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Successful Conflict Management Within Multidisciplinary Teams

Successful Conflict Management Within Multidisciplinary Teams
Mira Rollins, OTR/L
June 6, 2022

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Editor’s Note: This text is a transcript of the webinar, "Successful Conflict Management Within Multidisciplinary Teams," presented by Mira Rollins.

Learning Outcomes

After this course, participants will be able to:

  • Identify leadership and personality styles and most effective strategies to use in interacting with each.
  • Identify main sources of conflict in health care settings and strategies to mitigate these conflicts.
  • Implement specific communication and conflict resolution techniques. 

Introduction

I've spent about 20 years as an occupational therapist with over half of that being spent in management. I greatly enjoy people management. It is one of my passions. I've come to learn that if a company takes care of its people, then they will want to take care of the company. I know that sounds like a cliche or not very technical, but I firmly believe that idea should be the anchor that companies bank on. It should not be what their productivity requirements are nor what their operation goals are, but their employees, because that is what companies live and die by.

Speaking of employees, there is a startling statistic that approximately 70% of all difficulties in organizations stem from strained relationships between employees. I was amazed when I saw that percentage. The main issue is not productivity or technology issues, or customer service.  For this reason, it is crucial that as we sharpen our skill set of specific treatment interventions, it is equally important that we pause and reflect on how we are interacting with one another because those interactions affect our patient care and patient care outcomes.

I would like you to think about a time when you had an issue with a coworker or an ongoing issue with a supervisor or patient's family. At the end of this course, we will take some of the principles that are discussed and apply those to your situation. 

Categories of Healthcare Conflict

Even though there are many different reasons and different scenarios that we see conflict in healthcare, I believe that we can drill them down and separate them into three categories: territory, technique, and tone.

Territory

Territory is the perception of infringing on one's job, schedule, or workspace. I will be using the term ‘perception’ a lot because, as you have heard, “a person's perception is their reality.” So, if you said something and your intent was not how they interpreted it, if that is their perception, then that is their reality. That is the reality of how they are going to be dealing with you and interacting with you. Therefore, when navigating conflict, you want to clearly understand and place equal importance on the other person's perception.  If you cannot or will not do that, then you will continue to find yourself in cycles of conflict.

Here are a couple of examples.  An OT is working on cognition goals when the SLP has an active plan of care already working on that. So many times, the SLP says, "We are duplicating services. Why are you specifically working on cognition right now and have goals for that when this person has so many ADL dysfunctions that you could be working on?" Another example is an SLP who takes a patient to therapy when a nurse has scheduled an x-ray. The nurse told everyone that this patient had an x-ray, but the speech therapist needed to see the patient at this time. That is a perceived infringing on territory.

Another example is when a PT’s time with a patient is running into lunchtime and they know that is when the SLP works with the patient.  That is also an infringement on territory.  A final example is, PT and OT taking over the gym with their mats and big machines. You have given them 75% of the gym, and you have willfully relegated yourself to this one little spot, and today they want to go into your little 25% space, an infringement on territory.

Technique

Technique is the perception of a lack of competency, efficiency, or compassion. This is something that wasn't done right or wasn’t done well. This is when you don’t provide good customer service while you were doing a task.  This could be the overly aggressive PT.  I am not talking about abuse. This is the clinician who is a little too rough with the client and you're questioning their technique.

Another example is the aide who is always late giving meds. We all know that medications need to be given at a certain time in order to be most effective. Or, an SLP colleague is on vacation and you are seeing some patients on her caseload. As you look at her goals and interventions, it's clear to you that she hasn't been incorporating some of the modalities that needed to be done and she isn't working on some of the goals that are relevant right now.  Those are technique conflicts.

Tone

Tone is the perception of inappropriate communication of needs. This is the doctor that comes in, in the middle of a treatment demanding, "Who's the ST treating Mr. Johnson? What's going on with this?" It’s a valid question, but the tone is negative. This is also the therapy supervisor who is constantly reprimanding you in a way that feels like a parent-child relationship and you are always explaining yourself to them because they have this negative accusatory tone.

Resolution Strategies

What are some strategies that we can use to work on those three types of conflict?

