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Healthcare is by its very nature a team sport. But just like any team, healthcare professionals don't always get along, and when that happens, patient care can suffer — not to mention the stress of interpersonal conflict.
"The healthcare workplace is a fertile breeding ground for conflict because of the dynamics and interdependency of the various relationships that exist, including those between physicians and other physicians; physicians and nurses; physicians and administrators; and physicians, patients, and family members," says the Royal College of Physicians and Surgeons of Canada.
The college shares cohesive and creative guidance about conflict resolution, and asks us to consider, and then dismiss, the following myths:
- Conflict can be avoided: No, it's inevitable.
- Conflict is bad: The fact that people disagree should be seen as a healthy and integral part of human interaction.
- Conflict is impossible to resolve: Not so, but clearly, we are all rather conflicted about conflict.
- We need a lawyer: Don't rush to this, just because you don't want to be personally involved. Mediation might be really helpful.
- All disagreements escalate into conflicts: Try to resolve a problem at its earliest point, when it is still "ripe for resolution." Then actual conflict doesn't happen.
Good communication is so very helpful here, but not everyone knows how to do it, the authors say. And remember that unresolved emotion can help develop and exacerbate conflict.
Healthcare Is Unique (We know!)
"Healthcare requires people to work together very intimately, with very high stakes," says Leonard J. Marcus, PhD, founding director for the Program for Health Care Negotiation and Conflict Resolution at the Harvard T. H. Chan School of Public Health. He's also co-director of the National Preparedness Leadership Initiative.
Marcus is internationally known for his command of this subject matter and is lead author of two related reference books: Renegotiating Health Care: Resolving Conflict to Build Collaboration, Second Edition, and You're It: Crisis, Change and How to Lead When It Matters Most, the second book having just been reissued in paperback.
He understands the "unique problems, negotiations, and conflicts in healthcare." His second book also recognizes that different people working in the healthcare system have very different interests when it comes to problem-solving — something they do repeatedly. The idea is to build connectivity, Marcus says.
When thinking includes all the players, and from a wider perspective — including ones known to have larger egos — that's called "meta- leadership." It's also a kind of influence without authority, he says.
"It might be that professional perspective of what they know about the patient, or about procedures or protocols involved," Marcus says. "When people come to any problem with different perspectives, that could be a source of unresolvable conflict, but it could also be a means to enhance understanding of what a problem is."
Resolve to W.I.N.
When it comes to improving teamwork, and thus reducing conflict, "Whole Image Negotiation" or W.I.N. can really help, Marcus says. The concept first melds interdependence, fit, and collaboration, followed by imagination, and finally, interest-based mutual benefits.
Try to negotiate a "fit" among stakeholders based on a big-picture, imaginative, interest-based strategy, he says.
The main challenge for any hospital or health system or practice is, "How do you create the right fit between all the people who are party to the system?" And that's a big ask.
The second is, "How do you find people with imagination?"
"The best negotiators or problem-solvers bring this trait," Marcus says. "It's important to teach healthcare professionals that it's their job to negotiate to create that W.I.N."
It's Not Just Whether You Win or Lose
Marcus uses a very simple exercise that you can also employ with your team. Here's how it worked during a seminar he gave at a large healthcare system.
He directed the seminar group to find partners, and a prominent surgeon at the institute partnered with a petite, young nurse. They were both directed to arm wrestle, "to get the back of the hand of the other person down," and the doctor did that several times with the nurse's arm — as she offered no resistance. The doctor was clearly seeing the exercise from a win or lose perspective.
That doctor asked the nurse why she let him win. She looked at him quizzically, says Marcus, and then suddenly the two arms were swinging back and forth, between winning and losing — a visible demonstration of cooperation.
When the doctor then asked her why she didn't just explain what she was doing, her retort was that she assumed he wouldn't want to take instructions from her, so she showed, instead of told, him what needed to be done.
The exercise was a metaphor, Marcus says, and included principles of active listening. That's defined as when we dedicate our complete attention to the speaker, and then give our dedicated response to what they said. We might use reframing, new thinking about how to solve this problem. It's highly preferable to "I'm on the top and you're on the bottom and that's how we'll solve this."
