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Conflict In The Healthcare Arena: What Physicians Can Do About It

by Ellen Kandell
January 2011 Ellen Kandell
Do you and your partners frequently have difficulty working through strategic planning issues? Is there internal strife between your office manager and the lead nurse? Is the hospital committee you serve on a source of confusion and ambiguity rather than a source of professional pride?

Conflict is simply an incompatibility of interests, goals or perspectives. It is a natural occurrence in daily life and human interaction. It is an expression of differences. If it is managed correctly it can be the source of growth, strength and positive change. If not, it can mushroom into a host of damaging adverse results.

Conflict in healthcare arena

Research demonstrates that unmanaged conflict has numerous costly impacts and widespread implications on the healthcare system and its stakeholders. [1] There are numerous types of conflicts that can occur. They can be categorized by either the identity of the parties or the nature of the issues. Disputes include workplace issues, such as employee management concerns, organizational disputes, which relate to governance, power, structure and authority, bioethics disputes, facility vendor conflicts and patient care disputes. They can lead to poor outcomes and even patient death.

Regardless of the nature or severity of the conflict the adverse impacts include direct costs such as low patient satisfaction, litigation payouts, quality and safety issues, high staff turnover rates, decreased efficiency and reduced productivity. Indirect costs include bad press and public relations.

Complexity and diversity of roles in healthcare make conflict more likely. Physicians are in a unique role with respect to the healthcare system and the patients it serves. Depending on the nature and duration of this relationship there is potential for misunderstanding. Varying perceptions and expectations surrounding physicians roles also can give rise to disputes. In addition, the diverse set of actors in the healthcare system, such as nurses, and administrators whose perceived role with regard to specific issues, such as scope of practice often are at odds with each other, or at a minimum a potential source of confusion which can lead to conflict. Compounding these difficulties is the hierarchical top down power structure which don’t encourage expression of diverse views which may be at the root of the conflict.

Conflict management is a leadership issue

In 2009, the Joint Commission established a new leadership standard on conflict management (LD 02.04.01). This standard requires that the hospital manages conflict between leadership groups to protect the quality and safety of patient care. It took ten years after the Commission on Health Care Dispute Resolutions issued their report encouraging use of alternative dispute resolution for resolving these disputes for this new standard to be issued. Previously, standards were put into place about disruptive physicians. Now, with this new Joint Commission standard the importance of properly managed conflict is on the front burner for hospital administration.

Conflict management skills are now recognized as critical leadership skill. Successful physician leaders don’t shy away from conflict; rather, they take it on with a spirit of open communication, full involvement of all stakeholders and respect for every view point. They initiate a conflict resolution process to get to the root cause and fully resolve the issues. Unresolved conflict is like a festering wound, it only gets worse.

What physicians can do to manage conflict

  • Recognize it in your organization
  • Learn your inherent conflict handling mode--do you avoid, compromise, compete, accommodate or collaborate in conflict situations?
  • Acknowledge your emotional response to conflict
  • Address the conflict early and privately
  • Conduct regular meetings with your team to ferret out issues that may be swept under the rug
  • Convene a committee to establish a conflict management policy
  • Put systems in place to manage conflict proactively
  • Use an outside neutral mediator or facilitator to help the parties resolve the conflict
  • Create conditions and opportunities for problem resolution

What physician executives can do to implement the Joint Commission standard

  • Gather group of experienced clinicians especially those with a quality assurance background
  • Establish an environment where all staff feel safe to report problems without fear of retribution
  • Review existing contracts and agreements for dispute resolution language
  • Designate a conflict resolution subcommittee to draft guidelines for early identification and resolution of problems

Engaging in conflict, rather than avoiding it, is fundamental to good organizational health, whether it be a small medical practice or a healthcare system.

End Notes

1 Karl A. Slaikeu and Diane W. Slaikeu, Medispute: Resolving Health Care Conflicts: Confidential from General Counsel to CEO: “ I’m Fed Up, and We’re not Going to Take this Anymore!”, 5 Journal of Health Care Law and Policy 335 (2002).

Biography


Ellen F. Kandell is a certified professional mediator and attorney with over 30 years of public and private sector experience. She provides mediation, group facilitation and training to diverse, national clients. Ms. Kandell trained as a mediator at Harvard Law School in 1992 and has mediated over 800 cases. In June 2016, she participated as an assessor in the second annual Consensual Dispute Resolution Competition (CDRC), an international mediation competition in Vienna Austria.



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