ACVP Management Corner

Improving Communication Amidst Conflict: The Cath Lab Manager’s Guide

Jeffrey N. Doucette, MS, RN, CEN, CHE, CNAA, BC Founding Partner, Doucette & Associates Durham, North Carolina
Jeffrey N. Doucette, MS, RN, CEN, CHE, CNAA, BC Founding Partner, Doucette & Associates Durham, North Carolina
Conflict Management Creating a healthy work environment has been demonstrated as one of the most significant factors in reducing medical errors, improving patient safety, reducing work-related stress, and enhancing patient care delivery systems. Creating a positive and healthy work environment is a challenge for all cath lab managers. An understanding of your organization’s culture in handling conflict, the costs of conflict, the impact of organizational complexities, barriers to managing conflict, and strategies for effective conflict resolution are essential.1 Changes in the healthcare delivery system over the past two decades and the trend to move decision-making to the bedside have resulted in the dismantling of traditional hierarchal models. Many have been left to wonder who is really making decisions in healthcare organizations. This uncertainty, coupled with increasing complexity in the patient care environment, creates many opportunities for conflict. The intuitive idea that conflict among healthcare workers is counterproductive to patient care was proven by Forte.2 According to a study of the American Management Association, nursing managers spend an average of 20% of their time dealing with conflict management. Furthermore, the study identified conflict management skills as being rated equally important or slightly more important than planning, communication, and decision-making.3 Causes of Conflict Understanding how conflict arises can be very helpful to the cath lab manager in anticipating situations and dealing with escalating issues in the workplace. While sources of conflict in healthcare may seem endless, they are generally limited to certain root causes. A common source of conflict in healthcare is incompatible goals between individuals or groups of individuals at work. For example, an employee does not agree with a new management policy regarding time and attendance. The employee wants flexibility in his schedule and the manager expects employees to be ready to work on time. One can easily see how this level of differing goals could lead to conflict. A second source of conflict is inherent in the different personal values we bring to work. There are employees who, for example, enjoying going out for a drink after work, while others prefer to leave work and go home to spend time with family. Division and distancing can come to exist between varying groups which can frequently lead to conflict. A third factor contributing to conflict in the workplace is the extent to which we rely on others to complete our work. A fair amount of conflict can arise between nurses, technologists and ancillary support staff around their interdependence on one another to achieve outcomes for patient care. In addition to interpersonal sources, conflict can arise between individuals and the organization. The availability and distribution of resources in the workplace can be a significant source of conflict. “Resources” can be anything from budgetary dollars to office space or even time spent with the boss. Employees consistently report in numerous published surveys that “having the equipment I need to do my job” is a top ten job satisfier. Another source of organizational conflict is inherent in the distribution of power. People working in the best interest of the organization can inadvertently create conflict by “stepping on someone’s toes” because they do not understand the organizational hierarchy or politics that are part of any group. Finally, employees in healthcare organizations generally feel that policies are unpredictable and constantly changing. Working in a highly regulated environment, there is a tendency to have a policy in place for every action an employee is expected to perform. When these policies are not congruent with accepted practice standards or are not consistently enforced, they can be a major source of conflict between the organization and its employees. Effectively Managing Conflict There are some basic principles that apply to any counseling session with employees that will help managers prepare for a discussion. First, write out your thoughts about the situation and how you might handle it with the employee. Ask yourself if your thoughts are rational and if they paint a view of the situation that is as objective and free from emotion as possible. Second, write down some key phrases or outline the conversation that you will have with the employee when you meet. Third, always schedule a time to meet with an employee. This gives credibility to the fact that the meeting is serious and important enough to you as a leader for dedicated time on your schedule. When you are meeting with the employee, deal with only one topic at a time and be specific. Use concrete examples and always keep the conversation focused on the issue at hand. Finally, focus your expectations on the specific behavior that you want from the employee. For example, “I need you to clock in and out every time you are working,” is more direct than “I need you to pay more attention to detail when you come to work and go home.” Active listening is an effective method for dealing with conflict. It is imperative that the cath lab manager has a clear understanding of the perceptions of the parties involved in the conflict. It is also helpful to paraphrase the issue to the employee to ensure that everyone is on the same page. Powell suggests the following techniques for effective active listening:4 • Do not share anger. Remain calm and matter-of-fact. • Respond constructively in both verbal and non-verbal language. • Ask questions and listen to the answers. • Separate fact from opinion, including your own. • Do not respond hastily. Plan your response. • Consider the employee’s perspective first. • Help the employee find the solution. Ask questions and listen to responses. Do not be paternalistic. Many times employees simply want to be heard and, this, in and of itself, can be an effective way to deal with conflict. Valentine identified five potential conflict management strategies and looked at how nurses in particular utilize these strategies.5 Avoidance, compromise, collaboration, accommodation, and competition are widely accepted strategies for dealing with conflict. Valentine identified “avoidance” as the most frequent conflict management style chosen by staff nurses, while nurse leaders were split between “avoidance” and “compromise.” Avoidance is a strategy which allows both parties to cool down. When the issue is not critical, giving the involved parties time to think about the situation and scheduling a later meeting date can be effective. The leader must follow through by scheduling a follow-up meeting as soon as possible. Compromise is closely related to avoidance. Taking the middle ground may lead to a resolution of the conflict. Compromise can also be a temporary solution used to allow the parties to work out a more permanent solution. Accommodation is effective when the issue is more important to the other person. This technique maintains a spirit of cooperation and develops employees by allowing them to make decisions about the situation. Collaboration is generally viewed as a win-win approach to conflict management. When a collaborative approach is used, both parties make concessions and work together to improve the overall outcome of the issue that resulted in conflict. This method is widely practiced and accepted in healthcare organizations. Finally, competition as a conflict management style means the nurse leader exerts the power of his or her position over subordinates. This approach is viewed as disciplinary in nature and does not allow the subordinate to participate in the conflict resolution process. As a manager, choosing the most effective method to resolve conflict is a critical step with employees in the coaching process. The challenge of managing multiple levels of providers with varying levels of autonomy requires skills beyond basic management theory. The ultimate goal in conflict management is to minimize the long-term effects of conflict on the group’s performance and to keep the parties “whole” in the process. Jeffrey Doucette can be contacted at References 1. Filley AC. Types of sources of conflict. In: Berger MS, Elhart D, Firsich SC, et al, eds. Management for Nurses: A Multidisciplinary Approach. St. Louis, MO: C. V. Mosby; 1980: 154-165. 2. Forte PS. The high costs of conflict. Nursing Economics 1997; 15: 119-123. 3. McElhaney R. Conflict management in nursing administration. Nursing Management 1996; 24: 65-66. 4. Powell JT. Stress listening: Coping with angry confrontations. Personnel Journal 1986; 65; 27-29. 5. Valentine P. A gender perspective on conflict management strategies of nurses. Journal of Nursing Scholarship 2001; 33: 1, 69-74.