/ 27 April 2010

From the Public Conversations Project, as they seek to discover if there is anything dialogue can offer to health professionals caught in the middle of often dangerously vicious public debates about health care:

One answer came from a participant who appreciated learning about “helping people respectfully manage potentially horrendous problem-solving processes.”

And it’s true: our approach is an alternative to the practice of starting with whatever problem needs to be solved, and then lining up on different sides of the table to argue positions, benefits, costs. In dialogue, participants get rid of the table, put the issues in the corner, and find out more about the people in the room. What does each person wish others could understand about them? What does each person wish they could understand about the other? What really matters to them about health care? Dialogue involves responding to questions like these, listening and speaking in new ways, resisting any easy categorization of “us” and “them,” (whether it’s “providers vs. consumers” or “providers vs. administrators”), and being curious and interested in learning, instead of asserting what is certain, known, or true.

More broadly, dialogue is an opportunity to “rehumanize” people in systems like health care. Not just the people who are perceived to have power, and not just the disenfranchised, either. Dialogue invites all participants, equally, to share their experiences and explore the multiple and complex—even contradictory—perspectives. People are asked to speak as individuals, not on behalf of all people on their “side,” or in their role, or with their status.

This is not to deny real differences in power between, for example, providers and consumers of health care, or people in different racial or socioeconomic groups, but rather to suggest that systemic inequities might be addressed in new ways by shifting conversations and relationships. In dialogue, no one is expected to change their own or anyone else’s minds. But in the process of coming to know and trust one another, they discover what’s possible for them to talk about, and imagine, and do together. They might even be able to change the system.</blockquote>