose from

Quality assurance to be successful, tenderers would have to demonstrate track record,

credentials, appropriate indemnity insurances and references – this saves time for boards and ensures appropriate quality provision

5.8 Impartiality, neutrality and confidentiality

5.8.1 Pooling resources

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There are challenges in offering a genuinely impartial and neutral mediation service, especially in boards in remote and rural communities and small towns. Whilst having a diverse mix of mediators helps, it can be further improved by:

pooling mediation resources with neighbouring boards pooling mediation resources with local partner organisations, such as

local authorities, universities, further education colleges, emergency services

Whilst these options may not be appropriate for all boards, they do have potential especially for those who are just about to establish an in-house mediation service and/or are struggling with how to assure impartiality and neutrality.

5.8.2 Code of practice

Whilst we are in no doubt that all boards are fully committed to impartiality, neutrality and confidentiality in the mediation process, there are risks of inadvertent breaches, especially where mediators work closely together in the same department or function. It is also important to recognise that some staff fear their confidentiality will not be preserved, even when in reality it would be closely guarded.

To address both of these issues, it would be helpful to develop a national code of practice on impartiality, neutrality and confidentiality. This would set out the core principles that all boards and mediators would adhere to.

There is extensive expertise on this topic within the NHS Scotland mediation community, and it would make sense to ask some of the board mediation leads to work together to develop the code.

5.9 Wrap-around support for service users

It is important to provide appropriate preparation and support for individuals participating in mediation. Some managers and staff may perceive that mediation is a soft, easy route when the reality can be quite different. This can lead to a mismatch between expectations and actual experience. There can also be a disappointment and a loss of momentum when the problem is not instantly resolved after mediation.

We recommend that boards consider a wrap-around support system for individuals, including the following:

Preparation before entering mediation:

what to expect of the process what to expect of the outcomes who has responsibility for taking forward agreed actions what follow-up support will be available what will be communicated to the person referring the individuals to

mediation what happens afterwards

Post-mediation support:

helping individuals enact the agreed outcomes and rebuild the relationship

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providing individuals with a sounding board when things feel difficult creating a forum where parties can reconvene to review progress and

make course adjustments

We see this support system being compatible with the principles of confidentiality, provided:

it is voluntary it is explained to all parties in advance and they are happy to

participate the staff involved in providing the support do so within a clear

agreement on confidentiality

The mediation co-ordinator would have a pivotal role in this support system. We also see a valuable role for staff-side representatives. We would recommend that any support system is explicitly designed, rather than happening in an ad hoc way.

All staff involved in providing support would need appropriate training to ensure there was a consistent and appropriate approach to supporting individuals.

5.10 Inclusivity, accessibility and promotion

5.10.1 Inclusivity and accessibility

In keeping with the principles of equality, diversity and staff governance, if a board offers mediation it should do so to all staff groups for appropriate cases. Our review showed limited uptake of mediation overall, and little to no uptake from staff groups at or below band 5. At the same time boards also reported that formal complaints continued to be a drain on HR staff time, in addition to the impact these complaints have on individuals and the services they work in. Where mediation is offered there is a clear need to widen participation, to staff groups that currently do not access mediation either by choice, exclusion or lack of understanding.

Boards need to give consideration to:

engaging with lower grade staff groups to understand the real barriers to their participation

promotion techniques that will encourage staff in lower grades to engage with mediation

working with managers of staff in lower grade groups, to ensure they understand the relevance and benefit of mediation and promote its use accordingly

ensuring internal mediators are drawn from a cross section of professional groups and pay bands

5.10.2 Promotion

Selective promotion potentially excludes certain staff groups or those from particular demographics, who may wish to use mediation. Therefore widespread promotion is required. Promoting mediation to all staff groups brings its challenges, as it requires multiple advertising techniques and needs to appeal to a broad cross-section of society.

