Turning Conflict into an Opportunity for Improvement
Make a Plan
As we made clear in the last two Thinking Thursday TIPs, the world of healthcare is undergoing a major shift from fee-for-service care to value-based care. As healthcare facilities all over the nation are shifting to implement APPs (advanced practice providers) and create a culture within their facility that promotes the optimization of a healthcare team, the potential for conflict among healthcare professionals is higher than ever. It never fails, where two or more are gathered, conflict will inevitably arise. However, when an effective plan for de-escalating conflict is in place, the outcome can lead to improvement within a healthcare facility.
Reframing the Inevitable
Dr. Ashley Whitehorn writes in her JBI Evidence Summary, “Conflict is an inevitable reality in healthcare organizations. Traditionally, workplace conflict was viewed entirely as a negative aspect of organizational life, as ‘draining energy, reducing focus, and causing discomfort and hostility.’ Conflict was defined in negative terms as ‘processes occurring within a group in any of several forms, such as hostility, decreased communications, distrust, sabotage, verbal abuse, and coercive tactics.’ However, conflict may be defined in more positive terms as ‘discord that results from differences in ideas, values, or feelings between two or more people.’” (1) Simply reframing our foundational philosophy of conflict can help facilitate healthy resolutions and avoid destructive outcomes.
Samuel Greengard writes in his article, “How Leaders Can Turn Conflict into Improvement,” “Yet, conflict isn’t necessarily a bad thing. It can provide feedback about things that can be improved. In fact, when it’s channeled effectively, an organization can use conflict to improve processes and performance.” (2) The work to effectively handle interpersonal conflict begins long before the conflict ever arises. Once a healthcare facility has learned to embrace its inevitable reality as a potential good, rather than avoiding it, intentional actions can be made to create a culture that facilitates healthy resolutions and learning opportunities as a result of conflict.
The Fabric of an Organization
Greengard quotes Carlos A. Pellegrini, MD, chief medical officer and vice president of medical affairs at UW Medicine in Seattle: “Medicine is based on good human relationships…It’s critical to build respect into the fabric of an organization. People must be able to present ideas — and sometimes disagree — in a respectful and productive way.” (2) Creating a culture within a healthcare facility that prioritizes mutual respect in all scenarios is key to effectively resolving conflict. Simply assuming that staff members function under this conviction will not suffice. It requires intentional and frequent actions at all levels of the facility. Mutual respect needs to become a highly regarded pillar within the culture of a healthcare facility. If I can use the analogy of conflict as a house, a culture that prioritizes mutual respect would serve as the foundation.
Rules of Engagement
A framework, then, in which conflict can constructively occur, would represent the walls of the house. A huge component of that framework is the art of communication. Greengard writes in his article, “While the concept of good communication is simple enough to understand, establishing a framework to support it — and deal with inevitable problems — can prove daunting.” Creating frequent opportunities for staff members to communicate is crucial to planning for conflict ahead of time, before emotions are heightened and the potential for tumultuous outcomes are likely. Robert Provenzano, MD, FACP, FASN, chief medical officer of Nephrology Practice Solutions and vice president of medical affairs, encourages employees to email regarding any questions or concerns. In addition, there are several in-person meetings with supervisors and managers scheduled to discuss concerns and/or problems. Furthermore, their company provides its staff with a variety of training regarding conflict resolution including communication training, teamwork training, and even role play. (2) Communication guidelines, training, and opportunities all provide a healthy framework for conflict to be resolved healthily.
Managing Negative Behaviors
Although targeted towards nurses, I believe Elizabeth Angelo’s article, “Managing Interpersonal Conflict,” is applicable to those in leadership over all types of medical professions. (3) She lists several negative behaviors that, when present during times of attempted conflict resolution, can be destructive. She also lists several practical suggestions on how to respond to each negative behavior, leading to constructive conflict resolution. I’ll summarize them now.
It’s human nature to deflect to others when looking at our own shortcomings. Angelo recommends being prepared with specifics on how an employee can improve and remind him/her the point of the conversation is to help him/her improve. (3)
Victim mentality often presents itself when individuals think they are being treated unfairly or make comments such as, “You never told me I needed to do that,” or “How come other people aren’t getting in trouble for this?” Remind your employees the point of this meeting is not to discuss others, while reassuring them the standards and expectations are clear for all employees. (3)
Angelo sums this point up nicely and even includes some great example dialogue: “Confront passive-aggressive communication as directly as possible such as, “I was disappointed to hear from your peers that you’re upset about (policy, schedule, behavior standard, and so on). You didn’t express those concerns to me. My expectation is that you communicate with me directly if you have a concern to bring forward.” (3)
This type of scenario typically involves an experienced staff member who tends to challenge new leadership. Angelo explains the best way to handle this type of negative behavior: “Address this head-on and state your expectations such as, ‘I’m sensing that you don’t support some of the changes we need to make. Your peers look up to you and value your expertise. I’m counting on your support as I learn about this department. I’ll be looking to you to set the example for the behaviors and culture we want to have here and to follow policy so that others know it’s the expectation.’” (3)
Bullying needs to be addressed immediately. Provide specific examples of the bullying behavior, the impact of that behavior, the expectation of change, and a follow-up time.
Angelo sums it up nicely, “Often, performance information is relayed by an employee’s peer. This can put leaders in a difficult spot, especially if it’s about an issue that lacks objective evidence. Unless it’s an urgent patient safety matter, ask the team member to hold his or her peer accountable and help with the scripting to do so. If you hear the same information from more than one peer, it’s probably time to talk to the employee yourself such as, ‘I’m concerned about what I’ve heard from several team members…’” (3)
In This Together
Interpersonal conflict is inevitable, especially when relying on a team of people to work together to make decisions regarding a patient’s optimal healthcare outcomes. However, when viewed appropriately and planned for accordingly, conflict can create opportunities for growth and improvement. I’ll leave you with one more quote from Angelo’s article that sums up the bottom line nicely, “Set aside the time you need to thoughtfully prepare for difficult conversations. Be proactive by communicating clear expectations and recognizing good work. Remind yourself of the “why” and the importance for your team and your patients that these negative behaviors don’t go unaddressed. And don’t get discouraged! Remember, we’re in this together.” (3)
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Jerry L. Stone