Three Step Approach to conflict resolution

DocToc: The Newsletter for Academy of Medicine Ottawa Members
Issue 2, Spring 2010

It was a privilege to be a part of the AMO Executive Retreat in March, and participate in the discussions about interprofessional care and how the AMO can play a leadership role as the healthcare system evolves to meet the needs of the population.

It is clear that we are facing serious human health resources challenges in medicine, and physicians are working harder than ever, potentially risking their own health to care for the health of their patients.  We are starting to look for ways to extend the capacity of physicians to provide quality patient care. Patient focused collaborative care, with other health care professionals, physician assistants, nurse practitioners, is likely the way of the future. Yet, as we explored  potential solutions, we recognized that each solution is fraught with potential conflicts.  This led to a general discussion of conflicts, as summarized below.

Many of us avoid conflict, based on false assumptions such as conflict is horrible and ugly; there is a winner and a loser; it is a fight to the end; it must be avoided at all costs.”  These are all myths!  In fact, conflicts are inevitable, and cannot be avoided.  All a conflict means is that two people/parties do not agree about something – this will happen between any two people in any relationships at some time, since no two people agree about everything all the time.  Conflicts do not have to be horrible and ugly.  They are often uncomfortable, but this is only temporary and then resolves.  Conflicts do not have to have a winner and loser, nor be a “fight to the death”.  Much of the time, both sides can work together to arrive at a compromise.  Instead of avoiding conflicts, we need to anticipate and expect conflict and work on making it productive.

Conflicts always occur because people get stuck on the solution.  Each side wants it to be their way.  Yet, the solution is the last step in this process.  We run into problems when we make it the first step.  Conflict resolution must focus on needs, not solutions.

I suggest a three-step approach to conflict resolution. 

  1. Identify and state your need(s).  This is not easy for many of us, because we are so used to giving up our needs and do this unconsciously, without often even knowing what those needs are.  Take some time to think about what you may need the solution to take into account. Once you have identified what your needs are, state them to the other person.  They cannot read your mind.  Practice with short, clear, direct statements, using “I or me”. 
  2. Ask for and listen to the other person state their needs.  Be calm and respectful, and listen sincerely.
  3. Be prepared to negotiate a compromise. Now that all the needs are on the table, you can work together towards a compromised solution that best takes each side’s needs into account.  There is no right or perfect solution.  You are just looking for a solution that works for now.  Enjoy it for as long as it works, then go through these three steps to find a new solution.

These steps are simple yet powerful. They work for conflicts in all parts of your life – at home and at work, in relationships with your colleagues, spouses, children, friends, and neighbours.  I recall teaching these steps to my children at an early age. As you can imagine, three boys, a year apart in age, often had conflicts!  Yet, they learned these 3 simple steps and came up with many solutions for their conflicts that worked and seemed fair to them…even it they were solutions that I would never have thought about or would consider fair! 

Conflict: All three boys, aged 4, 4, and 5, want to play with the same 2-player video game at the same time.  Their compromised solutions included taking turns and offering a treat (the right to go first the next 5 times, another favoured toy, candy, ‘I’ll do your homework later’, even ‘I’ll make your bed tomorrow’!) to the one waiting, who then happily did something else.

Conflict: You and your colleague both want to take March Break off with the family. You brainstorm different solutions, to allow you to both meet your needs.  For example, she can go this year and you can go next year, and then alternate each year.  Or, you can split up the week, and each can take part of it off.  Or, you can try it next year, and find that a holiday with kids is too busy and decide to take more restful holidays on your own!  Now the needs have changed, and you can go back through the steps again.

Conflict:  You are a physician and work in a clinic that has introduced physician assistants.  You feel the PA is doing things for patients that you prefer to do yourself, and are frustrated because you are not sure he has the training to do it, and, you are sure that when things go wrong, it will just land up on your lap to fix.
The solution is who does what.  The needs that must first be addressed include defining the clinical leader, building trust and respect, communicating clearly, and clarifying roles, responsibilities, accountability and responsibility.

Luckily, when we physicians learn something, we learn it quickly and we learn it well.  The more you practice these three steps, the easier they become to use regularly.  Conflicts and challenges can be turned into opportunities and gains.