Conflict occurs frequently in any workplace. Healthcare is not an exception. The negative consequences for any industry include dysfunctional teamwork, decreased patient satisfaction, and increased employee turnover. Worse, patient safety is compromised.
Experience tells us that the majority of errors in healthcare come from communication problems. These problems stem in large part from conflicts, what one writer has called the “invisible” conflict that exists in healthcare. Whether small or large, the important characteristics of conflicts is that they exist, and they make it less likely that one healthcare person will communicate to another what may be important to the treatment outcome for the patient.
Conflicts of various magnitudes occur frequently. You share a workspace with a colleague who consistently leaves the space disorganized and messy, which seems unprofessional to you since patients are seen in that office. In the preoperative area, the anesthesiologist disagrees with your surgical plan in the presence of the patient. A more extreme example would be a disruptive physician who yells or throws charts or instruments.
The frequency of conflict has been measured in several settings. In a study of operating rooms, conflicts were described as “high tension events;” in all surgical cases observed there was at least one and up to four high tension events. Another study found on average four conflicts per operation emerged among operating room team members. In a survey of 5,000 full time employees in nine different countries, 85 percent of employees dealt with conflict at work to some degree and 29 percent dealt with conflict frequently or always. Another viewpoint focuses upon “toxic personalities” defined as “anyone who demonstrates a pattern of counterproductive work behaviors that debilitate individuals, teams, and even organizations over the long term.” In a survey, 64 percent of respondents experienced a toxic personality in their current work environment and 94 percent had worked with someone like that during their career. In another study, 91 percent of nurses reported experiencing verbal abuse.
Health care is a complex system that requires effective teamwork and cooperation to function well. Patient safety research reveals that patient outcomes are negatively impacted when conflict mismanagement and other dysfunctions occur. Another consequence of poorly managed conflict is disruption of care. In a survey of physicians, almost two-thirds of respondents reported seeing other physicians disrupt patient care at least once a month. More than 10 percent of the respondents reported witnessing that behavior daily!
Conflict is associated with significant cost to organizations. In the US, a study of employees from nine countries, the average number of hours spent per week on workplace conflict varied from 0.9 to 3.3 hours. In the United States, the average was 2.8 hours. The calculated expense based on average hourly earnings in 2008 was $359 billion in lost time. High rates of employee turnover and absenteeism are associated with environments where conflict is poorly managed.
Conflict occurs frequently and often results in significant disruption and cost for individuals and organizations. Although often avoided or poorly managed, evidence suggests the skills for effective management of conflict can be learned. Multiple studies confirm when conflict is successfully addressed, and multiple benefits accrue to the organization and individuals.
It is important for healthcare institutions to anticipate that conflict skills become primary predictors of the organization’s ability to progress in both quality improvement and patient safety, and will therefore equip all caregivers — not just managers and top executives — with these skills.