Pech - conflict resolution 1

• Conflict


  A disagreement within oneself or between people that causes harm or has the potential to cause harm
• Conflict can be physical harm
• Common myths about conflict

  • Conflict is avoidable
  • Conflict is bad
  • Conflict is impossible to resolve
  • We need a lawyer
  • All disagreements escalate into conflicts
• Many disagreements are settled quickly and easily. Escalation usually occurs when the situation is serious enough that one party is unable to "let it go".
• The origins of conflict in healthcare

  • A baby girl born at 26 weeks is ready for discharge to her local health centre but her parents refuse to leave. They say that they feel safe where they are, and that the baby won't receive such expert care and attention at the other health centre. Every time discharge is mentioned by the consultant they refuse to discuss it.
• The origins of conflict

  • When our needs are not met
  • When our needs are in opposition to others
  • When there is a clash of perceptions, goals or values
  • When there is disagreement about a common purpose
  • When there is competition for limited resources
  • When the other party challenges our decisions
  • When the other party has different priorities
  • When the other party misunderstands instructions
• Communication and conflict


  • Lack of communication creates mistrust and hostility
  • Complex multidisciplinary relationships don't help
  • Poor communication skills amongst HCP's
  • Poor listening skills
• Listening


  1. Listen fully to what is being said

  2. Do not plan your response

  3. Listen for insights into what is important to the speaker

  4. Check in with the speaker to ensure you got the message right

  5. Pause and think about what else you might need to know

  6. Ask further clarifying questions

  7. Then respond to the speaker
• Emotion and conflict


  • Frustration
  • Unresolved emotion is a critical contributor to the development and exacerbation of conflict between health care professionals and between providers and patients
  • HCPs often experience conflicts because of their inexperience and their place in the hierarchy of the medical care team, particularly when there is disagreement between trainees and senior staff
  • HCPs express more frustration and confusion around ethical conflicts in their early years of training
  • Moral distress occurs when health professionals know or think they know the ethically appropriate action to take, but are unable to carry it out for various reasons
• Continuing to provide care to a terminally ill patient because the family is refusing to stop treatment is a common situation that creates moral distress for caregivers.
• There are frequently conflicting views within the health care team, based on differing values and beliefs in what is the "right" or "moral" thing to do for the patient.
• Conflict is the natural result of the collision of these differing values and beliefs. Improving collaboration and communication amongst care providers will allow for the positive management and resolution of these difficult situations. Providers may not agree at all times, and yet they can and must learn how to respect and support each other.
• Factors contributing to conflict

  • Health care systems are complex
  • Hierarchical nature of medicine
  • Diversity of knowledge, power, and control
  • Social diversity of providers and patients
  • Ethical challenges that cannot be easily resolved
  • Anger and frustration with patients
  • Expressing negative opinions about colleagues in front of patients and other colleagues
• Avoidance


  This approach is low on assertiveness and cooperation. It is unlikely to satisfy anyone's concerns.
• Disadvantages of avoidance


  • Little or no input
  • Temporizing
  • Issues will fester
  • Frustration results at lack of action
  • Communication breakdowns can result
• Accommodation


  One's input is ignored. People who uses this approach develop a reputation as "pushovers". Giving in often builds resentment later.
• Compromise


  This approach is moderately assertive and moderately cooperative. It moderately satisfies everyone's concerns.
• Disadvantages of compromise


  • Creative, collaborative options remain undiscovered
  • This approach can be seen as feeble or indecisive
  • Real issues are unresolved, so solutions are short-lived and fragile
• Competition


  This approach is highly aggressive and minimally cooperative
• Disadvantages of competition


  • Issues will resurface because people do not feel heard
  • There may be silent acquiescence and a possibility of sabotage
  • It can create an environment of fear and lack of transparency
  • Feedback from colleagues is unlikely (surrounded by "yes" people)
• Collaboration


  In most situations, the best outcomes are achieved when the parties involved in the problem work toward resolution in a collaborative way. Using collaboration means that the parties who are in conflict focus on the interests or needs that lie beneath the conflict, rather than focusing on the positions that individuals may be proclaiming.
• The goal is to work toward a resolution that allows everyone to get what they need, not to try to win or defeat the other person.
• In addition to being more timely and cost-effective, using a collaborative, interest-based approach also allows the parties to maintain their relationships and create long-lasting, mutually satisfying outcomes.
• Strategies for conflict resolution

  1. Who should be sitting at the table?

  2. What are the main issues?

  3. What are the origins of the issues?
• Values-based conflicts or conflicts that raise ethical issues are often challenging to resolve and it may be wise to seek help from a neutral third-party from the outset.
• Disagreements frequently occur about the goals of care as well as the route to take to achieve those outcomes
• Rule-based conflicts may appear to be simple to resolve by referring to the rules that govern particular situations. Of course, that assumes that all parties feel the rules are relevant and equitable. A purely rule-based conflict may be fairly easy to resolve if all the parties subscribe to the rules.
• FACTORS CONTRIBUTING TO CONFLICT

  Health care systems are complex

  Hierarchical nature of medicine

  Diversity of knowledge, power, and control

  Social diversity of providers and patients

  Ethical challenges that cannot be easily resolved

  Anger and frustration with patients

  Expressing negative opinions about colleagues in front of patients and other colleagues.