Duties and responsibilities

Expectations of physicians in practice

Conflict between physicians and what can be done about it

Originally published December 2015
P1505-3-E

Can’t we all get along? The popularity of a workshop by that name at the CMPA’s 2015 symposia series reflects a desire by physicians for information about resolving conflict with colleagues. Interest in the topic also highlights a growing recognition that professional behaviour promotes safe medical care, and is important in the doctor-patient relationship and with physician colleagues — and indeed among all colleagues in the workplace.

Ideally there would be no conflict in the workplace or elsewhere. But the reality is that conflict is inevitable in both our personal and professional lives. Rather than fearing or avoiding conflict (as is often the case), it can be seen in some cases as a positive opportunity to better understand other points of view, to grow as an individual, and to improve communication and interactions within an organization.

While many everyday problems can be easily resolved, unresolved conflicts that are allowed to fester can lead to a toxic work environment, heightened anxiety and stress, and even professional burnout. In a healthcare environment such situations can negatively impact the quality and safety of patient care, which in turn exposes providers to greater risk of liability.

Causes of conflict

Conflict can arise from well-intentioned but poorly communicated expectations, shifting priorities, or lack of resources. Conflict may result when there are competing perceptions, goals, or values about an issue where people care about the outcome.1 In healthcare, competition for limited resources and the interdependencies among health professionals create conditions for disagreements that may escalate into conflict.

Impact of conflict on patient safety

Addressing conflict is important to achieving a workplace culture that values respect and collegiality. Ignoring or mismanaging conflict may not only be detrimental to care providers’ workplace engagement and personal well-being, but it may also create unsafe conditions that can lead to adverse outcomes for patients.2 Health professionals working in an environment of simmering conflict generally do not communicate effectively and may perform suboptimally.

Styles of managing conflict

The CMPA Good Practices Guide looks at various styles of handling conflict, as elaborated by conflict experts. Some styles are better suited to maintaining or improving relationships, while others are more likely to be used to achieve goals.

  • Avoiding: While avoidance means the issues are likely to fester and cause frustration, it can be useful as a temporizing measure when the issues are of low importance, when more time is needed and delay is inconsequential, or when emotions are too raw.
  • Competing or controlling: A competing or controlling style can be useful when quick decisions and actions are required, such as during emergencies or when reaching a goal is more important than what others think. However, creative solutions may be lost, and a climate of fear and resentment may surface if diverging points of view are repeatedly ignored.
  • Compromising: Compromise is likely to result in a middle-ground resolution, which may be suitable for time-sensitive issues of low importance, and when other solutions have failed and a temporary solution is needed. But it may mean the real issues fail to get addressed and may result in dissatisfaction among all parties.
  • Accommodating: An accommodating style may be useful when goodwill is desired to resolve conflicts of limited long-term importance and when pushing a particular view would damage the relationship. However, “giving in” too often may build later resentment.
  • Collaborating: A collaborative style is assertive yet cooperative and attempts to satisfy all parties equally. It is most useful for arriving at creative, long-term solutions, and to sustain relationships and a positive environment. While it is best to collaborate when an issue is too important for compromise, it can be time consuming and lead to frustration if the process for reaching a final decision is regarded as too slow.

Tips for resolving conflict

Conflict resolution is the subject of a great deal of literature and numerous professional development programs; we will touch on a few practical tips here.

Active listening and effective communication are the keys to de-escalating and resolving conflict. Better communication starts by applying the maxim, “Seek first to understand, then to be understood.”3 As Dr. Michael Kaufmann of the OMA Physician Health Program advises, “Planning to listen is a conscious choice and a deliberate act. Silence is your tool. Head nodding and similar gestures at the right time demonstrate active listening. Clarifying questions to understand the other’s perspectives are signs of co-operative listening.”4

Individuals involved in conflict may see issues differently or want different outcomes, but through good communication they should be able to identify underlying common interests. When in conflict situations, physicians should focus on these interests rather than the position the conflicting party is taking. They should strive to understand their own needs and the needs of the other individual, and to explore options on which both parties can agree, especially if patients are involved. Focusing on the issues rather than on personalities helps prevent personal attacks that can further aggravate the situation. Finding common ground validates the individuals involved and moves them closer to reaching a solution.5

Escalation of disputes can be avoided by calling a “time out” in which the parties agree to disagree and revisit the issue at a later time. When the conversation does take place, it may be more effective to use statements that begin with “I” (and “but” is avoided), and if the parties can speak freely in a private setting. The help of a neutral party to mediate the conflict may also be beneficial.

While there are system-level mechanisms — such as workplace legislation, College sanctions, and institution policies and procedures — that effectively address specific incidents of disruptive behaviour, respect and civility cannot be legislated or otherwise imposed. These must be woven into the fabric of an organization and the people who comprise it. And when conflicts occur, as they inevitably do, the participants can use various proven tools and techniques to resolve them. Physicians in leadership roles, for their part, can help by fostering a culture of respect, setting clear expectations, modelling exemplary behaviour, and facilitating access to training in such areas as teamwork, communication, and conflict resolution.6

Helpful CMPA resources

In addition to symposia and regional conferences offered to its members, the CMPA provides other helpful resources. For example, the CMPA Good Practices Guide includes a section titled "Dealing with conflict", and our medical officers are available to provide individual assistance and collegial support.

Additional reading

  • Getting to Yes: Negotiating Agreement Without Giving In, by Roger Fisher, William Ury, Bruce Patton
  • Crucial Conversations: Tools for Talking When Stakes are High, by Kerry Patterson, Joseph Grenny, Ron McMillan, Al Switzler
  • Difficult Conversations: How to Discuss What Matters Most, by Douglas Stone, Bruce Patton, Sheila Heen
 
 

References

  1. Marshall P., Robson R., “Conflict Resolution,” Royal College of Physicians and Surgeons of Canada. Accessed July 8, 2015 at: http://www.royalcollege.ca/portal/page/portal/rc/resources/bioethics/primers/conflict_resolution
  2. Ibid
  3. Covey, S., The seven habits of highly effective people. New York: Simon and Schuster, Inc, 2004, p.247
  4. Kaufmann, M., “The Five Fundamentals of Civility for Physicians,” Ontario Medical Review, (March 2014) Vol. 81 No.3, p.13
  5. The Canadian Medical Protective Association, “Dealing with conflict,” Good Practices Guide. Accessed August 2015 at: https://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/professionalism/Dealing_with_conflict/methods_for_handling_conflict-e.html
  6. The Canadian Medical Protective Association, The role of physician leaders in addressing physician disruptive behaviour in healthcare institutions, A Canadian Medical Protective Association Discussion Paper, 2013, p.11. Accessed August 2015 from: https://www.cmpa-acpm.ca/documents/10179/24871/13_Disruptive_Behaviour_booklet-e.pdf

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.