5
• Team-based domains.
With the rise of accountable care organizations and
other team-based systems of health care delivery
comes a much greater emphasis on functioning
efficiently in large teams, with an accompanying
need for more effective conflict management
skills for team members. There is much demand
and many new opportunities here, but training
interventions often need to be tailored to specific
roles. Working on these domains typically requires
clinician-partners for relevance. • Clinical based domains.
On issues of difficult patients, dealing with
colleagues, and how to give feedback and work
within hierarchical fields, buy-in hinges on clinician
guidance and typically a clinician as a co-trainer.
Across all domains there is typically one thing in common:
almost every health care professional is busy and overstretched.
Unless the examples, case studies, and scenarios are familiar
and drawn directly from their setting and work, trainers won’t
keep medical trainees engaged.
BORROW FROM WHAT WORKS
IN MEDICAL EDUCATION
Clinicians typically learn by doing things over and over. Be
experiential in trainings. Focus on coaching and real-life scenarios. Make use of “standardized patient encounters,” the
professional actors trained to enact specific types of clinical
interactions and used frequently in medical education simulation centers. Use the pressure of performing in front of peers
to your advantage in fish-bowl scenarios with standardized
patients, a widely used and well-received element of common
medical education models.
CHALLENGES
Despite the demand, health care is not an easy field for conflict management professionals to work in. Some notable
challenges include: • Time limitations.
Clinicians are busy, necessitating trainings that
are often shorter than desired. It can be difficult to
work with individuals longitudinally. But there are
opportunities. For each of the change agents that I
mentioned above, there are ways to help them find
time for training. • Need for an inside champion.
It can be difficult to make the first connections in this
field, particularly with physicians. But physicians only
represent one part of the field. Nursing programs,
nurse managers, patient safety departments, health
care leadership courses, physician residency directors
at academic medical centers, Physician Assistant and
Nurse Practitioner courses all may represent more
accessible opportunities to find internal champions. • Increasing the capacity of clinician
partners as facilitators and trainers.
When conflict management training interventions
are initially successful, this often leads to requests
to scale up trainings to larger (sometimes hospital-wide) audiences, a prospect that can be difficult to
accommodate. Mentoring clinicians to help them
assume increasing responsibility as facilitators,
coaches, and teachers in future conflict management
trainings can be key for this.
CONCLUSION
U.S. health care is going through a period of immense change,
and the amount of conflict in the field is only going to increase.
The field warrants more attention from more conflict resolution
specialists. The benefits are considerable.
When Mary’s physician finally gave up and left the room
to call the department chair in from home to deal with the
situation, I took a risk and stayed in the room alone with the
sister. I thought there was little to lose at this point, so after a
period of silence I said, “I am sorry about your sister’s cancer. It
seems like this has been a very stressful experience.”
She stared at me, and I thought she was going to lash out
again. Instead, she burst into tears. “I am so worried about my
sister,” she sobbed. “I am her only advocate. I am scared she
is going to die and I need to know that I have done everything
possible to help her. A surgeon at this hospital treated my
breast cancer five years ago, and I am hoping that someone
here can help my sister. I just don’t know what to do.”
She and I talked through a plan that could meet her interests.
When the physician returned to the room, the sister said to the
physician, “I am so sorry for being mean to you. I don’t need to
speak with the department chair. Thank you for helping me to
help my sister.” We made a few phone calls to enact the plan,
and the woman on her way out of the emergency department
hugged every person who was involved with her sister’s care.
Every medical professional has the ability to intervene in this
way. And if we can keep changing health care cultures, more of
us will.
Almost every health care professional is busy
and overstretched. Unless the examples, case
studies, and scenarios are familiar and drawn
directly from their setting and work, trainers
won’t keep medical trainees engaged.
