Does this sound familiar?
“Our organization is suffering from the cancerous wrath of interpersonal conflict, back biting and unregulated angry discrimination that threatens our human resource infrastructure and compromises our ability to deliver superior safe patient care. Our mission statement is under attack and we must change the culture of organization, implementing several critical pathways to stem this non-physical work place violence.” The anger and negative attitudes present impediments to the organizations cohesive growth and the partnership we as healthcare professionals represent in shepherding the infirmed and their families through their healthcare crisis.
We are collaterally victimizing the patient and their families as they look to us for professional medical care and compassionate understanding during their crisis. Instead we act in a self-serving and destructive manner when we fail to institute conflict management rules and techniques that demand everyone on our staff respect and create a harmonized work environment that is supportive, respectful, mindful and professional to their co-workers. Examples of nurses fighting, doctors arguing, or doctors belittling nurses, are all in direct disdain of quality care mandates and these recurring issues demand much needed management intervention to quickly deal with these quality improvement threats.
Let us scientifically investigate the impact the effects of this hostile work environment. Referencing Maxfield et al work with the AORN and AACN on “The silent treatment.” we see the discussion on this 2010 study of 6500 nurses and nurse managers discussed the impact of compromised communication for any reason in the healthcare work environment. Hostility between personnel creates this miscommunication and prevents sharing critical patient data. As this study points out, “creating a culture where healthcare workers speak up…the study shows that healthcare professionals’ failure to raise the following three concerns when risks are known undermines the effectiveness of current safety tools: 1. Dangerous shortcuts 2. Incompetence 3. Disrespect.” So what we see in our personnel hostility is profound disrespect for each other and our system, when a failure to communicate puts patient safety directly in harm’s way.
In addition, we must consider the tension created through unresolved interpersonal conflicts a form of lateral bullying and workplace violence. This issue is raised in several respectable journals and on-line resources. In 2004, Gerardi addressed this as a critical need in any work place and we must consider similar solutions within our hospital environment. He described the use of mediation techniques to identify conflict early and develop a plan to resolve it by “listening, re-framing the concerns raised, identifying commonalities and clearly defining decisions”. We have at our disposal several well tested dispute resolution techniques and several people within our organization trained or expressing a desire to be trained in this professional management role that our organization desperately needs. As Maxfield solutions suggest “… when it comes to creating healthy work environments that ensure optimal quality of care, individual skills and personal motivation won’t be enough to reduce harm and save lives unless speaking up is also supported by the social and structural elements within the organization. Changing entrenched behavior in healthcare organizations will require a multifaceted approach and, to this end, the authors provide a series of recommendations leaders can follow to improve people’s ability to hold crucial conversations.” We must adopt guidelines which are memorialized by employee contractual procedure and an institutional commitment at every level, from senior management to hospital personnel and provider-nursing communication. The doctrine we create and offer for ratification includes a methodology to identify and address access to our system of conflict management for the employees. Here, we outline for reporting abuse; a safe method to report this abuse and not suffer discrimination, retaliation, or termination; the methods our hospital will take to address this report and remedy the issue; the method of investigation of accusations and corrective education when abuse has occurred; and lastly, the follow up communication methods for the person reporting the initial issue. Indicate how the reporting person will receive information about the outcome of the abuse report.
We have excellent opportunities to improve our healthcare delivery and minimize errors and omissions by supporting conflict management in healthcare. First, we must present a unified and cohesive action plan to the employees but allow them to embrace the concepts and add to the identification process and ideas for resolution of these conflicts as they will then recognize that each employee is a key stakeholder in this process. In particular when we quote communication statistics of Angermeier, et al and demonstrate how this will protect our patient while improving the atmosphere in their work environment, we are confident we can get them to buy into the need for this professional outlet and methodology. The opportunities inherent in a conflict management system include: recognition of conflict as an indicator to allow early identification of problems, promotion of a proactive response to problems and conflict, encouragement of a culture of mutual respect, open communication, and problem solving during inquiry or intervention relating to conflict, and a means of working towards potential resolution. The tenants of our management system will emphasize a willingness to acknowledge existence of conflict; open communication between all team members; dealing with conflict within an environment of mutual respect; acceptance and tolerance of different perspectives through the process; commitment to fundamental fairness; educating all stakeholders about conflict management in healthcare; continually reflecting on and modifying our policies and procedures with input from every employee stakeholders and then holding our employees accountable to use the conflict management process.
In summary, we believe the JCHO mandate of 2009 demands we pay attention to these issues and that that the interpersonal conflict between our two nurses locked in angry avoidance exemplifies the difficulty our organization has with poor communication and this is a very real and present danger to our patients. We cannot tolerate this behavior and provide a safe and effective as well as compassionate work environment. We implore the administrative governing body to adopt techniques of conflict management into the professional training of every employee and make the training and surveillance of our organization in dispute supervision a top priority going forward.