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St. Sonia's is a multiplex healthcare facility based in the Midwest of the United States. This large hospital complex serves several surrounding counties and includes community clinics. Addressing conflict in the workplace has been a key focus area in the hospital since it adopted the 2009 recommendations of The Joint Commission regarding management of conflict in healthcare, to protect the "quality and safety of care." The Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States.

Radha Samson, Chief Administrative Officer at St. Sonia's, has been given primary responsibility for carrying out the new directive. While she enjoys the challenge, she also knew she couldn't do it alone and thus assembled a team of fellow administrators and managers who had all had the same training. Under her guidance the management team has focused on how to address disruptive behavior in the workplace and how to deal with other workplace conflicts.

The hospital relies on a progressive conflict management approach, starting at the lowest possible level—between the involved individuals themselves—and then moves to having managers and supervisors utilize the Exchange process if the individuals involved cannot solve their own disagreements. If it is an interdepartmental conflict or if a high level manager is involved, Radha consults with Drew Johnson, the head of Employee Relations, about the case and together they decide who should be involved and what the next steps should be. Radha relies heavily on the greatest supporters of the process—the Employee Relations team headed by Drew, whose members all spend some time each week mentoring managers and supervisors.

Central to the effective running of the hospital's conflict management approach is a four stage strategic process called The Exchange and the conflict resolution techniques that make it successful in resolving disputes. The Exchange is the subject of this book. We will take you with us, step by step, as Radha Samson tackles a series of everyday conflicts that affect the environment at St. Sonia's, and we will demonstrate how to make use of the principles of The Exchange in a variety of situations. You will see how it can be used in typical situations arising within the workplace, especially in those conflicts that involve high emotions and situations that come from miscommunication. Along with disputes such as two employees who can't get along or issues between departments and in workgroups, you will see how to adapt the process to meet with a disruptive employee, how to manage conflicts between patients and staff members and between patient families and caregivers and even conflicts totally off the healthcare campus—at home!

The entire process usually takes one to two hours. Compared to the endless hours necessary to prepare for litigation or the cost of not dealing with an issue at all and watching workplace morale disintegrate, two hours is a real bargain for busy administrators and managers. In our experience, proactively addressing problematic situations results in great payoffs: the saving of time and energy and the creative solutions that emerge. It results also in satisfied employees who are invested in their jobs—no need to elaborate on the financial savings of avoiding the recruitment and training of individuals hired to replace those who have left because of inadequately handled conflict. Most of all, it helps to ensure that the health care environment is focused not on internal squabbles or reactions to a disruptive employee, but instead on the clear priorities of patient care and patient safety.

Some of the situations we will discuss include:

  • An argument between two nurses leading to complaints by a doctor that a patient was adversely affected;

  • A public blow-up at one of the clinics between a physician's assistant and a front-desk receptionist;

  • The fallout caused by an indispensable "computer wiz" who is also a disruptive employee lacking in social skills;

  • A food service employee who is trying to deal with a petty and unfair boss;

  • A departmental flare-up among the 15 employees at the laboratory;

  • A financial donor who was a patient who felt a nurse had ignored his wishes;

  • A patient's charge of unnecessary surgery and threat of a lawsuit; and

  • A father's concern that his child had not been given appropriate treatment.

Sound familiar? Whether in the Midwest or any other region of the country, these situations repeat themselves time and time again. Fortunately, there is a solution! Let's get started!

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