For instance, physicians at CHI St. Alexius Williston (N.D.) Medical Center and their colleagues at CHI St. Alexius Bismarck (N.D.) Medical Center are together calling for a leadership change in CHI’s Fargo Division. Physicians at the Bismarck hospital threatened to resign unless a leadership change takes place, alleging the current leadership was leading to declining physician engagement and lower care quality.
Physicians at the Williston hospital joined the Bismarck physicians in solidarity. CHI St. Alexius Health officials said they are discussing the issues with physicians, but had not announced any leadership changes within the Fargo Division as of May 22.
In another example, conflict arose regarding the affiliation of two children’s hospitals in California. Although San Francisco-based UCSF Benioff Children’s Hospital and the Children’s Hospital & Research Center Oakland (Calif.) finalized their affiliation four years ago, physicians in Oakland are still upset about the partnership. Some physicians in Oakland specifically argue UCSF has prioritized the children’s facility at UCSF Medical Center’s Mission Bay campus in San Francisco, and located most of its specialists and leadership in San Francisco instead of Oakland, according to The Mercury News. The physicians overall claim the affiliation has negatively affected care at the Oakland facility — even declaring a vote of “no confidence” in the institution’s integration plan last March. However, UCSF Health officials argue the affiliation has improved care and helped the Oakland facility’s financial situation.
Disagreements like these are common, according to Rick Sheff, MD, CMO of The Greeley Co., a Danvers, Mass.-based healthcare solutions company serving more than 700 healthcare organizations nationwide within the past three years.
“We’re seeing increasing numbers of incidents of conflict, as well as the severity of the conflict and intensity,” he said.
Dr. Sheff has seen disputes arise in various forms. He said sometimes disagreements occur between an employed group practice and either the employing group or the hospital or system. He has also seen allegations of inappropriate competition — either physician to physician, group to group, or between medical staff and the hospital. Additionally, he has seen allegations on all sides of acting in bad faith and undermining trust, as well as disagreements over priorities such as whether quality of care or cost of care is most important.
Why conflicts occur
He attributed the rising number of conflicts to pressures hospitals and physicians are facing.
“Both physicians and hospitals are being squeezed today. We are heading into a time of more restricted resources, and in our experience working around the country, the best way to put it would be: When the amount of food at the table goes down, table manners tend to deteriorate,” said Dr. Sheff.
He argues it is also attributable to differences between how physicians approach challenges compared with hospital managers and leaders. He described it as “a Mars-Venus experience.”
“They use different language. They have different ways of making meaning of what they see. They have different priorities. They have different perspectives. And, we [Greeley] get called into these all the time,” he said.
There is a common thread between each situation, however. In each instance, Dr. Sheff sees the frequency and intensity of conflict rising and trust between parties deteriorating. He said how each side decides to address the conflict will determine the potential resolution.
To address each situation, Greeley begins by listening to the perspectives of all parties, and from there, work can be done to try to resolve the conflict.
“It’s best approached in phases because in the beginning they’ve gone to war or they’re about to go to war. The first step is to get the parties to be willing to come back to the table,” said Dr. Sheff.
Advice
As a first step, when facing the kinds of disagreements seen in healthcare, Dr. Sheff referenced advice from the late American educator, author and businessman Stephen Covey: “Seek first to understand, then to be understood.” Dr. Sheff also recommended involved parties listen to each other “deeply and effectively,” and noted sometimes it is necessary to get a third party to facilitate a resolution process.
“In every setting we’ve been asked to come into, there’s the potential for addressing the underlying problem and getting parties back together, and we’ve been successful in many settings,” he said. “But, the parties have to be willing to engage and be willing to change, and that’s up to them. They also have to be patient with the process.”
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