Inter-professional relationships and conflict resolution
“Unfortunately, healthcare organizations have not evolved as quickly as clinical advances, and the environment of care has evolved into a difficult and complex setting filled with poor communication, unclear policies, role confusion, turf battles, and stressful interpersonal conflicts.” (Gerardi, D., 2004)
Every physician working in Canada will work in a team at some point, either during training or practice. In the past, team work was generally thought of, if at all, in terms of the other health-care workers carrying out the physician’s orders. This is no longer the case. Skills in working in inter-professional teams are now expected of all health-care professionals, including physicians. The reasons for this are obvious:
- Health-care systems are complex.
- No one person can a) know it all, b) do it all for the individual patient or the health of society.
- Evidence shows that good team functioning leads to better outcomes in both patient and staff satisfaction.
Some teams are “permanent,” with a well-defined structure, personnel and roles (e.g., a stroke team in a tertiary care hospital) while others are more transient in makeup and dependent upon need (e.g., the health-care professionals a family physician may consult concerning home care for a patient).
How well teams function depends on several factors:
- Team culture or norms: the unwritten rules, the expected behaviours of the members
- Rules and regulations: the stated terms of function of the team (e.g., weekly meetings, a project to complete)
- Disciplinary features: what type of members (e.g., nurses, social workers, etc.)
- Personalities: leaders, facilitators, disrupters, collaborators, compromisers, etc.
- Conflict is the recognition of difference.
- Conflict is normal and need not involve anger nor obvious emotion.
- Conflict can be either constructive or destructive.
- Unresolved conflict leads to a toxic work environment.
Sources of conflict
- Values and beliefs (culture)
- Roles, including perceived disciplinary boundaries
- Goals, both personal and organizational
- Language, including non-verbal
Ways of thinking about conflict
Learn to recognize the signs and symptoms of conflict.
- In yourself: tension, fear, anger, threat, guilt, etc. Be self-aware. What is your level of emotional comfort?
- In others: body language, overt hostility, bullying, demanding, etc.
Learn to listen for understanding (hearing the other, gathering information). Mindful listening is non-judgmental, empathic, “in the moment” without thinking about your response to the perceived conflict, e.g., no assumptions.
Framing (or reframing)
Having heard, respond by acknowledging the speaker has been heard. Summarize what you have heard through paraphrasing, clarifying and checking in. This normalizes the conversation, reframes emotional or inflammatory remarks and tries to redirect the conversation to less confrontational levels.
Try to establish a “no-blame,” more problem-solving atmosphere. Find even a small area of agreement or a common goal (finding common ground) from which a more rational dialogue can proceed.
Can an agreement or solution be reached? If so, what technique is used?
- Something else?
The naming, framing, blaming, taming is adapted from Gerardi, D. (2004).
Read the following articles: