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INTRODUCTION

Clinical Take-Aways

  • Conflict within and between health care teams is inevitable. The important thing is to successfully manage the conflicts that arise.

  • The main objective for the clinician trying to manage conflict with fellow professionals is to prevent substantive conflict (over issues) from evolving into affective conflict (involving personalities and emotion).

  • An “integrating” or problem-solving style is recommended as the best long-term strategy for addressing most conflicts.

  • Clinicians should:

    • Try to separate people from the problem through active listening and empathizing;

    • Focus on interests, not positions, by framing the conflict as a problem to be solved collaboratively;

    • Generate options for mutual gain via brainstorming;

    • Decide on objective criteria by identifying shared principles.

SECTION 10.1: INTRODUCTION

This book is chiefly about negotiating with patients. A little over a half century ago, this might have been enough. In the community, most physicians were solo practitioners supported by a small, hand-picked staff; in the hospital the lines of power and authority were so clearly drawn that there was little doubt whose opinion actually mattered.

As health care developed in sophistication and complexity, however, the old models no longer sufficed. In the 21st century, health care is rarely delivered by a single individual acting alone. Most patients with complex illnesses are—at one time or another—cared for by teams of medical specialists; nurse practitioners and nurse anesthetists; physicians’ assistants; nurses; medical assistants; pharmacists; physical, occupational, and respiratory therapists; imaging technicians; and phlebotomists, among others. Effective health care delivery often depends upon the coordinated functioning of multiple team members.

Although care coordination surely places technical and administrative demands on health care systems (e.g., IT infrastructure to support communication and manage population health; protocols for connecting worried parents with the on-call pediatrician at night), an additional critical requirement is effective conflict management. Without diminishing the importance of organizational climate, culture, and resources (e.g., a dedicated “ombuds” to help with disputes), most conflicts in health care settings are resolved by the parties themselves. In this chapter, we examine the nature and types of conflict between health care professionals and consider negotiation strategies they can adopt to resolve, attenuate, or manage conflicts in the interest of providing the best possible patient care.

SECTION 10.2: TYPES OF CONFLICT IN HEALTH CARE

Conflict is defined as a “process of social interaction involving a struggle over claims to resources, power and status, beliefs, and other preferences and desires.”1,2 In essence, conflict involves competing interests or positions between individuals or groups in what appears to be a zero-sum situation—where gains on one side imply losses on the other. Conflicts in health care can arise in almost any setting over almost any issue. However, not every disagreement is a “conflict.” To qualify, a dispute must exceed a threshold sufficient for the individuals involved to experience the situation as problematic. This threshold is ...

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