Arnold M Zack, mediator and arbitrator of labour management disputes, has served as a consultant to the International Labour Organisation and the governments of Greece, Australia, Israel and South Africa, and chaired an international panel to recommend changes in the internal dispute resolution systems of the International Monetary Fund. This former president of the National Academy of Arbitrators (US) is the chair of the Executive Committee of the Alliance for Education in Dispute Resolution, and the author of 12 books on dispute resolution and international labour issues. He has been bestowed with the distinguished Service Award for Labour Management Arbitration and the Whitney North Seymour Medal of the American Arbitration Association and the Cushing Gavin Award of the Archdiocese of Boston. In an interview with Rita Dutta, Zack, who had recently come down to Mumbai for the ceremony of the appointment of first ombudsman in the hospital industry in India at the Bhakti Vedanta hospital, explains why he is a staunch believer in having an ombudsman in every hospital.

One has heard of ombudsmen in the banking and consumer electronics sectors. Why is an ombudsman required for a hospital?
The concept of ombudsman started in Finland some 50 years back and has since gained acceptance in most of the developed countries. Any organisation which wants to improve its services and be more transparent in its dealings with its staffers and customers, would seek the help of an ombudsman.

The hospital industry is marked by high levels of grievances as patients and their relatives are generally vulnerable, disoriented, frightened and largely dependent on others. People have to surrender control to the medical system whose language they may not understand, and that makes them impatient and perhaps a little less receptive than normal. The relatives are also on an edge and will be resisting their loss of control.

At the same time, hospital professionals are working with many constraints on their priorities and energy. Medical and nursing staff may have their sensibilities blunted to some extent by having to deal with thousands of patients. In such conditions, inability to communicate can lead to misunderstandings and can be the reason for a complaint.

In addition, communication gaps between staff themselves and between members of different disciplines can often have serious repercussions on patients. While the level of grudges are high, it is observed that employees would not complain against the employer for fear of being sacked, reprimanded unnecessarily or losing out on promotion. With the grudges bottled up, the employees cannot perform to the fullest potential and thus the hospital is at a loss.

In India, I am told that employees are afraid of pointing to the flaws of the seniors because of sheer respect. You have labour unions to redress complaints to the highest authority. My point is why not have an ombudsman, who would deliver judgements impartially, than having two people represent two sides. Perhaps, the situation would change with the first hospital ombudsman starting at BhaktiVedanta hospital, Mumbai.

How does an ombudsman function?
An ombudsman screens the complaint to see if it falls within his purview and whether there is a basis to take it up. In a majority of cases, complaints are resolved satisfactorily by sheer persuasion and gentle talking.

In the complex cases, a formal investigation may be required. The ombudsman is secretive about the complainant, unless the complainant chooses to be otherwise. The ombudsman makes oblique reference to complaints against the accused and asks him to give an explanation. He may recommend that the accused review his action, change decision, or offer some form of appropriate redress. He would also address the complaints of the employees of the hospital, even if that is a complaint against the employer.

He can demand any information, document or file from a body complained against and can require any official to give information about a complaint. He can look into all administrative actions including decisions, refusal or failure to act and administrative procedures. Any individual can approach him to lodge a complaint in writing, by telephone, fax or e-mail, or by calling his office. The complaint can range from sexual harassment to verbal tiffs to any misunderstanding.

Why should an employer listen to an ombudsman, especially when he is sexually harassing his employee?
The ombudsman has no power to impose anybody to accept or act upon his recommendation. But any employer who is concerned about the betterment of the organisation, would definitely listen to the ombudsman. May be the employer does not realise that he has caused wrong. Here, an outsider telling him that his behaviour is causing pain and harm to others, can really check the employer. If the accused is not ready to heed, than the complainant can go ahead and make his grievance public.

Why should hospitals have an ombudsman when there are already public relations officer to tackle grievances of the patient and an internal administrator to tackle problems of the staffers?
A public relations officer is paid for creating a good image about the hospital, by concealing all the flaws. An administrator cannot solve grievances, because he cannot be impartial. The complainant can be afraid of approaching him. Only an ombudsman, who has nothing to lose, can deliver impartial judgements.

Who should be made an ombudsman and who pays him?
Any employee of the hospital who is revered and respected by the hospital staff should be selected as the ombudsman. But the ombudsman should be professionally qualified to practice as one. He is paid by the hospital and not the complainant.

Express healthcare management
11 May 2003