Take a deep breath…let’s talk conflict

August 28, 2019 Jane Coutts

If you’ve worked in a busy and demanding health care organization (is there any other kind?) you’ve encountered on-the-job conflict.

Workplace conflict is the inevitable result when a lot of committed people — focused on their jobs, trying do their best for patients — work long hours in close quarters on tough problems. Sometimes conflict is a blow up. Sometimes it’s clenched teeth or a cranky snap at an innocent third party. Sometimes it simmers for weeks or months.

But have no doubt — conflict takes a toll. One Swiss study interviewed staff in four departments of the University Hospitals of Geneva, to learn more about how they were affected by conflict, in order to plan programs for managing it.

The researchers interviewed 82 people; 69 per cent of the stories they heard were about conflict’s personal impact. People also told them of decreased collaboration, communication and trust on their teams.

Conflict: good or bad?

Ironically, researchers can’t agree whether conflict is good or bad in the workplace.  A study by Lindred Greer and colleagues, in the journal Medical Education, looked at conflict in medical teams and concluded it’s bad for them. They classify the things teams clash over as tasks, interpersonal relationships, and processes (logistical issues).

Disputes over tasks leave people emotional and distracted, so they “waste energy on conflict resolution.” Relationship conflict (what most of us would call “not getting along,”) reduces collaborative problem solving, while process conflict — especially if team assignments and access to resources are the issue — can undermine people’s self-esteem.

A paper in “Mayo Clinic Proceedings: Innovation, Quality & Outcomes” acknowledges some conflicts may have a constructive side, by clarifying disagreements about roles and tasks. But at the same time, “…they can alter team dynamics and communication, decrease trust and team performance, and lead to poor mental health among professionals.” Ultimately, the paper says, they may distract professionals so much they become a threat to patient care and safety.

The other side of the coin is described in “Collaboration and Teamwork in the Health Professions: Rethinking the Role of Conflict.” Author Quentin Eichbaum found several studies that showed “making space for conflict and dissent on teams can promote the relay of important information and improve group decision making and performance.” He recommends finding ways to integrate conflict in work.

The advantages of learning the hard way

If the people who study conflict can’t agree, what are you supposed to do about seething tension in the morning meeting? Fortunately, there’s more agreement on that: no one thinks it’s a good idea to ignore conflict. The Swiss study found 40 per cent of people avoid dealing with conflict (to the point residents often leave their positions rather than speak up). Greer’s study cautions that “repressed conflicts may escalate over time and become more difficult to resolve.”

The other common responses, according to a piece by Allan Simpao in Physician Executive Journal, are competition, compromise, accommodation and collaboration. Competition, most would say, is not helpful long term, because for someone to win, someone has to lose. Compromise can offer a quick resolution, as does accommodation — where one person lets the issue go, but both approaches work best on smaller issues.

Collaboration is the most difficult approach, but “is a key strategy for many major conflicts in health care because it builds understanding of complex issues and interdependent systems,” the Physician Executive Journal piece says. It offers simple but powerful steps for negotiating a solution to a conflict:

  1. Identify and define the problem
  2. Get the facts (not the assumptions).
  3. Generate possible solutions without criticism
  4. Evaluate possible solutions using logic and mature judgment
  5. Select solutions. A combination may be preferable
  6. Implement the solution(s) with clearly defined roles for both parties
  7. Evaluate the results

There is help available for people on the front lines. CanMEDS, the Royal College of Physicians and Surgeons’s framework of competencies, includes a “collaborator” role, which specifies that a collaborative physician is one who can work effectively on an interprofessional team and work with others to resolve conflict. However, participants in a 2012 focus-group study on collaboration in Canadian health care said collaboration was mostly “taught” by physicians modelling it — which could be undermined by how those role models behaved when conflicts actually arose. The authors urged that it be taught and assessed more effectively.

A group of U.S. physicians have adapted teaching tools from business, diplomacy and theatre for conflict resolution in health care. Their approach was tested over two years and refined five times; the authors report participants liked the variety of conflict resolution styles it uses and its case study approach.

Dr. Simpao, who described the five responses to workplace conflict, offered an important piece of advice: slow down. Action-oriented health care workers, he says, tend to rush to solve problems. Maybe your mother, and a whole lot of self-help books are right: take a deep breath before you say something you may regret.

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This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at jouleinquiries@cma.ca.

About the author

Jane Coutts is an Ottawa-based writer and editor who specializes in healthcare issues. She worked as a journalist for 15 years, mainly at The Globe and Mail, where she was the health policy reporter for five years. Since she founded Coutts Communicates in 2002, Jane’s work has focused on making healthcare policy and research more readable and relevant. Jane also leads workshops plain-language writing.

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