Harvard Medical, Dental, & Public Health Newsletter: Conflict Resolution In Health Care

From the Disputing Blog of Karl Bayer, Victoria VanBuren, and Holly Hayes.

I recently read a healthcare conflict resolution article in FOCUS, the newsletter of the Harvard Medical, Dental, & Public Health Schools. The article begins with the statement, “Everyone in health care, it seems, has a war story about conflict at work.”

In an annual one-week intensive immersion course, Leonard Marcus, who directs the program for Health Care Negotiation and Conflict Resolution at Harvard, and his team teach conflict resolution skills to health care leaders from different organizations. The course adapts to health care the basic principles of conflict resolution described in “Getting to Yes” by Roger Fisher, William Ury, and Bruce Patton of the Harvard Negotiation Project.

Marcus discusses why conflict in the health care setting is different from conflict in other industries and reviews the ‘Four-step Approach to Problem-solving’ used in the Harvard course: “In health care, we are passionate about what we do, and that’s a plus,” Marcus said. “When passions collide, that same drive can be a source of conflict. The stakes are high–life and death, large amounts of money, big institutions, reputations. Therefore, people fight hard which, ironically, becomes an obstacle in and of itself.”

A Four-step Approach to Problem-solving

Four negotiation steps developed by the Program for Health Care Negotiation and Conflict Resolution guide minor and major negotiations in health care. The structured multidimensional problem-solving process is called “Walk in the Woods,” after a famous story in which international negotiators at loggerheads over a nuclear arms treaty went for a walk in the woods near Geneva and discovered common interests that led to new solutions.

Step one: self interests. Each participant articulates his or her view of key problems, issues, and options. They are encouraged to actively listen, question, and interact with one another.

Step two: enlarged interests. The participants reframe their understanding of current problems and possible options with a wider perspective, based on the integrative listening and confidence-building that occurred in step one.

Step three: enlightened interests. The group is ready to engage in innovative thinking and problem-solving, generating ideas and perspectives that had not previously been considered.

Step four: aligned interests. Participants build common ground perspectives, priorities, action items, agreement, or plans for moving forward. Depending on the scope of the intended objectives, at this point they recognize the tangible contributions and opportunities accomplished through the meeting.

Health care professionals at all levels who find themselves in a situation of work conflict can benefit from the “discovery of common interests” — after all, they share the overarching common interest of working together to provide patient’s with high quality care. The Harvard Four-step process can lead parties toward those “aligned interests” and enhanced teamwork.


Holly Hayes

Holly Hayes Bovio received a Masters in Health Administration (MHA) from Duke University and her undergraduate degree from Southern Methodist University. She holds a certificate in mediation from Texas State.  Holly brings a strong hospital operations background to healthcare mediations including a focus on clinical quality.  Holly managed her own consulting… MORE >

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