Suppose you supervise two nurses who work very differently. One focuses on building relationships with patients and their families and spends a lot of time at the bedside. The other — a computer whiz and your most detailed-oriented record keeper — is more interested in nursing science.
They are both excellent nurses, but when they work together they always seem to clash. Co-workers and patients have begun to notice. What do you do?
The National Conflict Resolution Center (NCRC) has a fresh approach that can be found in the book, “The Exchange Strategy for Managing Conflict in Health Care” (McGraw-Hill, 2013, $22). The center also offers one-day, onsite training for supervisors and leaders in health care organizations, as well as train-the-trainer sessions.
Health care has always been a high-stress work environment, and given the many changes taking place in the field, it’s even more so today.
“The tensions come from several factors,” said Steven P. Dinkin, director of the NCRC and co-author of the book with Barbara Filner and Lisa Maxwell. “Traditionally, the decision-making in health care has been hierarchical, yet many different practitioners must work collaboratively, which gives rise to miscommunication and conflict.
“Secondly, the stakes are very high. In other workplaces, conflict can mean lower productivity and less profit. In health care, it can lead to patient harm. Unresolved conflict has a way of breeding more conflict and creating a culture where patient care suffers and high turnover occurs.”
The Joint Commission has recognized the dangers of conflict by mandating that hospitals manage conflict in a way that safety and quality are protected, and problems are addressed.
Conflict isn’t necessarily a bad thing. “It can create energy and change, but if left unattended it can be destructive. And while it is inevitable, it can be managed,” Dinkin said. “We’ve been working in the mediation field for 30 years and we’re excited to make this strategy available to people in the health care field. We believe it can become a valuable part of a supervisor’s tool kit.”
The Exchange is a four-stage, conflict-resolution process that requires good communication and listening skills, and practice. While mediation is a slow, formal process, the Exchange is informal and can fit into a busy workplace.
Here’s how it works:
Stage One — Once a manager identifies an issue between co-workers, he or she meets separately with each party in a safe setting to hear how each perceives the situation and to inform them that it's being addressed.
Stage Two — The facilitator/manager plans an agenda for a joint meeting.
Stage Three — All participants from the first stage meet with a goal of increasing each person's understanding of the other's point of view, and their role in the unit's mission .
Stage Four — Once everyone has expressed their points of view, the participants are invited to explore options to solve the problem.
“The difference between the Exchange and the normal mediation process is that the manager has a stake in the outcome, and the solution must fit within the structure of the organization,” Dinkin said.
Ideally, if both workers help create the solution, they should be able to solve their own disputes in the future. One key to the process is the facilitator’s ability to ask open-ended questions, listen carefully and respectfully, use positive language, build trust, help decide on a mutual plan and document it to avoid misunderstandings later.
Identifying the underlying issues is important to establishing a real solution — not just mandating a truce, Dinkin added. “In the case of the two nurses mentioned, the real issue wasn’t that the one nurse always seemed to be on the computer; it was that the other felt disrespected when her requests for help were ignored.”
Engaging participants in the process allows a solution to be more sustainable.
“It also gives employees more confidence and a better understanding of their co-workers’ point of view and thinking,” Dinkin said. “Many supervisors tell us that they have used the process successfully in their families and communities. When you can address conflicts quickly and move on, you create a more productive and collaborative workplace, and that’s better for workers and patients.”
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