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Features: Managing conflict

25 March 2009

A Medical Director looks at how to deal with difficult situations in the workplace.

Dr Charles Gutteridge, Medical Director at Barts and the London NHS Trust, looks at how to deal with difficult situations in the workplace.

'Understanding how conflict arises and finding ways of harnessing the creative energy of conflict should be core skills developed by all doctors.

At the bedside, most, but not all, doctors develop an intuitive understanding of how to manage difficult discussions with patients. Those who do not may experience a breakdown in communications with their patients and are particularly at risk of complaints from patients and their families. While communication skills are now universally taught in medical schools, there remains a gap between knowledge and experience of conflict resolution for many doctors.

The risk of conflict is even greater in the workplace and is almost inevitable in the face of the competition for healthcare resources in all healthcare systems. Breakdowns in professional relationships are particularly likely when individuals use different ways of interpreting problems.

The aim of any resolution process should be to harness the dynamics for change that conflict produces. Many times, effective resolution will allow individual goals to be achieved without undermining others, while improving team cohesion and developing self knowledge.

The starting point is to develop in team leaders an extreme sensitivity to signs of danger. This requires such leaders to balance their determination to get things done with high levels of humility and an ability to recognise when plans are not working.

The underlying code of behaviour within the team must be one of mutual respect. Several ways of practically supporting this can be developed both internally and externally within an organisation or team (box 1).

Organisational development

While some conflict is inevitable in teams and may be a constructive tension for change in certain situations, highly performing organisations and leaders will have developed methods of early detection and resolution.

The key for healthcare organisations is to construct a method for quality improvement based on patient expectations. The supporting systems which may help to achieve this are set out in box 2.

Box 1 Internal support peer pressure mentoring systems unambiguous application of policies performance report. External support coaching mediation system reviews advisory organisations, Royal Colleges, NCAS etc.

Box 2 Organisational development clinical appraisal systems aligned organisational and personal objectives performance data and management training and personal development planned time for leadership development.