Territory Resolution Strategies

The first strategy is to clearly establish roles and responsibilities. If there are overlapping goals in a plan of care, then have a conversation with the OT and say, "Hey, I see you're working on some cognition tasks. Can we discuss which components you're addressing so that we can make sure not to overlap?" In any scenario where several disciplines are working on many of the same things, even with social work, oftentimes there seems to be some overlap in needs. The question that always needs to be in the forefront of our mind when we have a territory issue is, "Who's going to make this call to this family member? Whose responsibility is it?"

Once that is identified, then there will automatically be some resolution to this territory conflict. It will be clear whose responsibility it is and who should do what. If you are in a department where there are often territory conflicts, make that be the question you, in a safe way, pose to the person that you're in conflict with. Determine how you can strategically, without raising offense, ask that question to someone that you're having conflict with, "Who's responsibility is it?"

Be aware of others plans of care to make sure that you're not infringing or doing something that you should not be doing. Also, make sure that you are aware of the goals of other disciplines.  Ask for permission and not forgiveness. This is important. Sometimes it may seem easier to do it the other way around. But if there's a situation, whether it's a physical space, someone's desk, a computer that they normally use, et cetera, instead of just doing it and saying, "Hey, it's easier for me just to grab it and get it done," use some professional maturity and say, "Let me ask for permission and have a conversation rather than ask for forgiveness."

Next is to be aware of schedules. You know how important schedules are in our healthcare systems. We have appointments for our therapy sessions, appointments for x-rays and different scans, et cetera.  Sometimes the doctor is there and sometimes he or she isn’t. Be very aware of your own schedule and others. It's okay to ask the PT, "Hey, can I see your schedule today to see what patients you have and at what time?” It's okay to coordinate that. If the nurse's station posts schedules of appointments or if a list of patient appointments is on a computer, do your due diligence and look at any potential schedules or appointments that your patient or client passes.

Another important strategy is to communicate your schedule, specifically on days that you may be having mobile swallow studies and things of that nature. Also, go to the other disciplines and other people on the plan of care and let them know, "These are my four patients." You could even type it out and send it around. "These are my four patients that have swallow studies. You all know that they may come at different times. They told me that this is the window of time, but if for some reason they come at a different time, I just want you to know and am asking you to be flexible today with these four patients."  Those conversations can definitely ward off conflict when it comes to territory. Finally, if there are any scheduled changes, be sure to communicate those as well.

Be aware of systems. For example, the schedule for meal times is 8:00, 12:00, and 5:00. But the system at your facility is that the CNA starts checking on residents at 11:30 to make sure that they are all clean and dry. If you know that is the system, and you have several clients, some who are high level and continent and others who aren’t, maybe see your incontinent patients earlier in the day and further away from the lunch hour. That way, you won't find yourself in a territory battle when you have an incontinent client at 11:30 and the CNA needs to do a bowel and bladder check at the same time.  Being forward-thinking, accommodating, and flexible can help in scenarios like that.

Here is another system example. Insurance notes are due every Wednesday by noon. Oftentimes, you have a client at that time. You are in the middle of an amazing session and making progress, and your supervisor comes to you and says, "I need this note right now." You say, "I can't stop, I'm in the middle," and she says, "You're going to stop." There's a conflict. But if you had been more aware of the schedule and the system, then that could have avoided the territory battle.

The next strategy is to be an active member of the team. This means that if you operate on an island, be prepared to feel deserted. And I truly mean that because, in healthcare teams, we need to work in collaboration with one another. Oftentimes for SLPs, just by nature of the work being one-on-one with clients, it's easier to fall into an island of their own. I know that is not always the case.   But, just make sure that you are incorporating yourself and your clients into the overall system and the team that operates. When you do so, it allows for more flexibility from others.  They see you as a part of the team and are more willing to make some concessions when they see that and feel that energy.

Technique Resolution Strategies

The first, and easiest, strategy is to be good at what you do. Be proficient and efficient at what you do. That means keeping up on new techniques, new information, and new strategies. Show good results and outcomes for what you do or how you do something so that people trust you. Then, if there is a situation where they may question something they're seeing or you are saying, you have set yourself up to be trustworthy and there will be fewer technique conflicts. Leave little room for people to question you in this area.

Next is to be able to articulate the “why” of what you do. I have an example that I'm sure you all have seen. I've seen CNAs come into the clinic and they want to take a patient for a bowel and bladder check or to an appointment and I will say, "Well, I'm not quite finished. I have about 20 more minutes." As they are walking away, under their breath they may say something like, "Hmm, I wish I got paid like that to play with some pegs or play with some toys."

