Hospitalists face the potential for conflict every day. They work in highly complex organizations and in order to be successful they must interact effectively with a wide variety of individuals in what is often a challenging, emotionally charged environment. Hospitalists must learn to navigate not only the formal organizational bureaucracy of rules, systems, and processes, but also the informal political hierarchy that influences power and decision making. Often, they must do so with little or no formal training in conflict management at an early stage in their medical careers. In addition, they may encounter conflicts between what others would like them to accomplish and their own workload demands and professional expectations.
Hospital Medicine is also a young, evolving specialty that has enjoyed unprecedented growth by serving the needs of multiple competing stakeholders. Although the specialty is maturing, it is still populated by a high proportion of recent residency graduates and early-career clinicians who may not have a complete understanding of the specialty or even have career advancement on their radar screen. The potential exists for the service obligations—both clinical and in the area of institutional performance improvement—of hospitalists to overwhelm opportunities for professional development, and this may promote career dissatisfaction, turnover, and symptoms of burnout. Leaders of hospitalist services may find themselves isolated as they advocate for the professional development and job satisfaction of group members while meeting the service expectations of their employers or supervisors. The professional medical society for hospitalists, the Society of Hospital Medicine, is rapidly developing flexible support resources for hospitalists relating to business and clinical practice, engagement and career satisfaction, core competencies, and role expectations. Until these standards become widely disseminated and health care services become better designed and hence less prone to error, hospitalists will continue to work in a hospital environment where they will increasingly be expected to perform as change agents at a time when change may not be welcomed by their hospitalist colleagues or others at their institutions.
For the purposes of this chapter, it will be important to distinguish between disagreements and conflicts. Disagreements happen regularly in human interactions, and occur whenever two or more individuals have differing opinions about something. A disagreement need not devolve into a conflict, and many do not. Conflicts arise when a party perceives that another party has negatively affected or will negatively affect agendas that the first party cares about. Conflicts are defined as processes that occur when tensions develop, that is, the emotions associated with a disagreement become so elevated that they impede the ability of the parties to interact with each other effectively.
Almost all conflict is a result of unmet expectations. For hospitalists, this commonly arises when there is a lack of understanding or a difference in expectations about their role. Hospitalists may assume that primary care physicians have explained to patients that someone else will be seeing them in the hospital. Patients and ...