An Interview with David Richardson, Ombudsperson at Kaiser Permanente

Posted by:
Category: Negotiation

When I arrived at my hospital in California, I immediately hit it off with the ombudsperson here. Kaiser Permanente, as it turns out, has a very unique ombuds programs for the health care system. As a conflict resolution nerd, I was very interested in learning more. Going back to my theme about looking outside traditional law jobs, I find it encouraging that there appears to be a growth of jobs as third-party neutrals.  I thought it would be worthwhile to briefly interview my colleague, David Richardson, PhD, regarding what he does as a good illustration of conflict resolution as a field-in-itself. Here is that interview:

Can you introduce yourself?

Sure, here you go.

As a Kaiser Permanente Health Care Ombudsman – Mediator (HCOM), I bring a record of experience and success navigating in highly complex environments and working effectively with individuals at all organizational levels from diverse cultural and ethnic backgrounds in health care, academia and medical education administration. For four and a half years prior to coming to Kaiser Permanente, I served at The Charles R. Drew University of Medicine and Science as the Center Administrator for Behavioral Neuroscience Research Center and later as the Administrative Director for the College of Medicine.

In addition to a Ph.D. in Psychology I have an Ombudsman Certificate from the International Ombudsman Association (IOA) and a Mediator Certificate from the School of Law at Loyola Marymount University.   I am presently the only Certified Organizational Ombudsman Practitioner at Kaiser Permanente. The certification is through the IOA certification board of trustees.  Previously, I held certifications in health care administration, behavioral health care administration and correctional health care.  I am a previous Fellow in the American College of Health Care Executives.

Highly developed analytic and communication skills enable me to influence consensus decisions under time and situational pressures. Through active listening and narrative techniques I help parties to develop and generate options to assist in the resolution of individual concerns, organizational change and critical situations.

What does a HCOM do?

Serving as the designated neutral, a Kaiser Ombudsman is neither an advocate for any individual or the organization, but rather is an advocate for fairness.  The Ombudsman provides the continuum of services, including gathering information needed for assessment of the situation, assistance in interpreting institutional policies & procedures, developing options including those “outside the box”, and providing necessary interventions such as meeting facilitation, mediation and negotiation.  Your Ombudsman informally investigates complaints — opening lines of communication.  My focus is to assure consideration of those issues unaddressed by other existing channels such as Risk Management, Patient Safety, Quality Improvement or Hospital/Medical Administration.  Using an array of mediation tools such as shuttle diplomacy and other neutral functions (e.g., coaching, conciliation, and brain storming that helps people to help themselves).  In addition, I ethically mediate mutually satisfying agreements before they are in the litigation pipeline, track concerns to closure and provide feedback to senior management.

The primary focus when the Ombudsman is involved is to achieve a  resolution concerning patient-clinician issues at the earliest possible opportunity and lowest possible level, well before they are elevated to a legal claim.  Typical interventions may involve issues of:

  • Perceived medical mistakes
  • Unanticipated adverse outcomes
  • Dissatisfaction with the treatment outcome
  • Quality of care concerns
  • Poor patient-clinician interactions
  • Potentially compensable events

Lastly, in my role I bring an appreciation of how physicians are affected when their patients achieve less than optimal results or incur unanticipated adverse outcomes.  The medical clinician is often the forgotten victim in cases that have a poor medical outcome.  So I am sensitive to that fact and ensure that my services are both accessible and useful to physicians and other clinicians.

Can you speak to the art versus science of conflict resolution? In other words, how important has formal training been in your practice and what concerns do you have if any regarding lacking in training?

Training in my view is very important for those working in conflict resolution.   It is not sufficient to be a good listener, although listening skills are important.  Nor are highly developed problem solving skills wholly enough.  What is required is adequate training and supervised practice in communication, problem solving, negotiation and behavioral analysis in order to be a successful practitioner.   Having said this I recognize that there are successful practitioners who do not have formal training, and have not spent time in supervised practice nor have they developed a habit of reflecting on their practice with one or more trusted colleagues.  They are in the minority and a reasonable argument can be made for and con to new practitioners beginning this way.   What I have seen in my own practice and as a result to observing the practice of colleagues is this, without proper training you have a low probability of success.  Even with training there is no guarantee of successful practice.  But the trained neutral has a better chance of success and can be more aware of opportunities for practice improvement.   My last statement reminds me of my father’s favorite saying regarding education and training, “As long as you know what to do you can always work.  When you understand why you do you can always improve.”

Based on my experience as a psychologist working with people under stress and in distress, I have come to realize that both art and science are necessary in order to provide the best practice environment, offer the most appropriate interventions and have the biggest impact in working with people through medical conflict.  Here’s what I mean:   It is inefficient to develop my practice as a neutral based on the anecdotal evidence of my few cases and constricted experiences. It is far better to base my practice on the evidence available in the literature and from research where sample are sufficiently large to produce results that have a high probability of being caused by factors others that chance.  The problem with developing evidence-based practice as a neutral is the paucity of reliable research available to us practitioners.  But where it is available we should evaluate and use it. That’s the science.

