Foreword

Health care is a high-stakes business. Whether you work for a hospital, a doctor's office, or some other healthcare facility, you know people's lives are on the line every day. Failure is not an option. And the pressure to succeed combined with the stress of caring for patients and families, the regulations you must meet, and the many other challenges healthcare professionals face can lead to a big problem, conflict.

The impact of conflict gets expressed in many ways:

• A domineering, controlling administrator criticizes others in public settings.

  The Outcome: A crippling of creative thinking. Why bother?

• Nurses argue about protocol at the bedside of a dying patient.

  The Outcome: Increased anxiety about the end of life for the patient, loss of confidence by the family, fractured treatment.

• A physician's assistant leaves incomplete notes in the patient's chart.

  The Outcome: Potential patient harm; increased exposure to malpractice liability; extra time and effort are required to provide the best care.

• Members of a surgical team don't communicate clearly or at all.

  The Outcome: Compromised patient care.

The healthcare industry is currently under a microscope. As if the pressure and demands of new technology, sicker patients, and growing bureaucracy are not enough, everyone has become an instant expert on how to "fix" the system. It's no surprise that healthcare workers may be feeling more tension or experiencing more conflicts. The system is changing. One critical difference, however, between providers who consistently deliver high-quality care with high ratings for patient safety and those who don't is how quickly and how effectively they acknowledge problems or conflicts and how they choose to address them. If not addressed early and productively, the outcome of these ignored conflicts can be detrimental to patients, families, physicians, staff, and the organization.

What is a manager to do when he or she hears these complaints from staff? Though a natural reaction is to either simply avoid the complaints altogether or tell employees to go back to work, neither of these approaches tend to work very well. What most managers want is for their staff to treat each other with respect, work cooperatively, and focus on excellent patient care.

The question is how can an organization create a positive work environment and help channel the staff's energy toward contributing, instead of petty infighting or other disruptive behavior. One thing is known to be true—the more a manager ignores or tries to squash the problem, the more it tends to escalate and the more complaining increases. As a French philosopher once said, "Everything has been said before, but since no one listens, we have to begin all over again." Employees, like most other people, don't like to be ignored or told their concerns and reactions to a situation are wrong, bad, or inappropriate.

In the busy reality of delivering patient care, it may feel as though one does not have time to manage a conflict or to listen to employees' concerns. The cost of not listening to employees' concerns is great: escalation of issues, avoidance of other staff with whom they have a conflict, increased absenteeism, losing focus at work, and possibly patient harm; all of these are real consequences of workplace conflict.

Finding a way to respond respectfully and to hear the underlying interests, instead of focusing on the complaints, takes practice. What these skills can do is transform the workplace into one in which people work collaboratively and respectfully together. Having a structured conflict management strategy is an essential leadership tool which can also transform a dysfunctional team to a thriving one.

The Exchange Strategy for Managing Conflict in Health Care supports managers and supervisors, at every level of the organization, in the challenging work of managing conflict and disruptive behavior in the workplace. Fortunately, most employees do the right thing and are committed to improving, so the atmosphere is generally professional and positive. But even the best employees can sometimes find themselves in workplace conflicts for which they could use some help. Given that fact, many organizations have embarked on this training and support it for good reason:

• Ignoring the problem does not solve it. In fact, it exacerbates the problem. The employees in conflict (or the employee who creates a "toxic environment" in the workplace) can create a negative atmosphere for their coworkers and even impact patient care.

• High turnover rates are costly. When more people are let go from their jobs because of behavioral problems than competency issues, the cost to the organization is great and can be prevented in many cases.

• The Joint Commission is mandating that hospitals manage conflict in a way that healthcare safety and quality are protected (Standard LD.2.40). Additionally, leaders are to create a culture of safety, based on teamwork and respect, which means disruptive behavior by individuals must be addressed (Standard LD.03.01.01).

The Exchange program is based on state of the art methodology for managing conflict productively and respectfully. Combining the tools of leadership, adherence to policy, and working from an interest-based perspective, managers learn how to work through the inevitable issues that arise in the workplace. As one manager stated, "I thought that I was going to learn about conflict management, but I have learned good tips for communicating better with my staff on an ongoing basis."

Successful management of conflicts and disruptive behavior helps the overall mission, vision, and values of any organization. It also helps one reduce stress, manage in a more positive manner, and see other positive outcomes for employees.

The Exchange program can help create a safe, efficient, smoothrunning organization. Over the past 12 months, over 450 managers and supervisors on my team at Sanford Health have gone through this training, and it works! The healthcare industry has needed a strategic process like The Exchange for many years, and I am relieved to know that we finally have a professional, well-organized process to refer to when conflicts arise in our hospitals and clinics. The Exchange is all about results. Use it at your organization and be prepared to see more efficient, less stressed employees, and, most importantly, happier, healthier patients.