Conflict Conundrums
Contrary to popular belief, conflicts are not necessarily bad. In fact, conflicts can spark discussions that can lead to improved processes and quality care. They also can help open lines of communication among practitioners and between physicians and patients.
Of course, not all conflict is positive and discord can be detrimental to patients and to relationships in the hospital. It behooves hospitalists to understand how to resolve conflicts constructively and communicate effectively in emotionally charged and controversial situations.
Good Conflict
When resolved effectively, conflicts can lead to positive changes, process improvements, and enhanced quality, says Leonard Marcus, PhD, founding director of the Program for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health (Boston). In fact, conflict sometimes is necessary because it:
- Raises and resolves problems;
- Focuses change efforts on the most urgent and appropriate issues;
- Motivates people to participate in efforts to create positive changes; and
- Helps people learn to benefit from and recognize their differences.
Conflict is problematic when it:
- Hampers productivity;
- Lowers morale and/or hurts relationships;
- Creates more and continued conflicts; and
- Causes inappropriate and/or dangerous behaviors.
Conflicts often arise from everyday occurrences. Poor communication is one of the most common causes of disputes. However, conflicts also may result from insufficient resources, personality clashes, and leadership problems (e.g., inconsistent, missing, dictatorial, or uninformed leadership).
—Peter Prendergast, MD
Anatomy of a Conflict
A primary care physician, Dr. X, tells a patient, Mrs. Y, that she needs to be admitted to the hospital. If the hospitalist examines Mrs. Y and agrees that admission is necessary, there is no conflict. However, if the hospitalist determines that Mrs. Y doesn’t need to be admitted, the potential for conflict is ripe.
“This can create real tension,” says James W. Leyhane, MD, hospitalist director at Auburn Memorial Hospital, N.Y. “The hospitalist can find himself facing a conflict with the patient or the physician—or both.”
These situations can be highly charged and difficult to resolve. “Sometimes the person is adamant that he or she wants to be admitted,” says Dr. Leyhane. “And the stronger the relationship the patient has with the primary care physician, the greater the resistance they may have to what you are saying.”
The most common approach Dr. Leyhane takes to such a situation is to get on the physician’s side. “I will say something like, ‘I understand why Dr. Jones thought you should be admitted. However, after further examination, we now realize that admission is unnecessary,’” he explains.
Once the hospitalist addresses any anger or frustrations patients feel, most are relieved to avoid a hospitalization. But sometimes this approach doesn’t work, and some patients still insist on being admitted. In those cases, Dr. Leyhane will appeal to their pocketbook instead of their emotions. “I will tell them that I can admit them if they insist,” he says. “However, someone else will review their chart for insurance purposes, and they will have to pay out-of-pocket for the stay because it is not medically necessary. This is very persuasive.”
