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At St. Sonia's Hospital, The Exchange process is a key part of their Integrated Conflict Management System (ICMS). For those unfamiliar with the concept of ICMS, it is a graduated system for addressing conflicts. At its lowest level, only the disputing parties are involved. Individuals are encouraged to make an effort to speak to the person they perceive has offended them. Because of this, many organizations that have an ICMS system of conflict resolution offer communication skills workshops so employees can gain skills in giving and receiving effective feedback.

If the one-on-one discussion is not successful or is not attempted, people can contact their supervisor or manager, who then can convene and facilitate an Exchange process. The Exchange is an ideal process for the next step. At times, neither employee has initiated a conflict resolution process but the manager sees a need to convene one. Most disputes are resolved at this point, but there are other levels available should they be needed, including professional mediation by an outside neutral.

Many healthcare facilities, as well as corporate businesses, schools, and other institutions, have adopted such a system as a way to manage the conflicts that occur in every workplace. We're talking about the kinds of conflicts that, if not addressed, result in enormous costs, both financial and personal. Unaddressed conflicts or mismanaged conflict resolution procedures result in high staff turnover, low morale, and expenses associated with litigation, which in turn lead to a poor work product and an unacceptable bottom line.

In the healthcare industry, the fundamental concern of patient safety may be threatened by these conflicts. There have been studies to indicate that these conflicts, which are most often rooted in miscommunication or lack of communication, can even lead to medical mistakes. When human beings are involved, accidents and resulting errors will always happen, but some errors are not accidents. Errors caused by lack of a clear understanding of what is needed or by the inability of individuals to speak up constructively for themselves in an inherently hierarchical culture are not inevitable. It is possible to greatly reduce the occurrence of errors by introducing new protocols of respectful communication, together with new processes that deal with conflicts stemming from communication failures. The Exchange, including the techniques it utilizes, is one of those processes; it empowers employees, at all levels, and has had demonstrable success.

In recognition of the importance of managing conflict, in 2009 the Joint Commission, an independent, not-for-profit organization that accredits and certifies healthcare organizations and programs in the United States, issued recommendations that have been heralded and implemented by conscientious healthcare providers throughout the country (see Appendix B). St Sonia's is no exception.

The good news is that chronic, low-level conflicts can be dealt with respectfully and successfully. There is dignity and self-respect in dealing with an issue and speaking up ...

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