Boards that wish to introduce mediation should consider the following steps in promoting their service:

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Embed in policy – this is the critical first step, with mediation enshrined in organisational policies

Staged launcho ‘soft’ launch ie the service goes live, with training, policy and

processes in place, and it is then communicated to managers, confidential contacts and key stakeholders but not widely advertised

o mass marketing once the service is bedded-in (eg six months after the soft launch)

Visible sponsorship by senior leaders – Chief Executive, Partnership Forum, Staff Governance Committee

Continued promotion through a range of advertising channelso team briefso staff meetingso senior leaders’ ‘roadshows’o emailo staff newslettero staff payslipso posterso intranet

All promotional materials should be written using the Plain English Campaign’s guidance5, to ensure that the information is easily understood and does not alienate the reader from the mediation service being offered.

5.11 Monitoring and evaluation

Without monitoring and evaluation, it is impossible to articulate the impact of mediation other than through anecdote and gut feel, neither of which are reliable methods. Failure to monitor and evaluate mediation may leave the service vulnerable to budget cuts, in favour of services that have developed a more compelling evidence-base.

We recommend that boards consider establishing a robust monitoring and evaluation system that includes:

monitoring of mediation cases alongside Dignity at Work, formal grievances and disciplinary cases

collection of diversity data on mediation participants an evaluation approach that examines both:

o process – effectiveness of preparation and follow-up support, effectiveness of mediation process, effectiveness of mediator

o content (or outcome) – extent to which resolution was achieved, extent to which it was sustained, evidence of sustained changes in behaviours

evaluation data collected immediately post-intervention and then at one or two intervals thereafter (6 and 12 months ideally)

5 http://www.plainenglish.co.uk/files/howto.pdf

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5.12 Summary of recommendations

Boards that wish to introduce mediation should consider the following preparatory stages in designing their service:

Needs analysis Strategic framework Robust business case

Mediation should be offered as one of a range of options, as shown in the diagram below:

Boards should have clear criteria to determine when mediation is appropriate and when it is not. These criteria should be flexible, but should be based on the following:

Mediation may be appropriate when:

Mediation is not appropriate when:

Both parties are willing to work together to resolve the issue, and their participation is genuinely voluntary

Either party is unwilling to participate

The complaint, dispute or allegation between the two parties relates to the workplace

The law has been broken or legal processes are involved

The problem is something that the parties themselves can change, such as their behaviour or working processes

The parties are involved in a formal process such as disciplinary or grievance; however, a grievance process could be paused to explore mediation as an alternative if both parties are willingViolence or aggression is alleged to have taken placeThere is an unbridgeable imbalance of power between the two parties Agreeing a solution is outwith the parties’ power or controlEither party is unable to fully participate because of health issues

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Boards should make it clear to participants, managers and other stakeholders that mediation is not a soft option, and ensure that participants are adequately prepared.

In-house mediation services should include a mediation co-ordinator role.

In-house mediators should be recruited using an open selection process, to ensure a diverse mix of staff groups and grades are involved in providing mediation.

Mediation training should be around 5 to 8 days in duration and should culminate in an assessment; only trainees that pass the assessment should become internal mediators.

Boards should provide mediators with a programme of continuing professional development and supervision.

A supervisor training programme should be commissioned at a national level.

All in-house mediators should have sufficient practice to maintain their competence – including at least one case per year and additional observed role play practice.

There should be a national procurement exercise to create preferred provider framework contracts for external mediation and mediator training.

There should be a national code of practice on impartiality, neutrality and confidentiality.

Boards should give consideration to the opportunities for pooling mediation resources with neighbouring boards and with local partner organisations, to address challenges in ensuring impartiality and neutrality.

Boards should consider providing a wrap-around support system for individuals participating in mediation, to ensure they are adequately prepared for the mediation and are able to move forward productively afterwards.

Mediation should be available, accessible and promoted to all staff. Boards should give particular consideration to widening participation in mediation by staff in grades below band 6 (both as mediators and users of mediation).

Boards should consider the following steps in promoting mediation:

Embed in policy Staged launch

o ‘soft’ launch to managers, confidential contacts and key stakeholders when the service is ready to go

o mass marketing once the service is bedded-in (eg six months after the soft launch)

Visible sponsorship by senior leaders – Chief Executive, Partnership Forum, Staff Governance Committee

Continued promotion through a range of advertising channels

Boards should develop robust monitoring and evaluation systems for mediation.

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Brightpurpose ConsultingOctober 2009

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Appendix 1

Assessment Criteria

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NHS Dumfries and Galloway – Review of Mediation Services/Approaches

Final Assessment CriteriaCore criteria

Cost and value for money Quality Accessibility Sustainability Impact on individuals involved in conflict Impact on service

Data requirementsApproach

What is their working definition of mediation What model(s) are used Extent to which participation is voluntary for all parties How is participation encouraged whilst still maintaining the voluntary nature of

mediation? Extent to which mediator is neutral, impartial, independent (ie what roles do they

fulfil in the organisation, how are they matched) Who decides on outcome – participants, mediator or co-created? Confidentiality of process Extent to which equality and collaboration are encouraged Legal status of decisions/outcomes

Delivery model How many internal staff delivering mediation – their roles/professions/levels or

grades within organisation, is the number growing or planned to grow? How much time in a year are internal staff expected to commit to mediation? How many external staff – their background, other work done for the NHS Board? How are mediators selected (both internal and external)? How are they matched to cases? How are they trained? What criteria are used to decide whether mediation is an appropriate

intervention? (ie what is it used for, and what is it not used for?) Who decides the appropriate criteria for whether or not mediation is an

appropriate intervention? How many sessions (on average) are usually provided for a mediation

intervention? How is the mediation intervention run – process? How does the Board ensure that the delivery of mediation is relevant and tailored

to the needs of different staff groups/professions/grades/individuals? If mediation is currently delivered by external staff, how is this likely to shift

towards an internal model in future?Uptake

How many cases in past 2 years? Spread across grades/professions/roles? Is demographic information captured about the individuals accessing mediation? What kinds of issues did the cases relate to? Were they one-to-one issues or involving a number of parties? How many were resolved to the satisfaction of all parties at the time? How many of these surfaced again at a later date (eg in a formal process or

further request for mediation)?

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Are there particular departments or parts of the organisation that have embraced mediation more than others? If so, what are the reasons behind this?

Who tends to refer to the mediation service – eg parties in conflict, line managers, HR, senior managers?

Promotion How is mediation promoted or advertised within the Board? How is mediation positioned by the leadership of the organisation? What different promotion approaches are used to reach different staff

groups/grades/professions? Is promotion targeted at any particular staff groups/grades/professions? For what

reason? Extent to which staff are aware of mediation as an option Was an equality and diversity impact assessment carried out? What did it reveal

and how was this acted upon?Training and CPD

Who provided the training for internal staff? How long was the training programme? Was there an accreditation associated? If so, which? How was the training programme selected? How much did it cost? What arrangements are in place for ongoing support and CPD for internal

mediation staff? What training/qualifications do external mediators have?

Costs How much does the mediation service cost per year (at the current uptake

levels)?o Financial cost equivalent of internal mediators’ time spent on mediationo Cost of training and ongoing support for mediatorso Cost of external mediators

What is the average cost per case? How is the mediation service funded currently – eg from non recurring funding or

core funding? How does the Board plan to fund it in future – non recurring or core funding, how

vulnerable is the service to budget cuts? How much does the average formal complaint cost the Board? Eg in terms of

cover for absence, staff time to participate in investigation, cost of investigation team

How long does the average formal complaint take to resolve? Has any attempt been made to evaluate the cost benefit to the Board? If so what

factors and assumptions were taken into account in determining this?Monitoring

What processes are in place for monitoring, quality assurance, evaluation and continuous improvement?

What feedback is sought from service users in relation to their experience and evaluation of mediation?

What follow up is conducted with service users to find out if the solution has been sustained?

What impact has there been on the number of formal grievances or dignity at work complaints raised?

To what extent has the use of mediation contributed to reducing tension in the organisation relating to dignity at work, grievances and personality clashes?

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