Managing Conflict and Tension within a Healthcare Team

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Workplace conflicts may be inevitable in all professions imbued with a hierarchical structure. However, the consequences may be especially dire when the healthcare team is rendered dysfunctional due to conflict. In today’s multidisciplinary healthcare systems, the physician is fortunately no longer perceived as an infallible authority, yet tensions may arise when senior members of the team fail to create a culture wherein junior members can voice important concerns and share critical insights that may affect patient care. When conflict permeates the workplace, the hierarchy jeopardizes patient safety and compromises worker efficiency and productivity, leading to burnout, job dissatisfaction, and higher turnover rates.

The origins of conflict among members of a healthcare team, which may include attending physicians, mid-level providers, nurses, technicians, and residents and medical students, are manifold. Obvious culprits include poor communication skills, failure to pull one’s weight on the team, delivering harsh or inappropriate criticism, inability to manage negative emotions such as anger, preferential treatment, and usurping responsibility from other team members.

Unfortunately, some healthcare employees who have felt disrespected by authority figures relish the rare opportunity to return the favor when a novice trainee joins the team. As a third-year medical student, I was the bewildered recipient of several of these “power trips” during my first few times in the operating room, when hostile injunctions to maintain the sterile field and alter my body positioning from the circulating nurse and scrub tech left me almost incapacitated with anxiety by the time I was expected to finally participate in the case by closing the surgical incision. I was woefully unprepared to handle the destructive dynamic in the operating room, and I wish that I had exercised better coping techniques, rather than my preferred strategy of avoidance. While it is worthwhile to avoid a confrontation over a genuinely trivial matter – i.e. “don’t sweat the small stuff” – the misery and insomnia that I experienced after the case ended indicated that my experience was not an otherwise negligible nuisance during a stressful workday.

A junior member who is confronted with hostility should seek to identify the root cause of the conflict and tactfully remedy the situation in a way that allows the junior member to retain dignity and the senior member to “save face” during the interaction. Ideally, a conflict between team members should be prevented from escalating as soon as the first signs of trouble are recognized. For instance, a junior trainee who is introduced to a new environment may seek to clarify expectations from the more experienced member and request help and feedback to rectify any behaviors that are inciting the negative behavior.

All team members reserve the right to be treated with professionalism and respect, but when this covenant is violated, an assertive strategy may be the most beneficial in terms of reducing workplace stress. Indeed, highly experienced nurses whose conflict-resolution styles were characterized by a dominant and problem-solving approach that sought to gain acceptance of their viewpoint had higher rates of job satisfaction (Tabak 2007). Less experienced members of the team may benefit from framing the conflict as a learning opportunity and taking ownership of an error (real or perceived) in order to engage in a problem-solving dialogue with the other party. If a team member exhibits rage, profanity, or belligerence, this signifies that an intermediary should be involved to prevent the appearance of a personal attack and escalation of threatening behavior. Ultimately, if physical violence or illegal discrimination (based on sex, race, gender orientation, religion, or other attributes) is implicated in a conflict, referral to a higher authority may be essential to ensure that individual safety and civil rights are protected in the workplace.

Critically, the care of the patient should never be compromised as a result of an interpersonal conflict. All members of the healthcare team possess an ethical and moral obligation to advocate for the safety of the patient, and the authority of the most junior team member is unimpeachable when a medical error is prevented due to vigilance, dedication, and professional ethos.

Sources:

Ramsay MA. Conflict in the health care workplace. Proc (Bayl Univ Med Cent). 2001 Apr;14(2):138-9. PubMed PMID: 16369603; PubMed Central PMCID: PMC1291328.

Tabak N, Orit K. Relationship between how nurses resolve their conflicts with doctors, their stress and job satisfaction. J Nurs Manag. 2007 Apr;15(3):321-31.  PubMed PMID: 17359432.