The message, and one that can readily be applied to conflicts in healthcare, is that "Everybody's got a voice and has eyes around the table," Marcus says. "A team of people, as in the OR, have to work together, to collectively take responsibility. If you're acting like a team, you'll come up with a much better outcome."
It's possible to stem potential physician-patient conflicts this way, too, when the physician thinks more like "We're here to improve your [the patient's] health together, and we can negotiate. We can view our work in healthcare as 'people-to-people,' coming together to solve a complex problem."
"Conflict resolution is a tool in the process," Marcus says.
Walk the Resolution Talk
To clearly demonstrate conflict resolution principles, Marcus coined "The Walk in the Woods," a negotiation tool he uses because he says it helps people productively engage with one another. It involves identifying a problem and working together to resolve conflict with a few steps, beginning with:
- SELF INTERESTS: Identify and express the breadth of interests, clearly articulating your self-interests and actively hearing those of others. Distinguish legitimate "self" from "selfish" interests.
- ENLARGED INTERESTS: Identify points of agreement and points of disagreement among stakeholders in order to shape a multidimensional view of the problem. Reframe. Build the foundation for subsequent creative problem-solving.
- ENLIGHTENED INTERESTS: Imagine, explore, brainstorm, and invent options. Then assess which options generate potential agreement. Prioritize. Focus on solutions that could generate agreement.
- ALIGNED INTERESTS: Seek mutually beneficial solutions: "If I succeed, you succeed. And if you succeed, I succeed. So let's commit to options that advance mutual success." Generate agreement with buy-in. Resolve. Agree. Commit. Move forward.
Think Before You Speak
The "all for one" concept is also used by expert Jeremy Pollack, CEO of Pollack Peacebuilding Systems in Phoenix.
He agrees that instead of engaging in conflict, healthcare teams should understand they're all participants in shared responsibility and information, charged to come up with the best possible decision to accomplish the mission.
To do that, be aware of unintentional conflicts, where something gets lost in translation, when someone did something or said something and the behavior is perceived by someone else — an interpretation or meaning — that's different from what the person intended by that behavior.
Idea: Try to challenge your own assumptions of what people intend. Separate the behavior from your interpretation and remember that your interpretation may or may not be accurate, due to biases and filters already in place in your mind.
Maybe that email you got from someone asking "Are you going to show up tomorrow for the meeting?" isn't really a challenging email, with hostile or malicious intent. Ask yourself why this bothers you — do you think the person doesn't like you? Or they think you don't care about your job?
Why not simply ask the person what they meant, and give them the benefit of the doubt — and do it in a nonjudgmental way. Maybe you just need some reassurance here, and you can also give the other person some reassurance that you really do value these meetings and want to be clear on that.
"We're all human beings with similar biases and similar needs," says Pollack.
Motivate to Resolve
Think of how someone in a power position spoke to you in a certain way and you didn't like that so much. Try to approach the situation this way, direct but polite: "When you raise your voice or talk to me in the tone I was noticing, it feels to me like you don't really want my opinion, that you don't think I know what I'm doing, and I want to clear that up."
If conflict exists between two entities, there needs to be motivation to resolve that conflict, so that the parties can rebuild trust — and go through the discomfort involved to do that.
"If one person doesn't care if the other person sticks around or not, that's challenging, for this requires dialogue," Pollack says. It can be more complicated if the system has no consequences for someone if they act a certain way — and then motivation to change can be low.
"When a system doesn't support a culture of respect and communication, the only recourse is not conflict resolution, but an administrative measure to correct the person's behavior," he says.
The other troubled or offended person can also "suck it up" and reframe in their mind that it's worth it to stick around, or choose another alternative — which could involve leaving.
With so much conflict resonating these days, that inevitably trickles down and people become hypersensitive, Pollack says. "That can lead to minor conflicts becoming larger conflicts."
But resolving conflict can lead to growth and deepening relationships, and ultimately, better outcomes overall, always the goal in healthcare.
"Also, when you delete the news apps, and focus on life, you'll find people are really nice," says Pollack. "You'll find more peace in life."
This article first appeared on Health eCareers. Reprinted with permission.
