In the complex and dynamic field of healthcare, conflict is as omnipresent as it is multifaceted. From the recent record-setting healthcare strike at Kaiser Permanente, involving over 75,000 employees, to everyday disagreements over treatment approaches and administrative decisions, the presence and impact of conflict are undeniable. This paper endeavors to explore and synthesize diverse perspectives on understanding and leveraging conflict, with a focus on transforming conflicts from obstacles into opportunities for innovation and improvement.
Understanding Conflict: Diverse Perspectives
Conflict is often inherently associated with problems, a notion deeply ingrained in our language and thought processes. Common phrases like “let’s agree to disagree” reflect our continual struggle to navigate and manage conflict. When it comes to problem-solving, particularly within high-stress environments like healthcare, conflicts frequently result in solutions that are partial and transient. This begs the question: are problems and conflicts inherently linked, or are they distinct phenomena that we have habitually intertwined?
The definitions of “problem” and “conflict” suggest that they are indeed separate entities. A problem is typically defined as a situation that is unwelcome or harmful and requires a resolution. In contrast, a conflict is a serious disagreement or argument, often prolonged and complex. Where a problem could be considered a more objective challenge to be overcome (e.g., a patient is presenting with a specific clinical issue necessitating urgent intervention), a conflict is inherently subjective, steeped in personal interpretations and reactions (e.g., a conflict within the doctor-patient therapeutic relationship).
In healthcare, conflicts manifest in various forms. In addition to disagreements over treatment plans, the ecosystem is filled with clashes such as those arising from administrative decisions and tensions stemming from hierarchical structures within healthcare teams. These conflicts, if not understood and managed effectively, can hinder progress and stifle innovation.
The Nature of Conflict: Fragmentation and Subjectivity
At the heart of these conflicts lies the concept of fragmentation. Our individual perceptions, shaped by unique combinations of values, beliefs, motives, fears, needs, and experiences, filter and fragment our understanding of problems. These “interpretive filters” act as a lens through which functional problems are perceived and processed, influencing how individuals emotionally interpret and respond to these challenges. This subjectivity transforms objective problems into personal conflicts. The resultant fragmented problem-solving often leads to solutions that are misaligned with the actual issues, as they are colored by our biases and limited perspectives.
Understanding how the subjective nature of conflict can misguide solution development to the various dimensions of functional problems is therefore crucial. Conflicts in healthcare can arise from fragmented views on tasks (what work needs to be done), differences in processes (how work needs to be done), timing (when work gets done), hierarchical role constraints (who does what work), interpersonal dynamics (who works best together), and more. This multi-level overlay of conflict, spanning from structural issues at the organizational level to individual struggles, requires a nuanced approach to resolution.
Strategies for Conflict Resolution
To address these conflicts effectively, a shift in perspective is necessary. Moving from a mindset rooted in a null hypothesis — where predetermined assumptions limit the scope of problem-solving — to an inductive approach of “no hypothesis” can be transformative. This approach entails starting with a blank slate, free from preconceived notions, allowing for a comprehensive exploration and understanding of the problem.
In practice, this means reconsidering the use of broadly accepted problem-solving processes, which focus largely on rigid quantitative analytics and abstract future state solutions. Instead, leaders should lean into and leverage conflict, where the focus is on understanding the qualitative and quantitative intricacies of the challenge at hand, rather than prematurely jumping to solutions. It involves transitioning from theoretical assumptions about the problem to factual, holistic observations of conflict. In understanding the relationship between conflict and the functional problem, teams are enabled to see the functional problem with aligned clarity and develop sustained solutions. Embracing collective intelligence, fostering accountability, and encouraging high levels of engagement are key to this process.
Leveraging Conflict for Positive Transformation
Understanding and harnessing the nature of conflict can lead to significant positive transformations in healthcare. Similar to how Formula One racing teams expertly utilize airflow – a turbulent influence – to generate downforce and improve performance, healthcare leaders can adeptly leverage conflict, turning critical challenges into improvement and innovation. This approach involves identifying pivotal conflicts and using them to instigate a collective problem-solving mindset among stakeholders. Here are two examples representing missed opportunities and successful outcomes, respectively:
- The Kaiser Permanente strike serves as a poignant example. The lead-up to the strike, rooted in various dimensions of conflict, presented an opportunity for the leadership to apply these “value-in-conflict” concepts. By understanding the nature of the conflicts and employing the strategies discussed below, they could have navigated the situation more effectively, fostering a more harmonious and efficient environment. Instead, the company experienced the biggest health care strike in US history.
- The challenge of establishing scope of practice guidelines that enable top of license practice for Advanced Practice Professionals (APP) and physicians is another example. In the setting of provider staffing shortages, understanding the issues and concerns related to quality, safety, and productivity has enabled some healthcare organizations such as the University of Pittsburgh Medical Center (UPMC) to uncover the forgotten common APP/physician commitment to exceptional patient care. With the realization that both provider groups share the same core objective, APPs and physicians at UPMC were able to put aside their subjective differences, address the functional barriers, and collaboratively implement highly functional integrated team staffing models which led to “an increase in volume, APP productivity, and enhanced satisfaction scores for both providers/patients, and an increase in access to pediatric specialty care.”
