Zapping Workplace Tension to Improve Patient Safety


When clinicians and other members of a care team are distracted by each other and their personal relationships with coworkers, it can have a major negative impact on patient safety and quality of care.

Managing those conflicts was the topic of an Institute for Healthcare Improvement WIHI broadcast April 24, hosted by Madge Kaplan, director of communication for IHI. Neil Baker, MD, principal of Neil Baker Consulting & Coaching; Nan Cochran, MD, president of the American Academy on Communication in Healthcare; and Calvin Chou, MD, PhD, vice president for external education with AACH, joined Ms. Kaplan during the broadcast.

Studies show conflict runs rampant in healthcare, and "conflict and disruptive behavior are associated…with poor patient satisfaction, preventable adverse outcomes, and increased costs of care," Dr. Chou said. He noted healthcare teams are growing in size, leaving more opportunity for conflicts to arise — meaning there is a heightened need to recognize and manage conflicts effectively.

Conflict in teams isn't just endemic to healthcare professionals. Indeed, Dr. Baker pointed out that "all human beings are hardwired to leap to assumptions and create tensions," and the inherently stressful healthcare environment tends to heighten those tensions and can lead to people making faulty assumptions. One key to resolving conflict is setting aside time to discuss assumptions and what led to them without the push to come to resolution, Dr. Baker said. Some questions to ask during conversation to check assumptions include:

•    Could you repeat what you heard me say?
•    Here's what I heard you say, did I get that right?
•    Did you get my reasoning?
•    What are you basing that on?

Performing these checks can help resolve conflicts, but it does take time and practice to do it well, he said. Dr. Baker recommended performing these assumption checks during normal conversations, not just during conflicts. "Practice makes it much more likely that we will be at our best just when we need it the most."

Dr. Cochran then shared some conflict management principles and strategies that can be applied in the healthcare setting. "We all have the ability to learn to manage conflict well," she said, noting that when clinicians and other healthcare team members engage in conflict management, it can make the workplace one that provides better care to patients.

One main principle she shared is separating the person from the problem, or being hard on the problem but soft on the people involved. "We want to try to be unconditionally constructive," she said. During a conflict, she recommended colleagues envision themselves sitting on the same side of the table and tackling a problem together rather than attacking each other personally.

Dr. Cochran acknowledged that getting to the feelings behind a conflict can be difficult for healthcare professionals. "We've all been trained to diagnose and fix," she said. "I describe this as an occupational hazard, because we're tempted to jump over the emotions and try to go straight to the fix. But…listening for and understanding the emotions that underlay the conflict are really essential before we can get to the fix."

For more from Drs. Chou, Baker and Cochran on healthcare professional conflict and patient safety, listen to the full webcast here.

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