This is especially important for hospitalists, who have to establish patient relationships in a relatively short period of time.
Resolving Conflicts
Of course, it is impossible to prevent or avoid all conflicts. “To some degree, conflicts are inevitable,” says Dr. Marcus. “It’s the nature of medical practice.”
When conflicts occur, many of them can—and should—be resolved before they escalate into a dangerous confrontation or litigation. Listening is key to resolving conflicts quickly. “By listening, you can prevent a lot of conflicts from escalating or even starting,” says Dr. Prendergast. “We teach our physicians to listen, then repeat back what they heard—‘I’m hearing that you’re upset because … .’ If you get it right, the person knows that you are listening and that you understand their concerns. If you miss, they are likely to state their concern directly.”
Dr. Marcus believes conflict resolution may be particularly effective and satisfying when interest-based negotiation (IBN) is employed. IBN is a problem-solving strategy that focuses on satisfying as many interests or needs as possible for all involved parties. Because this technique addresses people’s needs and interests and separates people from the problem, it enables the parties to reach an integrative solution rather than creating a win-lose situation.
IBN enables those involved in a conflict to work together to reach a mutually satisfactory conclusion. The technique commonly results in creative and durable solutions, as well as enhanced relationships.
Conflict resolution efforts are more likely to fail, says Dr. Marcus, when the physicians and others involved apply position-based negotiations. With this conflict-management method, the parties argue only their positions, and their underlying interests may never be stated explicitly or understood. People are more likely to reach an impasse when they employ position-based negotiations, and they are more likely to see the situation as having a clear-cut winner and a loser.
“When you negotiate based on positions,” explains Dr. Marcus, “that is when situations are likely to escalate.”
While clear hospital policies and procedures can help resolve or prevent some conflicts involving physicians, more layers of policy are not necessarily the answer. “I think the time it would take to establish these policies would be better spent developing pathways for easier and better communication,” says Dr. Gildersleeve. “You see few of these hospitalist-physician conflicts when there is good communication between all the players.”
Professional mediator Pat Costello suggests that policy changes actually can help resolve some disputes. “Continued conflicts might suggest a need for a policy change or a new policy,” says Costello. “I have mediated a lot of situations that were resolved by policy changes.”
15 Seconds to Make an Impression
Hospitalists must remain cognizant of mistakes they can make that actually exacerbate conflicts with patients and families. “When physicians use an overbearing approach, they can’t accomplish as much,” says Dr. Marcus. “You have to take care to treat patients and families with care and concern and the same respect they afford their colleagues.”
It is important for hospitalists to be aware of how they come across to others, stressed Carole Houk, Esq., president of Carole Houk International, Alexandria, Va.
“You make a snap judgment of whether or not you like someone in about 15 seconds,” says Houk. “Studies show that physicians who use a dominant tone of voice are more likely to be sued than those who don’t.
“Explain what happens and why—and put a lot of focus on your tone of voice,” she says. “Rather than coming down imperiously, reach out to patients in a compassionate way. You need to be seen as someone with a heart and not a gatekeeper for the insurance company.”