At that point, I have one of two choices. I can snap back or I can be professional. Personal maturity says, "I can explain what I'm doing.” I can take a minute at that moment or later have a conversation with that CNA and say, "You know, I know it appears that sometimes a lot of what we do is just fun and games. I know you see us playing with dominoes and playing with pegs, but actually, we're working on visual and verbal memory. We're working on some hand-eye coordination. Ms. Johnson has visual neglect because of her stroke and this activity that I'm using, those pegs you thought I was playing with, helps her to visually scan."  So, take a minute and explain what you do and why you're doing it. Sometimes that mitigates those technique conflicts.

On the flip side, seek understanding of other people's roles and responsibilities. Just as you would like people to respect what you do with the clients and how you fit into the overall scheme of enhancing their lives, other people want that same respect. If you're questioning why a nurse is doing something in a certain way, seek understanding by non-confrontationally and non-aggressively asking her, "Can you enlighten me?" Make sure that the feel of that conversation is not, "Prove to me why…", but more, "Educate me on…"  That is a massively different conversation. Coming to someone with an attitude of, "Prove to me why this is right" versus, "Hey, I'm not sure. Can you explain to me why this works," is a completely different conversation and a completely different outcome.

Tone Resolution Strategies

People can generally be put into three different categories for how they resolve conflicts and how their tone is going to be as they do that. The categories are passive, aggressive, and assertive. As I discuss the differences between these categories, think about which category you and people you have had a conflict with fit into.  Then we will discuss ways to best interact with these particular people or if you find yourself in the passive or aggressive category, how you can move from those?

Keep in mind that this course is not about pointing the finger at other people. The purpose is to make sure we have some self-reflection and work on ourselves in our professional and personal growth.

Passive Style

Passive individuals avoid or delay necessary conversations, "I just don't want to have it." Some people can literally get anxiety when they have to approach a conversation so they choose to put it off for way too long or avoid it altogether.  And these are necessary conversations.

They tend to handle conflict covertly. For example, "Instead of telling the person directly as a supervisor, and doing this one-on-one, I'm going to send a mass email to everyone." Everyone knows who the email was meant for.

Passive individuals also handle conflict at the height of the behavior or consequence instead of choosing a better time to handle it. Because they often suppress issues, eventually they explode because they can't take it anymore. They find themselves going from not handling conflict at all to handling conflict at the height of the conversation, interaction, or negative energy.

Aggressive Style

Individuals with an aggressive style handle conflict immediately and often. If there's an issue, they're on it quickly and possibly abrasively. They're going to handle it in their words. They will “handle” conflict overtly and in front of people. They are not really strategic about how or when they handle that conflict. They address issues regardless of the frequency and often with the same technique. They see everything as, “everything is a nail and I have the hammer.”  Typically, an aggressive person is going to handle all conflicts with the same intensity. Even if it's a level one problem, they're going to handle it at a level 10.

Assertive Style

An assertive style is where we all want to be.  We want to carefully consider conflict and decide how and when to address it. These individuals address conflict appropriately and have different resolution strategies depending on the level of the conflict.

Leadership Styles Exposed

Let's expose these strategies of leadership, conflict resolution, and personality. Oftentimes, people who are passive believe, “I am just non-confrontational." But they're not truly non-confrontational, they are avoiders.

If you're finding yourself in conflict with someone, could it be because you have been non-confrontational much too long? Ultimately, what will happen is a collision. If this is your style, maybe move away from the notion that you are non-confrontational and explore the possibility that you are an avoider of confrontation.

Aggressive individuals are overly confrontational. They will say things like, "I nip it in the bud, that's just me." However, what is really going on is that they're being overly confrontational.

So how about you? Is there a tone or culture in your department that's negative right now? If so, could it possibly be because you are one of the people in that department that is overly confrontational? A passive person often feels and tells others, "I am in control of my emotions." When again, we've seen that they are actually just pushing their emotions down. They are calm on the surface, but internally they are brewing and boiling over.

The aggressive person expresses emotions openly and often. That's what they tell themselves, "I just express my emotions. I tell people how I feel." That's okay unless you're doing it too much and too often.

Passive people will tell others and believe that they “just go with the flow." When, again, if you could look at their head and heart, they would not be going with the flow inside. They would be boiling over and wanting to say and do things. But because they avoid confrontation and want to convince themselves that what they're doing is right, they tell themselves that they're going with the flow.

