Author: BMJ Learning consultant Sophia Bourne
In the healthcare workplace, most people work in multidisciplinary teams, where trust, mutual respect and shared understanding is central to successful outcomes.
However, conflict — where there is an active disagreement between people with opposing opinions or principles — is also common.
The NHS employs people with diverse abilities and approaches to serve patients with diverse morbidities and needs, so it’s no surprise that disagreement and challenge arise frequently.
Impacts of conflict
Conflict can be addressed in a healthy way — in some circumstances, it encourages dialogue and brings about deeper understanding between parties, resulting in the best possible patient outcomes.
In too many cases, however, conflict can be a destructive force, causing long term damage to relationships and risking unfavourable outcomes for patients.
Negative — and sometimes disastrous — consequences include colleagues experiencing lower morale and even stress; less cohesive and poorer performing teams; a decline in patient care; as well as direct and indirect costs to the employer in terms of lost time, low productivity and even litigation.
Causes of conflict
Conflict may arise due to individual differences, professional or group allegiances, different expectations, blurred role boundaries, as well as external pressures.
In healthcare, organisational hierarchy and complexity can also cause conflict because individuals operating within it will have limited authority and may have to comply with processes that constrain their discretion, take more time, increase bureaucracy, and this leads to frustration and conflict.
Working conditions can also increase the chances of conflict. Healthcare workers often work in a fast-paced environment and have to make quick decisions in ambiguous circumstances. They may lack necessary resources and face unpredictability too — all factors that create a sense of diminished control, and result in frustration and flared tempers.
Different approaches to dealing with conflict
People use various approaches to deal with conflict. Some choose to avoid it completely or find a compromise, where both parties essentially lose some ground in order to move forward.
Another approach is to accommodate a view you don’t agree with — a lose-win approach that assumes the other party’s way is right/superior to/better than yours. Some people may choose to persist with a view or direction, and push their agenda through, despite opposition.
All these ways remove the immediate problem, but are one-sided and/or store up problems for later.
An alternative approach is to collaborate. Here, both parties assume they are equal and find a mutually acceptable solution. Collaboration is best for long term relations as it will permanently remove the source of conflict, however it requires more time and effort.
Conflict management skills — the 5 key skills
The key in managing any conflict situation is to face the situation early on, to prevent escalation and further damage.
It is also essential to use skills to manage the many manifestations of conflict. These include listening; showing empathy and mutuality; reflective learning; shared solution-seeking; and promoting constructive behaviours in others.
1. Use active and deep listening
Engage with the person who is speaking. Make them feel that they and their opinions matter, and that you want to understand their perspective — note what is said and how it is said. Paraphrase and clarify what they have said.
Suspend your own judgement and refrain from seeking solutions until all relevant information is revealed. Create an atmosphere of openness and acceptance encouraging active dialogue amongst colleagues and between teams.
2. Demonstrate empathy and mutuality
Actively demonstrate to colleagues what will and will not be tolerated - a healthy working environment is in everyone’s best interests. Invest in team working relationships by demonstrating that you understand their position and can relate to their situation.
Emphasise the goals and values that you share and emphasise equality, as partners rather than adversaries. Avoid assigning blame, even elsewhere, and take responsibility for your actions.
It is understandable that people are quick to assign blame for conflict, mistakes or adverse outcomes, if people feel under scrutiny. Resist this knee-jerk response and, instead, undertake individual and group reflection to explore circumstances and causal factors.
This is more productive, powerful and forward-moving than mud-slinging and shifting blame – and shared learning informs future practice.
4. Take a problem solving/solution-seeking approach
Doctors face problems every day, usually in a clinical setting, where they must apply their powers of assessment and information gathering; analysis and diagnosis; formulation of a solution; and evaluation.
Applying this method to emotive conflict situations, invites a thorough and methodical approach, fully appraising all possible solutions before one is agreed as most mutually beneficial for the parties.
5. Promote constructive behaviours in others
Encourage closer working relationships by creating opportunities to be together professionally and socially. Share thoughts, values, concerns, frustrations, successes, and ideas to increase mutual understanding and break down barriers.
Set rules of engagement, and create a forum in which to raise future issues so they don’t manifest. Seek out opportunities for regular cross-team working. Agree forms of communication that work for everyone.
Your personal response to challenge
People revert to a preferred response mode when under pressure — they may become aggressive, passive, indirectly aggressive or assertive.
Aggression assumes superiority and may involve denial, blame and offensive/defensive behaviours.
Passivity assumes inferiority, as with avoidant and accommodating approaches, choosing the path of least resistance.
Indirect aggression also assumes superiority but in a non-confrontational, subversive way.
Assertiveness assumes all are equal, faces into the problem directly and seeks a mutually acceptable solution.
Improve your assertiveness skills
Assertiveness is key for dealing with many situations at work and can be used in conflict situations to rebuild relations.
There are different approaches to being assertive. Sometimes a direct approach is useful — a simple “no” to a question, for example, but there will be other times when such directness will be too blunt or unhelpful and few people want to come across that way.
Find out more about how to manage conflict situations at work in this BMJ learning course.