Effective Conflict Resolution to Maintain Healthy Teams

Differences in opinions, values, beliefs, skills, interests, backgrounds and priorities based on different types of personalities, workplaces, specialties, team environments and career stages mean conflict is sometimes unavoidable.

 

The following scenarios are based on actual medico-legal claims or referrals:*

 

• A private practice compromised the health of patients due to inconsistent medical practices caused by bitter infighting. The practice was split in two camps over different approaches to patient care. The acrimony between staff caused a breakdown in communication, respect and professional cohesion.
• A doctor had concerns in having to share an office with another colleague when providing confidential patient telephone advice. He felt he was unable to raise the issue with his supervisor due to an ongoing conflict and instead discussed his concerns with multiple junior colleagues in an attempt to create dissent from the ground up.
• In the interest of patient safety, a doctor felt he had to speak loudly and quickly to a nurse due to her hearing difficulties. The nurse made a complaint to her manager about the doctor’s communication towards her being rude and aggressive.

Top tips for a constructive resolution

• Use the DESC script to formulate an assertive response.²
• Objectively describe the situation or specific behaviour, e.g. “I have noticed that for the past couple of days you have been 45 minutes late to work”.
• Express how the situation makes you feel and what your concerns are, e.g. “This made me feel frustrated when I had to take on some of your work and it worries me that I won’t be able to get my work done as well”.
• Suggest alternative actions and seek agreement, e.g. “Do you think it would be possible for you to get to work on time tomorrow or make up the lost time?”
• State the consequences in terms of impact on the team, e.g. “When we all pull our weight our team can improve our productivity and patient satisfaction”.
• Focus on interests rather than positions. (Positions are what people want, which are often irreconcilable. Interests are why they want it, which may be compatible.³) By understanding others’ interests you can shift the focus of the conversation to the actual underlying issue which will help when exploring solutions.
• Remove blame which may cause the other person to argue a point by turning “you” statements into “I” messages. For example, say “I felt my suggestions were not acknowledged” rather than “You never listen when I make suggestions”.⁴
• Acknowledge emotions. A useful phrase may be “I can see you’re upset. It’s important to me that we can work together”.
• Collaboratively evaluate potential solutions. This creates a shared stake in the outcome which can help to end stalemates and improve commitment to the agreed resolution.⁴

Top tips for a mediator

You may be called on to mediate conflicts between others, or it may be necessary to restore team functioning.

• Remain neutral. Do not take sides even if you personally dislike or disagree with one of the parties.
• Actively listen with your full attention to show you take the situation seriously. Paraphrase to show you have heard and understood what someone has said.
• Be aware of body language and explain behaviour that is counterproductive, e.g. someone pointing their finger or rolling their eyes can escalate animosity.

A structured process to mediation

• Bring both parties together in a private area. Ensure the room is set up in a way that is conducive to cooperation, e.g. position chairs at an angle to each other so that everyone can see and hear one another, but are not close enough for touching and not face to face (which can feel confrontational).
• Establish ground rules. Explain that each person will have a chance to discuss their concerns so there should be no interruptions, and that the process is confidential.
• Identify key issues. Allow each party equal and sufficient opportunity to discuss their concerns from their point of view. Make a list of the issues and, if possible, prioritise them in order of urgency.
• Understand both sides. Invite each party to explain how they feel about each item on the list. The objective is for each party to understand where the other is coming from.
• Find a resolution for each issue that is acceptable or at least tolerable to both parties. Invite each individual to suggest solutions and their consequences. Discuss options that seem to meet both parties’ interests. Get both parties to agree to the solution.

MDA National Education Services

* The case scenarios are based on actual medical negligence claims or medico-legal referrals; however, certain facts have been omitted or changed to ensure anonymity of the parties involved.

References

1. Greer L, Saygi O, Aaldering H, de Dreu C. Conflict in Medical Teams: Opportunity or Danger? Med Educ 2012;46(10):935–42. Available at: onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.2012.04321.x/pdf
2. Agency for Healthcare Research and Quality. DESC Script. Pocket Guide: TeamSTEPPS. Team Strategies and Tools to Enhance Performance and Patient Safety. [updated January 2014; cited 14 December 2015]. Available at: ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.html#descscript
3. Malhotra D, Malhotra M. Negotiation Strategies for Doctors – and Hospitals. Harv Bus Rev 2013;21 October. Available at: hbr.org/2013/10/negotiation-strategies-for-doctors-and-hospitals/
4. Wachs S. Put Conflict Resolution Skills to Work. J Oncol Pract 2008;4(1):37–40. Available at: ncbi.nlm.nih.gov/pmc/articles/PMC2793934/
5. Janss R, Rispens S, Segers M, Jehn K. What is Happening Under the Surface? Power, Conflict and the Performance of Medical Teams. Med Educ 2012;46(9):838–49. Available at: onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.2012.04322.x/epdf
6. Saltman D, O'Dea N, Kidd M. Conflict Management: A Primer for Doctors in Training. Postgrad Med J 2006;82:9–12. Available at: ncbi.nlm.nih.gov/pmc/articles/PMC2563732/