By James A. Lomastro, PhD
January 2025
The emergence of Dignity Alliance Massachusetts (DignityMA) represents a significant evolution in the concept of honest brokers within healthcare systems. While traditional honest brokers typically strive for complete neutrality in mediating conflicts, DignityMA has pioneered a new approach that combines advocacy with intermediary functions, challenging conventional assumptions about the role of honest brokers in healthcare reform.
Traditional Honest Broker Model
Historically, honest brokers in healthcare have operated under a strict paradigm of neutrality. These entities, often emerging from established institutions or state agencies, position themselves as completely impartial mediators between conflicting parties. Their primary function has been to facilitate dialogue and resolution without taking positions on the issues at hand. This approach, while valuable in certain contexts, can sometimes perpetuate existing power imbalances by failing to acknowledge systemic inequities.
DignityMA’s Transformative Approach
DignityMA’s model represents a significant departure from this traditional framework. Rather than attempting to maintain complete neutrality, DignityMA explicitly acknowledges and embraces its role as an advocate for dignity for marginalized older and disabled persons while still functioning as an intermediary between various stakeholders. This hybrid approach emerged from the crucible of the COVID-19 pandemic, where the devastating impact on nursing home residents demonstrated the limitations of purely neutral mediation.
Value-Based Mediation and Examples of Its Efforts
What makes DignityMA’s approach particularly innovative is its integration of clear values into the mediation process. By prioritizing dignity, transparency and quality of care, DignityMA creates a framework for dialogue that acknowledges fundamental human rights while still facilitating meaningful communication between different stakeholders. This value-based approach doesn’t compromise DignityMA’s ability to serve as an intermediary; rather, it enhances its effectiveness by establishing clear principles around which negotiations and reforms can be structured. Here are some examples of that effort.
- Securing 200 million bond with legislators and veterans groups
- Development of a group of impacted stakeholders to address a state initiatives designed to take away local control of assessment and centralize it
- Participation in nursing homes closures to assure that rights and needs of impacted resident addressed.
- Editorials to bring attention to the plight of people with disabilities
- Participation in suit to provide nursing home resident with access to community living. Participation in a suit to provide nursing home residents access to community service and specialize services for others.
Balancing Advocacy and Mediation
DignityMA achieves this balance through several key strategies:
- Transparent Positioning: Unlike traditional honest brokers who might obscure their values in service of neutrality, DignityMA is explicit about its commitment to dignity and quality care. This transparency enhances trust among stakeholders by clearly establishing the framework for dialogue. It utilizes open forums, makes all its deliberation open and virtual and public.
- Inclusive Representation: By operating as a peer-led coalition, DignityMA ensures that traditionally marginalized voices – particularly those of residents and frontline workers – are centered in discussions about care reform. It has no member fees or other requirements. It allows each to give according to their needs and talents and take away according to their needs.
- Digital Empowerment: The use of virtual platforms has democratized participation in advocacy and negotiation processes, creating more equitable conditions for dialogue between industry representatives, government officials, and advocates.
Implications for Healthcare Reform
This evolution in the honest broker role has significant implications for healthcare reform efforts. DignityMA’s model suggests that effective mediation in healthcare doesn’t require absolute neutrality, professional brokers but rather a clear commitment to fundamental human rights and dignity, openness, and transparency. This approach may be particularly valuable in addressing systemic inequities where traditional neutral mediation might inadvertently perpetuate existing power imbalances.
Future Directions
The success of DignityMA’s approach points to several potential developments in healthcare advocacy and reform:
- Recognition if the process and use by impacted parties. Incorporation process into commissions, taskforces and any similar group that will make recommendation for future policies affecting older and disabled persons.
- Integration of Rights-Based Frameworks: Future honest brokers might increasingly incorporate explicit rights-based frameworks into their mediation efforts, particularly in healthcare contexts where fundamental human rights are at stake.
- Expanded Stakeholder Participation: Digital platforms and decentralized organization models could further democratize participation in healthcare reform discussions, building on DignityMA’s successful use of virtual tools during the pandemic.
- Enhanced Accountability: The combination of clear values and transparent processes could lead to more effective accountability mechanisms in healthcare systems.
Conclusion
DignityMA’s continual evolution of the honest broker role demonstrates that effective mediation in healthcare reform can – and perhaps should – incorporate clear values and advocacy positions. This approach, while departing from traditional notions of absolute neutrality, may be better suited to addressing systemic healthcare inequities and ensuring dignity in care delivery. As healthcare systems continue to face complex challenges, this model offers valuable insights for developing more effective and equitable approaches to reform.
Jim Lomastro is a member of DignityMA’s Coordinating Committee, and he chairs several workgroups. He has been involved with health and long-term care for more than 50 years.
A variation of this essay was published in Nonprofit Quarterly in January 2025: Honest Brokers, Technology, and Health Justice: What Are We Learning?