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Leonard J. Marcus, Ph.D.
Leadership requires foresight, and an effective leader often develops a solution before most other people realize that there is a problem. In the mid-1980s, foreign affairs dominated the political debate, while domestic issues such as health care were relegated to the back burner. The quality and accessibility of health care were becoming major concerns for many Americans, however. Skyrocketing health care costs were blamed on the traditional fee-for-service payment method for medical care, and corporations began stepping in to offer a managed care alternative. Under a managed care system, preventative health care is encouraged, and doctors are rewarded for performing fewer tests and procedures. The new system did much to keep costs under control, but many patients began to question the quality of care. To many Americans, it seemed that medical decisions had shifted from doctors to a corporation more concerned with the bottom line.
Leonard Marcus, who holds a Ph.D. in health policy, anticipated the impact of managed care on the health care profession. He recognized that when patients lose control of their medical care, conflict and adversarial relationships between patients and health care providers become more common. Marcus wanted to provide an alternative to litigation for people involved in such conflict. He wanted to facilitate conflict resolution so that people could find better solutions to their health care problems. Marcus believes that conflict is not necessarily negative -- it can be used constructively to focus attention on how to effect system improvement. Unfortunately, as he stated in an interview with Physician Executive magazine, "...people can get so caught up in the conflict that they can't even see the costs of escalation and the potential benefits of resolution."
Marcus became interested in the field of negotiation and conflict resolution while serving as an instructor in health care organization and health policy at Massachusetts General Hospital. Mediation and arbitration techniques were being used in labor and business disputes, but Marcus was interested in a broader application.
In 1986, he was one of forty fellows chosen from across the country for the Kellogg National Leadership Program (KNLP). This fellowship gave him the support and funding he needed to develop a broad understanding of this new field and its applications. During his three-year fellowship, he traveled extensively, interviewed people and examined conflict resolution in many different settings. During this time he also studied at Harvard University, George Mason University, and at CDR Associates, a mediation firm located in Boulder, Colorado.
When his fellowship ended in 1989, he discovered that no one was promoting mediation in the health care arena. Marcus decided that there needed to be a "bridge between the fields of conflict resolution and health care." He had an idea for an organization do this but was unsure how to implement his vision. He sought guidance from his KNLP advisor. Marcus explained his desire to create a new field of study as well as provide an alternative for individuals and large entities seeking to resolve a health care dispute. His advisor made him realize that what he needed was more than one organization.
Following the Kellogg fellowship, Marcus joined the faculty at Boston University in 1990. It was his aim to train health care professionals to be leaders in the field of negotiation and conflict resolution. He sought out the "best and brightest" in Massachusetts medical societies, hospital associations, and nursing associations as his students. In 1990, he received 160 applications for the first training session. Twenty-five were accepted, and the Program for Healthcare Negotiation and Conflict Resolution was born with a $50,000 grant from the National Institute for Dispute Resolution, to fund the training of health professionals to become mediators.
In collaboration with this new cadre of mediators, he next established in 1991 the Center for Health Care Negotiation, Inc. The Center is a non-profit service that allowed health care consumers to seek mediation when they became involved in a health care dispute. The Center was unique not only because it applied negotiation and conflict resolution to health care, but also because it provided mediation internships to health care professionals. As Marcus explained to a reporter for the Boston Globe, "when outside mediators {who did not understand how health care systems operated} have tried to settle health care disputes in the past, the disputants often spent most of their time educating the mediators on the ways of hospitals, insurers, and medicine." Marcus wanted to change that reality.
Under his leadership, the Center partnered with the Massachusetts Board of Registration in Medicine to launch the Voluntary Mediation Program. This program was the first to mediate medical practice disputes between patients and doctors under the auspices of a state agency.
In 1992 his work led to the establishment of Health Care Negotiation Associates (HCNA) [http://www.hcna.net]. In collaboration with other colleagues, Marcus organized this entity as a for-profit corporation that would provide services to health care organizations such as consulting, mediation, facilitation, executive coaching, and on-site negotiation training. HCNA's clients include a number of health care associations, hospitals, and insurance companies.
In 1995 Marcus had the opportunity to move the Program for Health Care Negotiation and Conflict Resolution [http://www.hsph.harvard.edu/php/PHCNCR/phcncr.html] to the Harvard School of Public Health. Marcus continues to serve as the director. At Harvard, he is teaching courses in negotiation and conflict resolution, and has developed continuing education workshops for health care professionals on the topic. His current research focuses on the implications of conflict in health care services and the uses of mediation for resolving those disputes. He also is examining the role mediation can play in resolving larger social conflict.
In addition to his teaching and research, Marcus has collaborated with colleagues to advance scholarship on health care negotiation and conflict resolution. He authored the major text for the field, Renegotiating Health Care: Resolving Conflict to Build Collaboration. (San Francisco: Jossey Bass) He writes frequently on the subject of mediation and health care negotiation for professional journals and news publications.
Marcus also remains an active mediator. He has mediated major national health policy issues with both private and public agencies, health care organizational disputes, professional issues, and patient care conflicts. He is currently working to resolve merger-related issues between two large hospitals.
Marcus believes that his teaching is like "planting a seed." His greatest satisfaction, he says, "is knowing that others have learned from this work, and have used what they have learned to expand their own vision for what this field can contribute and accomplish." To others struggling to make their vision a reality, Marcus advises: "Don't allow yourself to be limited by a particular organizational construct. Determine what it is you want to achieve and then figure out the best means for getting there."
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