The CMPA regularly receives inquiries from physicians seeking information about resolving conflict with other healthcare providers, including other physicians. Ideally, there would be no conflict in the workplace or elsewhere, but in reality, conflict is an inevitable part of our lives. As challenging as it is, especially in the moment, conflict can also serve as a catalyst to understanding other points of view, growing as a professional, and improving communications within an organization. This is especially true when conflict is managed successfully and resolved appropriately.
Where does conflict begin?
Conflict can arise from shifting priorities, well-intentioned but poorly communicated expectations, or misaligned perceptions of an issue where people care about the outcome.1 In healthcare, competition for limited resources and interdependencies among professionals can lead to conflict as well.
In early 2020, the COVID-19 pandemic became a serious potential source of conflict in healthcare settings. As the pandemic continued, many physicians became fatigued from adjusting to new schedules and unforeseen demands. In such a context, disagreements can develop between healthcare providers regarding what is the best approach for unprecedented scenarios, and tempers can fray more easily. As providers learn to work together in different ways, conflict resolution is as essential as ever.
The impact of conflict on the safety of care
Addressing conflict is important to achieving a workplace culture that values respect and collegiality. If left unaddressed, conflict can lead to heightened anxiety and stress, a toxic work environment, and even professional burnout. Health professionals working in an environment of simmering conflict generally do not communicate effectively. This can impact performance, potentially leading to adverse outcomes for patients, including:
- disruptions in continuity of care
- delayed diagnoses
- unnecessary testing
- iatrogenic complications
- frustrated physicians and patients
- development of unsafe workarounds
All of these factors can expose providers to a greater risk of liability.
Handling conflict
Dealing with conflict appropriately is a key competence for family physicians and specialists. The CMPA Good Practices Guide looks at the various styles of handling conflict, as elaborated by conflict experts, and expands on many of the topics presented here.
Resolving conflict through effective communication
Be an active listener. During times of conflict, the first question on an individual’s mind might be, “How can I make myself understood?” It is better to pre-empt this question with a different, more productive question: “How can I truly understand the other person’s perspective?”2 Active listening, including acknowledging the ideas and emotions of others, is an important communication skill. To facilitate active listening, make sure the other person is given the chance to share their point of view and finish their thoughts. Use silence as a tool, and resist the urge to interrupt or immediately refute. Head nodding and similar gestures demonstrate active listening, and clarifying questions can also be used to make the other person feel truly heard.
Use disarming statements. When communicating with colleagues, it’s important to remember that the way we say things matters just as much as what we are saying. When someone says something you disagree with, try alternative ways to express your point of view. To avoid escalating the conflict, use non-confrontational and non-blaming language. Statements that begin with “I feel that…” can be effective throughout discussions. Another useful approach is to make a “disarming statement” before you give your own opinion, such as one of the following:3
- "Interesting––it seems we have different points of view. Do you mind if I explain where I'm coming from?"
- "I've made different observations, probably because I had different experiences...."
- "I value your ideas on this matter and I can see why you're concerned about trying a different way. Perhaps we could look at how we can use this new approach?"
Find common ground. Individuals involved in conflict may see issues differently or want different outcomes, but through good communication, they should be able to identify underlying common interests (e.g. the importance of patient safety). Physicians should focus on these interests rather than the position the conflicting party is taking, especially if patients are involved. Focusing on the issues, rather than on personalities, helps prevent personal attacks that can further aggravate the situation. When common ground is achieved, everyone involved feels that their perspective is a valid one. This motivates individuals to move past the conflict by finding an equitable solution.
Keep it thoughtful. Getting angry, blaming the other individual, or being accusatory usually does little to move the issue toward resolution. Physicians should never insult other healthcare professionals by using disparaging comments or behaving dismissively, and it is imperative that they don’t comment on the care provided by another physician in front of other individuals, including patients, or in the medical record. A single, thoughtless comment often forms the basis for dissatisfaction and complaints by patients and their families.
Know your limits. Escalation of disputes can also be avoided by calling a “time out” in which the parties agree to disagree and revisit the issue at a later time. When the conversation does take place, a private setting, in which individuals can speak freely, is most appropriate. The help of a neutral party to mediate the conflict may also be beneficial. Lastly, it’s a good idea to summarize key messages, particularly when there are language barriers or significant differences in communication style.
Conflict with other healthcare professionals
Just as physicians can face conflict between each other, they can also potentially experience conflict with the other healthcare professionals they work with, such as nurses, pharmacists, respiratory therapists, technologists, and medical students. Team factors can be a key patient safety issue.
To avoid conflict, physicians should encourage open, respectful, collegial, and professional communication amongst everyone with whom they interact. By fostering a psychologically safe environment in which everyone feels that they can speak up without any fear of retribution, you can prevent the development of dangerous workarounds within your team.
High-risk situations
In high-risk situations, such as clinical crises or distressing situations, physicians should place particular emphasis on clear communication. Physicians should also consider communication techniques to escalate concerns across authority levels to match the seriousness of the clinical situation.4 Escalating the matter to a higher level of authority (department head, clinical lead, or chief of staff) may be reasonable. Training on conflict resolution can be critical to enhancing physicians skills in this area as well.
The bottom line
When conflicts occur, as they inevitably do, you can use various proven tools and communication techniques to resolve them. By addressing conflict, you can foster a more effective workplace, and a safe and positive experience for your patients.
References
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Marshall P, Robson R. Conflict Resolution [Internet]. Ottawa (ON): The Royal College of Physicians and Surgeons of Canada; c2021 [cited 2021 May 19]. Available from: https://www.royalcollege.ca/rcsite/documents/bioethics/conflict-resolution-summary-e.pdf
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Covey S. The seven habits of highly effective people. New York (NY): Simon and Schuster, Inc; 2004. 247 p.
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Kaufmann M. The Five Fundamentals of Civility for Physicians. Ontario Medical Review. 2014 Mar;81(3):13
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The Safety Competencies: Enhancing Patient Safety Across the Health Professions, 2nd Ed. Edmonton (AB): Canadian Patient Safety Institute; c2020 [cited 2021 June 17]. Available from: https://www.patientsafetyinstitute.ca/en/toolsResources/safetyCompetencies/Documents/CPSI-SafetyCompetencies_en_Digital.pdf
