The Art of Listening: A Mediator’s Perspective on Healthcare Disputes

The Art of Listening: A Mediator's Perspective on Healthcare Disputes

I spent 20 years as a nurse before I became a mediator. In the ER, I learned to listen fast. You have seconds to hear what a patient is really saying underneath their initial complaint. The person who comes in saying their stomach hurts might actually be having a heart attack. The family member who seems angry might just be terrified.

That same skill translates directly to healthcare mediation, but with one critical difference: I listen to understand and ask questions to clarify.

The Listening Problem in Healthcare Conflicts

Here's what I see constantly when I mediate healthcare disputes: everyone is waiting for their turn to talk. The physician is mentally preparing their rebuttal. The nurse is cataloging all the times this exact thing happened before. The administrator is thinking about policy language. The patient's family is rehearsing their complaint.

Rarely are we actually listening.

We hear words. We might even write notes. But we're not doing the kind of listening that resolves conflicts. We're doing something I call defensive listening - filtering everything through their own experience, looking for what to disagree with, preparing their counterargument.

That's not listening. That's just waiting.

What Real Listening Looks Like

In my ER days, I worked with a physician who was brilliant but a real challenge to work with. Every shift with him meant conflict. Nurses dreaded his name on the schedule. One day I watched our charge nurse do something that changed how I think about listening.

He came storming up to the desk about a delayed lab result. Started his usual rant. Instead of defending or explaining, she said: Tell me what you need right now to take care of this patient safely.

He stopped mid-sentence. Blinked. Then actually told her what he needed.

She didn't agree with him or disagree with him. She didn't explain the lab's staffing issues or defend the delay. She just listened for the actual need underneath the frustration. Turned out he was worried about a possible sepsis case and needed specific labs immediately, not the routine panel that had been ordered.

Problem solved in 90 seconds once someone actually listened for the real issue.

The Three Layers of Healthcare Listening

When I mediate healthcare disputes, I teach people to listen at three different levels:

Content listening is the surface level. This is the literal words being said. Most people stop here. A nurse says the staffing ratio is unsafe. An administrator hears a complaint about numbers. But that's just the first layer.

Concern listening goes deeper. What's the actual worry driving those words? That nurse isn't really talking about ratios. She's saying I'm scared I'm going to miss something critical and a patient will be harmed. That's the real message.

Identity listening is the deepest level. This is about understanding how this situation affects someone's sense of who they are personally and professionally. That same nurse might also be saying I'm a good nurse and this situation is forcing me to provide substandard care, which conflicts with my identity. An administrator hearing a budget complaint might be defending their identity as someone who keeps the organization financially viable.

Most healthcare conflicts happen because people are talking at different levels. One person is discussing content while another person is defending their professional identity. They're not even in the same conversation.

How to Actually Practice This

One powerful listening tool I use in mediations is a pause. When someone finishes talking, I try to pause before responding. That pause does two things: it makes sure they're actually done, and it gives my brain time to process what I heard instead of just reacting.

In healthcare settings where everything moves fast, that pause feels unnatural. But it changes the entire dynamic of a conversation.

The second tool is the reflection check. Not Do you understand? but rather Let me make sure I'm hearing you correctly, followed by reflecting back not just their words, but what I heard at the concern or identity level. So instead of You're saying the staffing ratio is 1 to 6, I might say It sounds like you're worried that with six patients, you won't be able to catch a deteriorating patient in time. Am I hearing that right?

That's when people say Yes, exactly or they correct my understanding. Either way, we're actually communicating now instead of just exchanging words.

So much conflict is avoided when we take the time to reflect. People feel seen and heard. They become more clear and so do we. We build a connection through understanding.

The Mindset Shift That Changes How We Listen

Here's what I tell people in mediation: often we are listening for what's wrong with what the other person is saying. Consider listening for what's right.

This is hard. Our brains are wired to spot disagreement. When someone's talking, we're mentally checking off all the points we disagree with, all the ways they're wrong, all the facts they're missing. That's not listening. That's building a rebuttal.

Instead, listen for where you agree. Even in the most contentious healthcare dispute I've ever mediated, there was always common ground. Both parties wanted good patient care. Both wanted to do their jobs well. Both were frustrated by system failures. When you listen for agreement instead of disagreement, you find it.

The second part is letting go of what you don't agree with, at least temporarily. You don't have to accept it or endorse it. You just have to set it aside long enough to understand why they believe it. Once you understand their reasoning, you can address it, if it really matters. But you can't address something you haven't actually heard.

Listen to learn and understand, not to win. This is the shift that separates mediators from arguers. If your goal is understanding, you ask different questions. You hear different things. You find solutions that wouldn't have occurred to you when you were just trying to be right.

Why This Matters in Healthcare Specifically

Healthcare conflicts are different from other workplace disputes because the consequences are so immediate and so high. A communication breakdown in a hospital doesn't just create tension. It can harm patients.

I've mediated cases where a conflict between a physician and nursing staff led to delayed care. Where administrative decisions made without understanding frontline concerns created dangerous workarounds. Where family complaints escalated because nobody listened to the fear underneath the anger.

Every single one of those situations could have been prevented if someone had paused and actually listened.

The fascinating thing is that listening isn't just a mediation skill. It's conflict prevention. When people feel heard at the level they're actually communicating, conflicts de-escalate naturally. You don't need perfect solutions. You just need people to believe you understand what's really at stake for them.

The Listening Gap I See Most Often

The most common listening failure in healthcare isn't between patients and providers. It's between different professional roles. Physicians and nurses speak different languages and often don't realize it. Administrators and clinical staff operate from completely different frameworks. Everyone assumes everyone else sees the situation the same way they do.

They don't.

A physician saying we need to admit this patient is making a clinical judgment. A case manager saying we need to move this patient is making an operational assessment. Both are right from their perspective. Both think the other isn't listening. Really, they're just speaking different professional languages and often we're not translating.

That's where a mediator becomes useful, but honestly, that's where anyone with strong listening skills becomes useful. You don't need a neutral third party. You just need someone willing to slow down and hear what's actually being said.

Your Turn

The next time you're in a healthcare conflict, try this: Before you respond, ask yourself what level the other person is communicating at. Are they telling you content, expressing a concern, or defending their professional identity?

Then respond at that level.

If someone's defending their identity as a competent professional, don't respond with policy. Acknowledge what this means for them first, then address the policy issue.

If someone's expressing a safety concern, don't explain the budget constraints. Hear the fear first, then problem-solve.

Most healthcare conflicts aren't actually about the thing people are arguing about. They're about feeling unheard. And that's completely fixable.

You just have to listen.

Kimberly Best, RN, MA, is a Supreme Court listed mediator specializing in healthcare conflict resolution. She combines her background as an ER nurse with advanced training in mediation to help healthcare teams navigate challenging conversations. Learn more at Best Conflict Solutions.