The art of practice is required because we are working with people, who may share some similarities, but are at their core individuals, often with unique and idiosyncratic responses to the same event or intervention.  So the techniques we use must be nuanced and massaged to produce the intended result.  Not only are people different from each other in their responses but tend to be inconsistent in how they respond across time, situations and people even when those factors are very similar.

And, for our legal audiences, are any HCOMs JDs?

The HCOMs as a group come from various backgrounds and professions, not all of which are in health care.  Of the 28 HCOMs practicing in California across 35 locations, five are lawyers.  Point of fact, of the last three new hires two are lawyers.   The education and experience is diverse among the group.  There are registered nurses, psychologists, marriage and family therapists, social workers and business people practicing as Kaiser HCOMs.   What is common among them is the training as both Ombuds and Mediators.  While some have been mediators or other types of neutrals before coming to Kaiser each person is given specific Ombuds training based on the Standards of practice and ethical guidelines from the International Ombudsman Association and interest-based mediator training.

Questions from the audience?

Print Friendly, PDF & Email

You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.

AddThis Social Bookmark Button

11 Responses to “An Interview with David Richardson, Ombudsperson at Kaiser Permanente”

  1. Dear Dr. Richardson and Mr. Pauley:

    I saw this statement in the article, “So I am sensitive to that fact and ensure that my services are both accessible and useful to physicians and other clinicians,” yet I am unsure of whether Dr. Richardson is available to staff and providers for organizational (non-patient) issues such as interpersonal treatment, communications, performance reviews, potential fraud, etc. Or is Dr. Richardson available only for patient concerns? Thank you very much.

    Respectfully, Arlene Redmond

  2. David Richardson Says:

    Arlene, thank you for a really astute question. Here at Kaiser the Ombudsman works with patients and clinicians on issues related to patient care. Unlike other organizational ombudsmen, I don’t address employment issues.

  3. How do patients contact you with concerns?

  4. Eric Aichwalder Says:

    How do patients get in touch with you to go over resolution of some of the issues with Kaiser care and what is available in terms of that care?

    Regards, Eric

  5. Denis Grady Says:

    Why When I called 3 separate people at member services, why are are none of them aware that an ombudsman exists? I specifically asked for an ombudsman to resolve an issue but no one could/would give me a name or contact.

  6. Nancy Rubinstein Says:

    I saw the last comment from Denis Grady on 8/28/13, and was wondering if this is common.

  7. Ona Mastrandrea Says:

    Recently I was billed over $6,000 for a second visit to the emergency room because Kaiser stated it was for a duplicate procedure. No explanation was given as to how shortness of breath and problems breathing and heart palpitations were considered identical in nature. I’m 81 years old and on a limited income, and I don’t know how to fight this unwarranted billing. Can you help? I’m desperate.

  8. Judy Pohlod Says:

    What?? I’ve been dealing with Kaiser for TWO YEARS over Nissen surgery, investigated by KePro,First surgery herniated into my chest, Dr. Stated, “Maybe I messed up?? Second RE-DO surgery and still having issues. Horrible test to see if I need a THIRD surgery!! And Now I hear Kaiser has an Ombudsman. I’ve turned a lot of people off Kaiser they way I have been treated. Lest remarks on FB. No one at Kaiser cares or follows up to check on you. Hear that Corporate offices in Oakland, CEO Bernard Tyson. Judy Pohlod Colorado Springs

  9. Toren Hudson Says:

    Funny – Dr. Richardson responded to one comment, then went silent when people asked him how they could contact him or others regarding their service needs. From my own experience, I find this typical of Kaiser (and schools and other private companies, etc.). They make noises like they want to help and they have a service for you, and then they make the service almost impossible to find and put up hurdles that you have to jump through before you can get the help (even if you were lucky enough to find the contact number).

  10. Leonard Johnson Says:

    I have been dealing with the same BS too over a claim filed over a year ago for an out of country incident. Every time I call them I get a runaround and we are sorry call back in 30 days. I am so tired of paying my bills faithfully for over 50 years and when I need help they keep messing with me. I have about had it with Kaiser.

  11. It seems like I’m constantly hearing about additional ways in which we’re polluting our atmosphere. It saddens me to hear about all of the harm we’re doing – especially to our air quality. I’ve been doing tons of studying over the past 18 months or so, and I was probably most surprised to discover that the Environmental Protection Agency has publically stated that the air inside of the typical home in the United States is even 2-5x more polluted than the air outside. Combined with the reality that many adults can process up to seventy thousand liters of air a day, it seems like a indicator for worry regarding the ongoing pollution of our world. How can we expect to stay healthy – regardless of how well we try to live and take care of our bodies – if we are steadily breathing in airborne particles and contaminants?

Leave a Reply