Question

Describe conflicting values and principles of different groups within healthcare. Describe what to look for, how to empathize, and adjusting your approach.

Answer 1

Managing conflict in the workplace is a time-consuming but necessary task for the physician leader. Conflicts may exist between physicians, between physicians and staff, and between the staff or the health care team and the patient or patient's family. The conflicts may range from disagreements to major controversies that may lead to litigation or violence. Conflicts have an adverse effect on productivity, morale, and patient care. They may result in high employee turnover and certainly limit staff contributions and impede efficiency.

Ethical dilemmas about care arise when the persons involved in care decisions have conflicting values. Patients, health care providers and society in general all have an interest in health care decisions and may not share the same values. The values and abilities of the care provider must be balanced with the values and needs of the patient

Physicians, both male and female, often have hard-driving, type A personalities and little training in interpersonal skills. They may have high IQs but lack emotional intelligence.

Physicians and other health care professionals, confronted with what they perceive to be overwhelming work demands or threats to their own values orientations, will respond to these threats or challenges in various ways, continually attempting to conserve their internal resources. However, overwhelming work demands or conflicts involving basic values make increased stress, diminished or depleted resources, and burnout more likely

Physicians and other health care professionals are heavily involved with various medical organizations (eg, hospitals, health care clinics and agencies) and extraprofessional entities (eg, managed care organizations; governmental programs, such as Medicare and Medicaid) that strongly influence the extent and type of medical care that is provided.

The dysfunctional physician presents an insidious cost to any practice or health care organization. He or she increases the stress in the work environment and the accompanying loss of efficiency.

Physicians and other health care professionals often question many of the commitments, however, as they come to feel frustrated and stressed by administrative, bureaucratic, or financial pressures that seem in many cases to be more oriented to these latter pursuits than to ethical or values-oriented care.

The pressure to discharge patients too soon from the hospital, the pressure not to admit patients to the hospital because of cost or insurance status, the provision of a reduced level of care to patients without sufficient insurance coverage, the provision of minimal information about procedures, the avoidance of “less desirable” patients (eg, the sickest and most time-consuming), the failure to provide necessary information (or provision of it in a cursory and perfunctory manner), and the scheduling of insufficient time for patient visits make them feel frustrated

In a stressful workplace, such as the operating room with a berating physician, morale and team spirit suffer, which results in an increased turnover of staff and a dysfunctional team. Once this stage is reached, various negative factors begin to interplay. Communication is poor, and staff withhold information because of fear of an outburst. The information withheld may be vital for patient well-being. The physician loses staff support and may become isolated.

Violent incidences have been reported between physicians, as the changing pattern of medical practice creates enormous stress on both work and family. If the warning signs are not heeded, disastrous consequences can occur. Similarly, interactions with families of very sick patients can turn physical as emotions overcome rational thought.

Some professional practices are considered unethical by all or nearly all health care professionals. Such practices include deriving personal income by referring patients for particular tests or procedures in which the physician has a pecuniary interest, splitting fees and paying for referrals, or not providing full and necessary information about procedures.

What to look for and the ways to empathise are:

Understanding how conflicts arise is important in their prevention. From an employee's perspective, triggers include lack of communication, colleagues who don't pull their weight, unfair criticism, silly rules, preferential treatment, sexism or racial inequality, being put down, unreasonable expectations, and verbal abuse. On the management side, problems arise from poor communication, inappropriate responses, poor prioritizing, personal work interfering with professional work, and clock-watching.

Pitfalls that leaders should be careful to avoid include taking people for granted, failing to keep promises, failing to take responsibility for one's own errors, and failing to practice what one preaches. The key to survival as a leader is to develop emotional intelligence and to engender it in the work environment.

Emotional intelligence has been recognized as necessary not only to be a successful leader but also to be successful in life. A high mental intelligence quotient revolves around a narrow band of linguistic and mathematical skills, whereas emotional intelligence involves self-awareness, management of emotions, empathy, “people skills,” and motivation.

The development of interpersonal intelligence allows understanding of other people—what makes them “tick,” what motivates them, and how to work with them. This not only enables leaders to “get inside the other person's head,” it lets them understand and recognize their own emotions, making control of those emotions easier. If emotional control is lost, smart people become stupid.

Anger is the most difficult mood to control; it can be energizing, exhilarating, and even seductive. Early intervention provides the best chance of successfully defusing the angry situation. A cooling-off period may actually exacerbate the anger. Leaders should stay cool, avoid direct accusation, be good listeners, and repeat the argument in their own words to demonstrate that they are trying to understand the problem. Asking a meaningful question can be a powerful distraction.

The leader should try to defuse the situation by being nonthreatening and by taking verbal control: using a calm, controlled voice, he or she should be very clear and respectful. The leader should take a nonaggressive posture—by not cornering the individual or getting into his or her “space,” by allowing a buffer zone to exist,

Regularly scheduled seminars, discussion groups, and consultations related to ethical practices and health care values. It is also important that leaders, both clinical and nonclinical (eg, executives, board members), have education and training related to ethical and values perspectives in health care.

Willingness of health care organizations to alter approaches, improve communication, or negotiate a variety of issues related to health care ethics and values.

Empathy should be expressed but change must be demanded, with a delineation of the consequences if behavior is not improved. The communication should be direct and clear, with the subject not given an opportunity to respond until the end of the dissertation.

The competent leader will be able to handle difficult people and tense situations with diplomacy and tact. If possible, a winwin solution should be looked for, where the physician sees the advantage to his practice and patient care if resolution can be obtained.