Pediatricians, subspecialists and surgeons likely can recall disagreements, conflictual conversations or interactive stress in the workplace. Whether the conflict is related to patient care, guidelines or policies, or team collaboration, it can have detrimental consequences.
Conflict can lead to work-related stress, anxiety and burnout; reduced efficiency and quality of care; decreased engagement and cooperation; lower productivity; weakened teamwork; conflict-infused documentation; diminished job satisfaction; and risks to retention and recruitment.
Additionally, legal risks may result from a clinician’s sense of diminished value or substandard patient care, including missed physical exam findings, inappropriate diagnostic testing, ill-conceived or inaccurate treatment, diagnoses influenced by cognitive errors or procedural/surgical mistakes.
These risks can be reduced by using conflict resolution strategies that aim to achieve cultural uniformity, shared meaning and engagement, common goals and agreement, a value-driven environment and shared priorities. Additionally, individuals and teams should foster inquiry, mutual respect, civility, morality and professionalism.
Road to collegial conflict resolution
Collaboration should be seen as negotiation that addresses conflicting interests and differing endpoints. As with all negotiations, patience, sensitivity, appropriate words/body language, calmness and professionalism are key.
Following are five stages of conflict resolution that can impact the success of an interaction.
Convening
Before meeting with a patient/family or colleague, think about the purpose of the interaction, circumstances and your anticipated response if the person is a poor listener, is not interested or has a conflicting agenda. Contemplate how conflict could be remedied.
Opening
At the beginning of the interaction, identify who you are and the issue or circumstances surrounding the inquiry or interaction. Create an atmosphere of collaboration and understanding, accentuating the positive and placing the patient’s needs first. Find common ground, show respect, demonstrate empathy and avoid ego. Focus on the content, context, structure and importance of the relationship.
Communicating
Essential ingredients of effective communication include openness, honesty, directness, politeness, sincerity and sensitivity. Use words with intention and refocus when necessary. Use analogies or metaphors to improve influence and understanding. Be aware of one’s communication style and self-correct if necessary.
Negotiating
Skilled clinicians (negotiators) spend as much energy on the relationship as on the issue. An effective negotiator understands how people talk, how they feel and what they care about. Problems typically arise when the relationship is out of sync.
If problems or obstacles occur, create a “differential diagnosis” related to the conversation. Then, think about options that may lead to greater congruence with the other person such as refocusing, changing words and body language, and offering alternatives. Configure a “zone of possible agreement” where both sides can agree in part or wholly. If no agreement is reached, think about the most advantageous alternative course of action.
Closing
Summarize the agreed-upon points of the conversation. If disagreements persist, schedule another meeting to discuss issues and where missteps or misunderstandings occurred. Humbly and professionally admit any difficulties, sincerely apologize if needed and aim to forgive, reconcile and agree to move forward in a positive manner.
The medical workplace is fraught with complex and challenging interactions. Working through the five stages of conflict resolution can improve personal value, relationships with patients and colleagues, and workplace fulfillment. It also can lower stress and reduce or eliminate medico-legal risks.
Dr. Nager is a member of the AAP Committee on Liability and Risk Management.
