Seven dispute resolution tips for physicians leading care teams

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I’ve worked closely with many physicians—both personally and professionally--as a full-time dispute resolver for more than 35 years.

In that time, I’ve witnessed some amazing teams and some that were less than amazing.

To help keep the amazing ones operating at a high level and help the others to improve, here are seven insights gleaned from my years as a patient, parent, and service provider to the profession.

1. Get trained. Conflict resolution is more than mere common sense.

If you were promoted from a “line” position to management (e.g., from being one of the doctors in the emergency department to the head of the ED), you should learn how to negotiate from a place of interests, not positions; about “different kinds of minds”; and how to have difficult conversations. While you were learning about medicine, others were studying conflict prevention and resolution.

While we all develop some ability to navigate conflict during our upbringing, there’s a lot more to it than just common sense. Start reading. Get trained.

Training your staff in these crucial areas helps too, as the more conflict resolvers there are, the better.

2. Take psychological safety seriously.

When each member of a medical team feels empowered to offer ideas and critiques without fear of retribution from supervisors or colleagues, when they don’t need to be armored up to deal with harsh remarks at the coffee station, when they can be critiqued constructively, engagement soars. And the result is a workplace that is not only more pleasant, but also more productive.

Research studies have demonstrated that a psychologically safe workplace—modeled by a leader who compliments and rewards those who point out opportunities for improvement, implements rules and regulations regarding interpersonal interactions and enforces those rules even-handedly—is usually a higher-performing one.

3. Understand the three main styles of conflict.

Over our lives, we develop strategies that work for us, and those strategies are the results of a complicated mix of experience, culture, upbringing, and other factors. We tend to repeat what’s worked for us and discard what’s failed.

Broadly speaking, when confronted with conflict, some people become controlling, some accommodating, and some avoidant. These styles have been described, respectively, as high in assertiveness/low in empathy, low in assertiveness/high in empathy, and low in both empathy and assertiveness.

Controllers like to take charge. While that may work in some situations, it can lead to others feeling steamrolled. Two controllers can argue for control while the conflict gets worse. Accommodators put the needs of others ahead of their own, often stifling their own good ideas and ending with a feeling that “I do everything for everyone and no one looks out for me.” Avoiders seldom make conflict worse, but they can bury problems deep in the soil only to find that the problem developed even deeper roots and when it breaks out, it’s bigger than ever.

It's useful to recognize your own conflict style and that of others. Once you understand that people approach conflict differently, you may be able to intervene in your own problems and those of colleagues differently and more sensitively. The hope that everyone will just adopt your style or do things the way you like is both naïve and short-sighted. A wider perspective is more realistic, more charitable and more productive.

4. Listen effectively. Replace judgment with curiosity.

When you hear someone recount a story of how a conflict started, you are likely to have an emotional response to what they say. Perhaps they aren’t acknowledging their role in conflict and that bothers you. You’d like to interject, “It takes two to tango,” but that’s a judgment. If they hear that judgment, they are likely to shut down.

Instead, when you feel the hairs on the back of your neck start to tingle or your brow starts to furrow, use these magic words: Tell me more about that. You can even say that you noticed their voice or facial expression change when they brought up the conflict. An open-ended invitation to expand is more helpful than making a statement.

5. Conflict can be productive.

There are generally two kinds of conflict: task conflict and relationship conflict. Task conflict is defined as a disagreement about the best way to get something done. One person might think the fastest route is via surface streets, and another might think that the highway is quicker. These people share a goal: getting to their destination as soon as possible. Their disagreement involves how to get there. If handled effectively, task conflict is a great way to generate multiple possible solutions to a problem and that will lead to better outcomes.

On the other hand, if the two colleagues start to take the disagreement personally, it becomes relationship conflict, and that’s generally destructive. If one says, “We’re taking the highway,” and the other says (or thinks), “You never treat my ideas with any respect,” the choice of route will leave bruised feelings and may make it difficult for them to work together in the future.

Many conflicts start as task conflict and turn into relationship conflict. If mindful of this distinction, you can have more of the productive kind of conflict and less of the destructive kind.

6. Caregivers need care too.

Medicine is a high-stress field, especially now, with high demand for top-notch care and a shortage of personnel.

To prevent conflict, arrange time for staff to decompress while on the job.

Be supportive and use language that promotes a strong sense of self. This doesn’t mean you should compliment shoddy work, but instead that you call out everyday good work—the kinds of tasks that account for most of what we do. Look for opportunities to say positive things.

Make lists of resources for mental health. Broadcast them widely and make it clear that it’s a good thing to engage in self-care and the care of peers, not just patients.

As Daniel Goleman put it in his book Social Intelligence, “[M]ore emotionally connected nurses had better physical health, as well as a sense of a meaningful mission. And they were far less likely to leave their jobs.”

7. Know when to enlist outside help.

It’s no more a sign of weakness to call in a conflict resolution professional than it is to have an accountant do your taxes or a plumber to fix your leaking sink. Your HR department, your general counsel, and maybe even your ombuds all have their hands full and may not be able to dedicate the time and attention needed to resolve a particular matter.

It’s a sign of wisdom and strength to know when you are in over your head. There are many conflict resolution professionals who are experienced in intra-departmental dispute resolution. They can turn conflict into an opportunity to improve your organization and its employees.

These are just a few insights into how to prevent and resolve conflict among your care team. We hope that these tips motivate you to explore the world of conflict resolution more deeply.

Richard Birke is the chief architect of JAMS Pathways and is experienced at resolving complex, multiparty disputes. With over 35 years of hands-on dispute resolution, he draws on experience in a wide range of disciplines, including mediation, psychology, economics, law, communications, negotiation theory, strategic behavior, and diversity, equity and inclusion, to apply the right tools to every client situation.