To help leaders lean into and leverage the value of conflict for positive change, we’ve developed the following steps:
Create Conditions for Success
1. Foster a Safe Environment for Voicing Concerns: Ensure that employees feel safe to voice their concerns without fear of retribution. A psychologically safe workplace encourages open dialogue and is crucial for effective conflict resolution.
2. Empower Frontline Staff: Empower those at the forefront of patient care to voice concerns, make decisions, and suggest improvements. Empowering frontline staff not only improves job satisfaction but also leads to better patient outcomes as they are directly involved in care delivery.
3. Encourage Diverse Perspectives: Actively seek and value different viewpoints. Diversity in thought and experience can prevent groupthink and foster innovative perspectives of conflict.
Identify and Prioritize Key Improvement Opportunities
4. Establish Open Communication Channels: Create platforms where staff can express their concerns and ideas freely to identify key conflict areas. Regular meetings, suggestion boxes, anonymous surveys, and AI-powered chatbots can be effective tools. This openness not only helps in identifying conflicts early but also fosters a culture of trust and collaboration.
5. Incorporate Visibility for Capturing Issues and Concerns: Visibly document shared issues and concerns using flip charts, white boards, or digital tools to capture the full spectrum of team contribution. This validates participation and exposes the complexity of the challenges.
Understand the Functional Problem to Develop and Implement the Sustained Solution
6. Leverage Feedback to Clarify System Improvement Opportunities: Use qualitative and quantitative data from conflict situations, employee feedback, and patient outcomes to understand functional system problems. Analyzing trends and processes informs high-impact and sustained functional solutions.
7. Adapt and Refine Strategies Continuously: Adapt strategies based on feedback and changing circumstances. For example, if a new healthcare regulation introduces fresh conflicts, apply your conflict management approaches to get at the underlying functional problem.
Enable a Culture of High Performance and Well-being
8. Promote a Safe Learning Environment: Promote an organizational culture where conflicts are seen as opportunities for team alignment and growth. For example, lean into the stress associated with conflict and leverage its value in identifying functional problems. After successfully addressing conflict, share the learning and improvement steps organization wide.
9. Measure and Evaluate the Impact: Regularly assess how effectively conflicts are being captured and managed. Use metrics like employee satisfaction, patient care outcomes, or efficiency improvements as indicators. For example, after implementing a new improvement process, track changes in team performance and patient feedback.
10. Celebrate Collaborative Effort: Celebrate with teams who effectively lean into conflict and leverage its value. Recognition can reinforce positive behaviors and motivate others.
11. Develop Conflict Competence Training: Implement training programs that focus on conflict resolution skills, emotional intelligence, and effective communication. Equip leaders and staff with the tools to understand, proactively navigate, and resolve conflicts constructively.
12. Implement Collaborative Conflict Workshops: Regularly schedule workshops where teams collaboratively address current conflicts or challenges. Use structured methodologies like design thinking to guide these sessions, ensuring a focus on understanding the conflict comprehensively before jumping to solutions.
13. Leverage Technology for Conflict Management: Utilize AI-powered tools to monitor and predict areas of conflict. For instance, use predictive AI to foresee scheduling conflicts and implement proactive measures.
By tailoring these steps to fit the specific context and needs of people, healthcare leaders can turn conflicts into catalysts for positive change, leading to improved employee satisfaction and better patient outcomes. The steps provide healthcare leaders with clear, practical strategies to harness the value of conflict effectively.
Conclusion
The omnipresence of conflict in healthcare is not a harbinger of perpetual discord but an opportunity for growth and improvement. It’s crucial to distinguish between problems and conflicts and adopt strategies that transform these challenges into opportunities for collaborative, innovative leadership. Healthcare practitioners are encouraged to apply these insights, leveraging conflict for positive transformation and fostering a more effective healthcare ecosystem.
About the Authors
Brian R. Spisak, PhD is an independent consultant focusing on digital transformation and workforce management in healthcare. He’s also a research associate at the National Preparedness Leadership Initiative (Harvard T.H. Chan School of Public Health, Harvard University), a faculty member at the American College of Healthcare Executives, and the author of the best-selling book, Computational Leadership: Connecting Behavioral Science and Technology to Optimize Decision-Making and Increase Profits (Wiley, 2023).
Rick van Pelt, MD, MBA is the Chief Clinical Transformation Officer (CCTO) and leader of the Clinical Practice Transformation Department at the University of Alabama at Birmingham (UAB) Medicine. Dr. van Pelt is a board certified anesthesiologist with more than 30 years of experience in clinical practice, performance and quality improvement, patient safety, and change management within health systems.