In medicine as well as any other profession, conflict is inevitable. Medicine is a high pressure and high stakes profession where errors, misunderstandings, and misinterpretations are inevitable. How individuals resolve these situations and conflicts will determine their effectiveness in providing the best care possible to their patients. Meaningful conflict resolution provides a positive and inviting workplace for the members of the healthcare team and organization.
Medicine is based on open communication, evidence-based therapy, and compassion and empathy for patients. A 2016 study that was reported in the British Medical Journal found that 70 percent of preventable medical errors happened because of poor communication and teamwork.¹ If issues are addressed in a timely and productive manner, errors can be prevented, and best practices can be implemented to help reduce risk in the medical setting.
Where Does Conflict Originate?
Conflicts arise from shifting and competing priorities, poor communication, differing expectations, limited resources, and interdependencies. During the COVID-19 pandemic, many physicians became fatigued from adjusting to new protocols, rules, and regulations for taking care of patients while ensuring staff remained safe and healthy. Amidst a stressful and uncertain period, it is critical that providers align in different ways to address conflicts to provide the best care possible.
There are four interpersonal factors that can lead to conflict: personal differences, informational deficiencies, role incompatibilities, and environmental stressors.² In medicine, like in other professions, individuals in different roles have varying personalities and communication styles. When information and role clarity are lacking, patient care can be compromised. Healthcare teams who work in high pressure environments must effectively find ways to collaborate for the best possible outcomes.
Conflict Resolution Styles
Addressing conflict is an important and vital component of a productive workplace culture that values respect and collegiality. If communication within an organization is not effectively utilized, members of the team will deviate from procedures or avoid working with key team members. There are several resolution styles that can help resolve conflicts.³
1. Avoiding
Avoiding conflict resolution is used when there is no consequence for waiting to address the issue. It gives everyone time to reduce the emotional tension, think clearly, determine what is most important, and resolve the conflict in a calm and effective manner.
2. Compromising
For time-sensitive issues that require a temporary solution when other options are unavailable, compromise may be in the patient's best interest.
This conflict resolution style may be viewed as short-lived, and future discussion will be needed for a long-term solution.
3. Controlling
This style is used in certain situations where quick and decisive action is taken by a qualified decision-maker on the patient's behalf within a limited time frame because the patient’s life is at stake. Some involved in the conflict may feel ignored and become resentful. It is important to make sure that everyone understands and appreciates that the urgent goal of taking care of the patient is the most important objective, while emotions and feelings are put aside.
4. Collaborating
Collaborating is effective when everyone is willing to compromise and explore all possible options. This style can create a productive and positive environment to achieve a long-term solution while sustaining healthy relationships with those involved in the conflict. The downside to this style is that it is time consuming. If a quick resolution is needed, this approach is unrealistic.
5. Accommodating
Finally, this style is one that creates goodwill and allows everyone to express their points of view and their position within the conflict. However, resolution of the conflict may be restricted and undervalued by some because they may end up disagreeing with the ultimate decision.
Effective Communication Skills
There are five effective communication skills to help de-escalate conflict.4
1. Listen actively
Observe nonverbal gestures to understand how others are reacting to the situation. Do not interrupt others and be respectful of everyone involved in the discussion. Be patient and wait to give your opinion. Do not change the subject until the issue is resolved.
2. Find common ground
Seek common ground for potential solutions. Reduce potential barriers that could lead to escalation or hinder any resolution.
3. Acknowledge everyone involved
Understand and acknowledge others’ positions. Keep an open mind and be willing to compromise to achieve a common goal to resolve the conflict.
4. Apologize when needed
Be willing to offer and accept apologies as appropriate.
5. Act as a team
With every conflict there are multiple points of view and multiple objectives that each individual values as important. Work together without blaming or judging anyone involved. Throughout the discussion clarify who is responsible for the next step in the conflict resolution.
Conflict Resolution Strategies
Several strategies can be used to address underlying human behaviors that contribute in a conflict:5
Strategy #1: Both parties in a conflict typically think they are right because they cannot imagine that they could be wrong. What would constitute a fair conflict resolution is seeing a situation from another person's perspective, a feat that is often difficult to do. Be unbiased and fair to reach a common ground.
Strategy #2: Avoid escalating the situation with threatening or aggressive behavior. If you are feeling ignored, do not try to capture the other party's attention by making threats such as litigation or take it or leave it offers that will worsen the conflict. Before making a threat, make sure you have exhausted all other options for managing the conflict.
Strategy #3: Overcome the “us versus them” mentality by having a good connection with your group. Building loyalty and strong relationships with members of the healthcare team can be useful within an organization. However, during conflict, a strong group connection between some may lead to hostility and suspicion towards others. To establish fair and sustainable relationships, identify and discuss points of similarity between the groups to achieve a resolution.
Strategy #4: Look beneath the surface to identify deeper issues. The conflict could be one that stems from an overall perception of how we are treated and respected. The next time you find yourself arguing, put the conversation on hold and determine the major issues of the conflict that you would like to be resolved, and find common ground and come to an agreement.
Summary
All organizations and healthcare teams experience conflict. Effective resolution is necessary to ensure that patient care is not compromised. Proven tools and communication techniques should be used to resolve conflicts and ensure a positive and inviting workplace environment where everyone feels safe and comfortable expressing their points of view.
Robert Parhizgar is a Senior Risk Management & Patient Safety Specialist. Questions or comments related to this article should be directed to RParhizgar@CAPphysicians.com.
References
¹ Liu W, Gerdtz M, Manias E. Creating opportunities for interdisciplinary collaboration and patient-centered care: how nurses, doctors, pharmacists, and patients use communication strategies when managing medications in an acute hospital setting. J Clin Nurs 2016;25:2943–57
²Lipcamon JD, Mainwaring BA. Conflict resolution in healthcare management. Radiol Manage. 2004; 26:48–51.
³Thomas, K. W., & Kilmann, R. H. (1974). Thomas-Kilmann Conflict Mode Instrument (TKI)
4Payton J. Improving Communication Skills within the Nephrology Unit. Nephrol Nurs J. 2018 May-Jun;45(3):269-280.
5Behfar, K. J., Peterson, R. S., Mannix, E. A., & Trochim, W. M. K. (2008). The critical role of conflict resolution in teams: A close look at the links between conflict type, conflict management strategies, and team outcomes. Journal of Applied Psychology, 93(1), 170–188.