Professional Interactions – Best Practices Series
Tools for Healing Physician Conflict
By Fred Corbus
This article first appeared in Round-up Magazine, official publication of the Maricopa County Medical Society.
At an early age, we are taught to “behave.” Be nice, don’t be rude or mean, and always consider the other person’s feelings. It’s a necessary thing to learn if we are to thrive and have fun in this world. What we haven’t been taught very well is how to recognize when our happiness depends on constructively confronting someone. Some of us are fortunate to have learned how to stay in touch with our feelings and recognize when a confrontation is necessary. But now for the really hard part: how does someone address the issue without being rude or mean? After all, silence is safe (even if you’re unhappy).
In truth, being silent is the opposite of being safe. Those things that “everybody is thinking about, but nobody is talking about” sabotage relationships, teamwork, trust, and the overall quality environment in which you practice medicine.
Case Study Examples
As a facilitator during the past 25 years, I’ve spent hundreds of hours helping people heal conflict. The following list identifies some of the most emotionally laden, potentially devastating conflicts I’ve worked with. Undoubtedly, your practice has its own version.
- Unequal sharing of the clinical workload
- Unequal sharing of the non-clinical workload
- Unequal allocation of/scheduling of patients (real or perceived)
- “Stealing” another physician’s surgery patients (real or perceived)
- Non-compliance with an agreed-upon protocol
- Lack of agreement on the roles of bedside spirituality (such as praying with the patient)
- Disproportionate sharing of practice physician income (real or perceived)
- Disagreements over what constitutes a legitimate practice expense
The above list does not include physician behavior or attitudes that should be addressed in an internal peer review process (which I will cover in a subsequent article.). I’m talking about conflicts, open or covert, that are really arguments. I’m talking about those situations that have gone beyond people rationally sitting around a table and examining the fact. I’m talking about people who are publicly or privately upset, if not seething. I’m talking about broken trusts, relationships and teamwork.
Confrontation is necessary, and you have to do it without being rude or mean, while taking into consideration everybody’s feelings. You have the opportunity to facilitate, whether you are one of the parties or playing the role of assisting other parties.
If you’re lucky, you can arrange a meeting to address the issue. However, because there is a tendency for people to “play it safe,” you may not have this luxury. If you’re not lucky, the moment of conflict suddenly appears. The flash point has arrived. In either case, you have the choice of proactively using one or more of the following tools.
TOOL #1: ASSUME THE ROLE OF A “FACILITATOR”.
- Gain the respect and trust of all parties before facilitating any meeting (often through extensive one-on-one interviews).
- Demonstrate “remarkable” impartiality during facilitation.
- Role model the skill of truly listening to each person’s point of view.
- Make sure every person involved is asked for and has the chance to provide his or her input.
- Synthesize and record on a flip chart all significant input (perceived facts, beliefs, feelings, preferences, possible solutions) even if they differ from one another.
- Recognize the need for venting and catharsis (which should always come first), but be prepared to move the conversation toward constructive solutions.
- Reach comprehended closure and endorsement on agreements, decisions, and action plans by recording on a flip chart.
- Schedule the next meeting, as necessary, before adjourning so that everyone involved has confidence that the issue will continue to be addressed until resolved.
- Distribute typed versions of the agreement, decisions, and action plan within 24 hours of the original meeting.
TOOL #2: HAVE EACH PERSON “MIRROR” THE OTHER PERSON’S INPUT.
In a typical unhealthful conversation, each person is mentally preparing his or her own defense instead of listening to the other person. “Mirroring” forces each person to listen to the other.
Process:
Step1 - The first person (sender) says what he or she needs to say.
Step 2 -The second person (receiver) asks for any needed clarification and repeats what he or she heard.
Step 3 -The sender restates the original message (more clearly).
Step 4 -The receiver repeats the message. This exchange continues until the sender is completely satisfied that the receiver understands the intent, feelings, and content of the communication.
Step 5 -The process then reverses itself.
Step 6 -The conversation then moves toward compromise, agreements, and action plans.
TOOL #3: HAVE EACH PERSON COMPLETE THE SENTENCE, “WHEN YOU , I FEEL ."
You can argue opinions, points of view, and perceptions, but no one can disagree with how each person says he or she feels. Additionally, there is always an opening for fresh listening when someone is willing to publicize his or her feelings.
Process:
Step 1 - Each person is coached into stating his or her issue with a “When you…” (a statement that factually describes the behavior or action of the other person, free of judgment or any exaggeration). The statement is finished with “I feel…”
Step 2 - The process continues back and forth until each person has constructively expressed him or herself and has been heard by the other person.
Step 3 - The conversation then moves toward compromise, agreements, and action plans.
TOOL #4: HAVE EACH PERSON DEFINE HIS OR HER OWN “WIN-WIN”.
When opposing sides truly hear each other and engage in give and take discussion, innovative and mutual solutions are common. This kind of open discussion is usually precluded, however, when one or both of the parties come to the table determined to “get what they want.” When this happens, the best that a facilitator can do is to reach a compromise, which falls short of a win-win solution.
Process:
Step 1 - Have the first person list the things he or she wants out of the situation – in other words, that individual’s “win” (while the other person listens quietly).
Step 2 -The second person then lists the things that would be a “win” for him or her.
Step 3 -The conversation then moves toward compromise, agreements, and action plans.
The development of documents such as these is an investment of time, requiring meetings where participants listen and understand. Gaining a joyful environment within which to practice medicine makes it all worthwhile!
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