More than thirty years ago, American health care began a transformation from a paternalistic and authoritative system dominated by medical professionals and their institutions to a system in which medical care was expected to incorporate patient and family preferences and promote individual autonomy.

This transition to medical consumerism began in the 1970s with social movements intended to give patients more control over their treatment and to promote a more involved consumer base. Along with this emphasis on medical consumerism, came state and federal regulations that were intended to facilitate “voice by requiring standardized grievance procedures and patient advocacy programs as well as a burgeoning malpractice crisis.

The Centers for Medicare and Medicaid Services (CMS) established a Patient’s Rights’ Condition of Participation in 1999 that guarantees patients the right to receive information and that requires hospitals to establish a patient grievance process (Hospital Peer Review, 141.) In addition, The Joint Commission requires that patients be informed about their right to complain and the process for complaint resolution that is consistent with CMS’s Condition of Participation. The American Hospital Association describes patient advocates as problem solvers who bridge gaps, act as liaisons, and keep everyone in the system focused on the consumer (Martin and Tipton, p. 185).

The dominant discourse of grievance or complaint resolution in health care systems today is one of an adversarial relationship in which one side must win and one must lose. The process seeks to place or avoid blame and tends to destroy trust and sacred relationships amongst health care providers and between health care providers and their patients. It does not lend itself to systemic improvements, stakeholder satisfaction or the sense that one (victim or offender) has been heard.

This process has been fraught with the challenge of protecting the rights of patients and families while protecting the integrity of the health care organization and its providers. It may be possible, however, to bring together the victims, offenders and the greater community in a way that harm is repaired and the community is transformed. This system could operate within a postmodern framework that embraces uncertainty as opposed to certainty, the good of the relationship as opposed to a concern with individuals wining or losing, and organizational/individual learning as opposed to problem solving and fault finding. An approach that embraces relational responsibility and restorative justice can bring together caregivers, patients, families, and communities in a way that seeks to heal rather than punish. Law Professor Susan Daicoff has proposed a therapeutic alternative to the traditional adversarial approach that will serve as a model for this project. Her model seeks to bring about a positive result such as healing, wholeness, harmony or optimal human functioning as part of the resolution process and strives to maximize the emotional, psychological, and relational wellbeing of the individuals and communities involved in each legal matter (Daicoff 2006).

A novel approach to resolving patient and family grievances that involves the “offenders” and the “victims”, as well as participants from the greater health care community will be created for this research. This design will incorporate methods drawn from relational responsibility, restorative justice, and appreciative inquiry. I will utilize the newly designed approach with consenting parties who will be interviewed to determine how this approach affected them. If possible, I would like to interview patients, families, and providers (doctors and nurses) who have participated in the existing process for grievance resolution and compare responses. This process could provide health care organizations, providers, and patients and families with space for critical reflection, help us explore the limitations of the existing process and improve patient safety through shared learning.

A mixed methodological approach will be employed encompassing narrative, ethnographic, and grounded theory research. In addition to telling the victim’s and the offender’s stories (how the experiences have affected them), I discuss implications for (a) improved patient safety and quality, (b) organizational success, and (c) healing for victims, offenders, and our organization.