November 2003

Physicians are often expected to be team leaders. From directing housestaff teams to running ICUs or office groups, we cannot avoid having to deal with groups of diverse individuals. Conflict is inevitable whenever diverse groups of people work together. In the last two columns, we have stressed the importance of communication in effective management and leadership; making sure that goals and expectations are clearly understood by all; and giving timely feedback. While these steps can minimize conflict, they do not prevent it entirely. As a manager, your team depends on you to respond in a fair and decisive manner.

Given that conflict management is not a part of standard medical school curriculum, many physician managers tend to avoid dealing with conflict in hopes that it will go away. A common attitude is that we have more important things to deal with instead of "petty" conflicts between individuals. Too often, the idea is to let the involved parties work it out by themselves. The danger is that short-term problems may evolve into chronic festering sources of resentment that eventually will affect your team's efficiency and productivity. Conflict, if handled in a positive manner, can be beneficial by bringing about needed changes.

In resolving conflicts, communication between the involved parties is usually needed in order to come to some kind of mutual agreement. Make the involved parties responsible for coming to some kind of resolution. Realize that there are some issues, e.g., violence, gender or cultural harassment that should not be tolerated. After documenting the incident, this should be made clear to the involved parties. Also, you may not always have to start off with a group discussion. It may be helpful to speak with the individuals involved and then to bring them together to work on the resolution. The danger of this approach is that you may find yourself getting drawn into one person's viewpoint and it may impede your ability to be an impartial mediator.

Set the Ground Rules
Your job as team leader is to mediate the resolution process and keep the discussion on track. To do this, you must do your best to be objective and avoid the impression that you favor one party over another. At the beginning of the discussion, set the ground rules. Explain the purpose of the discussion and that everyone will have a chance to have his/her say. Participants are expected to be courteous and to listen while another person is speaking.

In order to identify the issues, give everyone a chance to state their side and be heard, without interruptions. This may be difficult because people may be emotional at the outset and reflexively will tend to interrupt a speaker if they hear something they don't like. Avoid being drawn in by hostile or emotional comments. Above all else, you must remain impartial. Be prepared to intervene to give everyone a fair chance at stating their side as well as to make sure that the discussion stays focused. If needed, put your hand up and say "STOP" in a firm tone. Be empathetic ("I understand that you're upset, but its Smith's turn to speak; you'll have a chance to state your side," etc...) Reiterate the ground rules and that everyone will have their chance to speak. Try to avoid sounding patronizing. It is also important to keep the speaker focused on the specific problem. Avoid hearsay. Ask for what the speaker actually saw or heard him/herself.

Listen
Listen, really listen to what people are trying to say. Often, a precipitating incident may seem minor but actually results from other deeper sources of resentment, such as jealousy of a co-worker or perceived mistreatment by a colleague. In this case, you may start to hear a litany of unresolved conflicts that date back many months or even years. As much as possible, keep the discussion focused on the current conflict but be aware of what the larger problem may be. It is important that you be able to tease these issues out and to state them openly so that the root cause of the conflict can be addressed.

Clarify the Issues
At the end of the discussion, once you have figured out what the real issue is, summarize what you have heard so that everyone understands what is being discussed. First of all, this focuses everyone's attention on the issues, not the personalities, and also shows that the concerned parties can at least agree on something! Often, one of the most difficult problems in these types of discussion is getting each party (and yourself) to accept each person's interpretation of the event as a valid one. However, a key step in avoiding future conflicts is realizing that our actions or words may have unintended consequences.

Work towards a Resolution
Involve all participants. It is important that the solution(s) appear to come from the involved parties, not from you. What are the options? First, identify what can be changed or worked on. Realize that you cannot please everyone, and there are institutional rules that must be followed in every organization. If a problem does not appear to have an immediately identifiable solution, try to identify a potential work-around or a compromise solution.

Take your time, if at all possible. Avoid being pressured or coerced into a solution. If needed, have everyone take a break and come back refreshed and cooled off. Ask for suggestions. Some may come across as flippant or angry. If at all possible, repeat them back in an impartial, constructive manner. Avoid generalities like "Stop being bossy."Instead, try to elicit specific suggestions for changes in behavior or policy. Make sure the proposed change or plan is clearly understood by the involved parties.

Follow-up
Be sure to schedule a follow-up session to review how things are working out. This holds the involved parties accountable for implementing any proposed plan. It also provides an opportunity to identify unforeseen problems as well as to give positive feedback if things are going well.

References:

1. Foster, Mary. Conflict in the Workplace. April 2000,
    http://www.workplaceissues.com/arconflict.htm.
2. "Management Tips" Workplaceissues.com,
   http://www.workplaceissues.com/mgttips.htm.
3. "Resolving Workplace Conflicts" University of the Sciences in Philadelphia,
   http://www.usip.edu/affirmativeaction/resolvingworkplaceconflicts.shtml.
4. Poter, Beverly. From Conflict to Cooperation.
   http://www.docpotter.com/frocon_article.html.