3ADDRESS WHAT MATTERS MOST TO HEALTH CARE PROVIDERS Anchor trainings in the types of conflicts that health care pro- viders face daily on the front lines of patient care. This is important o establish legitimacy and relevance, as the conflicts experienced
by clinicians often require a different focus and different skills than
those fostered by many existing training programs.
The conflict paradigms that have reliably had the most reso-
nance in our work with clinicians include: • Dealing with “difficult patients” and de-escalating
tense interactions • Negotiating with consultant services regarding
patient care decisions • Navigating power dynamics and providing
feedback in hierarchical systems • Dealing with inter-personal dynamics within
health care teams
Part of what makes clinical health care conflicts so interest-
ing to work on is that allow almost daily opportunities to apply
a wide range of conflict resolution skills, including principled
negotiation, organizational conflict, crisis intervention, and com-
DESIGN INTERVENTIONS TO TAKE ADVANTAGE
OF THE “HIDDEN CURRICULUM”
Health care professions often involve a long training process.
U.S. physician training, for example, requires a minimum seven
years of focused training, a deliberate process of acculturation in
which physicians are taught a very specific way to think, speak,
and interact with others. In this process, physicians learn by
doing things over and over and over again.
So while it is great to get a three-hour conflict management
module included in a medical school curriculum, to really make
a difference in changing culture, we need to design interventions
to take advantage of the “hidden curriculum”—the way medical
trainees learn from what they see being modeled around them
on a regular basis, which may not be part of (or even consistent
with) the explicit curriculum.
For example, an explicit curriculum might be a 2-hour team
skills training as part of a residency orientation. The hidden curriculum is the hundreds of times we watch our senior residents
hang up the phone after talking with a physician from another
field and say, “What a stupid reason to call.” Or when we overhear more senior clinicians repeatedly belittling colleagues. Or,
alternatively, when I see a physician, with every single patient,
take the time to invite any questions or concerns the patient
might have. The hidden curriculum can be either positive or negative. And in health care fields where the training process often
extends for many years, it is the behaviors we see modeled
every day that are powerful drivers of our own behavior.
INVEST IN CHANGE AGENTS
AT PERIODS OF TRANSITION
A key to successfully accessing the hidden curriculum is to
invest in role models at periods of transition. Our experience
suggests that some of the largest impact and the biggest
opportunities to shape the hidden curriculum come from tar-
geting interventions to audiences such as: • Residents and 4th year medical students • Chief residents and fellows • Early career medical and nursing faculty • Nurse managers • Participants in leadership courses and
courses for new managers
Each of these groups are moving into arenas of increased
responsibility and opportunity for influencing the education
and daily work life of others.
We need to invest more time and more energy in these
change agents, including supporting them over longer periods of time. We should try to build communities of practice
with mentoring and tiered training models, ideally incorporating multiple disciplines within the trainings (i.e., physicians,
nurses, physician assistants and nurse practitioners). This
is both practical and well-aligned with established clinician
GET A PARTNER
Team-teaching in partnership with a respected clinician
is crucial for the success of these interventions. Health care
providers respect the expertise of conflict resolution specialists and value the outside perspective they bring—but only if
those specialists can show how this expertise matters for the
everyday life of a health care professional.
Health care providers are a tribe, with many sub-tribes. It
is hard to penetrate these cultures without a trusted insider
as a guide. It is hard to get the terminology right, hard to
understand the technical nature of the conflicts, hard even
to design an appropriate training course. Our experience has
been that we have a small window of opportunity to gain
participants’ trust, and having a partner from the sub-tribe
is key to this.
There is growing demand for more conflict resolution specialists to work on health care, but some domains of health
care conflicts are more accessible than others. These include: • Management and leadership skills courses.
People are asking for training in principled
negotiation and how to manage competing interests.
This is an accessible entry point for many conflict
resolution professionals that often does not require