reason and scientific inquiry over emotion – can produce an environment that, rather than diminishing conflict, actually fosters its growth.
In response to these findings, we devised a facilitated workshop for
staff to help develop tools to better work through conflict on a day-to-day basis. Leadership was happy to assist in scheduling to try to bring
together all relevant staff.
These workshops focused on the “ladder of inference,” on metaphorically checking your pulse in difficult situations, and on different
frameworks for addressing conflict. These actions are admittedly hard
to do in a surgical setting, given the difficulty of interrupting a surgery to
discuss how one is feeling, as well as the culture of strength and “
thick-skin” inherent to the profession. The groups we engaged with ranged
from approximately seven to 20 individuals. We started with nine workshops, and continued by working more extensively with a smaller group
for another three sessions. Each workshop lasted 90 minutes and was
conducted with the help of two co-facilitators, one of whom was a commercial airline pilot with extensive mediation training.
All staff who attended the workshops were encouraged to be active
participants. However, some were very engaged in the process while
others were more resistant to the idea of sitting together and speaking
about conflict and communication styles. During one meeting, Chelsea
had to detour from the agenda to have an open discussion about the
resistance in the room, which was demonstrated by facial and bodily tension in the opening minutes of the session. After an open conversation,
though most participants were willing to move forward, a few were still
questioning the need. Eventually all were able to engage actively, with the
understanding that no one is perfect and we can all improve on how we
communicate with each other.
At the completion of the workshops, we repeated our initial survey,
along with a few extra questions designed to explore the workshops’
impact in greater depth. In response, we found:
1) A subtle increase in responses expressing satisfaction with
the work environment.
2) An acknowledgement of staffing deficiencies as an underlying
issue contributing to poor communication, teamwork, and
trust. In analyzing this, we saw correlation with Kim’s work
finding that task based conflict in healthcare settings often
transforms into relational conflict.
3) A decrease in percentage of individuals who had experienced
an episode of bullying or disrespect in the past 6 months
(50% down from 62% on our initial survey).
What we did we take away from this project? First, just as Dr. Paul Charlton said in his Spring 2015 ACResolution article, “Conflict Management
Training in Health Professions Education,” when doing conflict resolution
work with this community, you have to bring facilitators with a medical
background to the table. Our non-medical co-facilitators commented
that Chelsea’s medical background as a registered nurse allowed for
much greater buy-in than would have occurred otherwise. While it was
not necessary for all the facilitators involved to have such background,
using a curriculum designed by healthcare professionals, and having at
least one such person involved in facilitation addressed the participants’
concern that the training be relevant to the healthcare environment.
In addition, echoing legitimating themes within the field added to our
acceptance as conflict resolution practitioners. As a registered nurse/
(future) doctor team, we echoed current emphasis on interprofessional
teamwork, especially as it pertains to patient safety. This not only pro-
vided different viewpoints that informed our practice, but also made us
credible in the eyes of the managers and staff with whom we worked.
The background of one of our co-facilitators, a commercial airline pilot,
was also an asset. Medical practice draws heavily on aviation for con-
cepts and guidance in risk management and safety. The adoption of
surgical checklists is one obvious and well-known appropriation from the
field. Having a co-facilitator with an aviation background allowed us to tap
into such expertise, and appeared also to increase buy-in.
As we expected there were also obstacles. Our initial schedule for
the workshops quickly fell by the wayside due to time constraints
and competing training priorities. As the distance from initiation of the
workshops grew, so too did episodes of resistance to the material.
Anecdotally, it appeared that staff who were closer to retirement age,
had been in the field for decades, and had seen many changes over the
years, were more resistant and less willing to actively engage in the
workshops. On the other side of the equation, we perceived that less
senior staff with many years of work ahead, were more engaged in the
workshops and more willing to be introspective.
Where do we go from here? After completing our project, we continued working with management on sustaining engagement with staff
members and continuing to enhance their ability to engage effectively
with conflict. We are also considering the possibility of working with
physicians in the next iteration of this project. Although they are obviously central to the surgical community, we did not include them in our
initial workshops because of timing, administrative, and logistical considerations. When considering this next iteration, we knew some of
the obstacles that could stand in the way of their engagement, such as
limited time, competing training priorities, and cultural norms. However,
based on conversations and observations of other projects that had
succeeded in involving physicians, we believe that with help of a champion within their department and our standing as an interprofessional
team, this could be a fruitful path to follow.
The healthcare field depends on individuals and teams coming together
to communicate and work effectively, often in urgent, stressful situations.
Due to occupational and cultural factors, conflict is a salient issue with a
potential damaging impact on both staff and patients. There is a growing
recognition in the field that to optimize the medical skills at their disposal,
healthcare professionals must also be able to navigate conflict productively. We are encouraged by our project to believe that affecting healthcare
professionals one at time through group training sessions, designed with
input from those with a healthcare background, can help build meaningful
skills in communication and conflict management. And while these efforts
will not reach every individual, over time such work can help build a culture
that effectively deals with conflict, enhances the work environment, and
allows healthcare teams to perform to the highest levels of their ability.
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