Aggressive people think, "I need to challenge people. People need to be critical thinkers. I sometimes need to be the devil's advocate and make sure that we've looked at this thing from all different aspects." They feel that's their job in the communities and environments that they are in.  But often they are making their teams and employees feel on edge, judged, and the need to answer to this aggressive person.

Take a moment to write down some peoples’ names that you are in conflict with, and if they are passive or aggressive.  Then write down if you are passive or aggressive.  This is an important task because we want to cross out these behaviors. We don’t want to stay in these styles. We want to push past being passive.

Pushing Past Passive

If you have identified yourself as passive, what are some ways to change that? Think about the energy and implication of a passive person within your department and how it will affect the whole team.

First, practice crucial conversations. By practice, I literally mean getting in front of the mirror and having a conversation with your supervisor, the nurse, or the patient you are in conflict with. Practice what to say instead of doing it on the spot because that has an anxiety element for you. Instead of handling that conflict on the spot with no practice or thought, do it in the mirror.  Talk through possible retorts that they may have or things that they may say. Work through that process and practice the conversation before having it.

Consider your timing, your technique, and your tone. Remember, passive people typically avoid conflict and then explode. So, if you're finally revved up to handle this conversation, ask yourself, "Am I doing it because I just can't take it anymore?" If that's the case, you may want to wait and reflect and practice before handling that conflict.

Ask or allow questions. Passive people, oftentimes because they are avoiders, don't gather information and make stories in their heads as opposed to going to the person and getting information.  Practice proficiency because the better you are at the things you do, the fewer conversations you have to have about it.

Give or provide feedback. Manage your personal or environmental stress. Passive people typically work with higher levels of stress than the aggressive and assertive person, and people think that's odd because on the surface passive people seem controlled. But they are spending so much emotional energy, suppressing what they really feel. Therefore, passive people, even more so than some of the other two categories, need to manage their personal and environmental stress.

Be specific about your needs. Passive people oftentimes feel taken advantage of.  For example, in the department, are you always the last one to get the computer to do your notes? Are you always the last one to see the client? Maybe you wanted to see him in the morning, but because you avoid these confrontations, you don't express your needs. Passive people need to practice being specific about their needs.

Avoiding Aggression

Practice crucial conversations. Aggressive people, because they have no problem handling the conversation, don't realize that they handle it poorly.  If you are an aggressive person, walk through a conversation and ask yourself, "Okay, I went through that conversation. If I was on the other side of that conversation, how would that have made me feel?”  Practice those conversations and change any kind of aggressive language or behavior that you have.

Consider timing, technique, and tone. Aggressive people handle things on the spot every time.  Instead, if you are an aggressive person say to yourself, "Maybe I should have this conversation later when cooler heads prevail. Maybe I need to consider how I'm saying this, not what I'm saying.”

Listen, wait, restate, and validate. Aggressive people are talkers. They capitalize on a conversation. If you have identified yourself as an aggressive person, then you need to learn how to be a better listener, and not listening to respond but listening to understand. Aggressive individuals need to wait. This could literally mean take a breath or it could mean, "I hear what you're saying. Let me consider that and get back to you."   Restate what you've heard and then validate what they feel.

Let's consider the flip side of this.  Let’s say you have an aggressive supervisor and you're a passive person. A conversation that you can practice when it comes to expressing your needs with this aggressive supervisor is,  "Thank you for carving out some time for me. You typically give me really great feedback. But in the future, I would like to request that our conversations about feedback be handled more so in your office. Also, if you wouldn't mind giving me a little bit more time to express my thoughts because sometimes I feel a bit rushed when we speak."  That's a crucial conversation that takes practice, professional maturity, and also an understanding of what you need to ask from that aggressive person.

Provide appropriate outlets. If you are an aggressive person, people around you may be a little bit reluctant, hesitant, or even fearful to speak with you.  As an aggressive person, you might need to understand the environment that you may have created and allow people safe and appropriate outlets.  

If you are working with an aggressive colleague then ask them, "I have something that I want to say. Do you have five minutes that I can talk to you?" You're asking for that outlet.

Don't push back, lean in. This is huge for an aggressive person. Aggressive people tend to push back on all issues. They play devil's advocate with all of these solutions and possibilities.  That can create anxiety for other people. Instead of taking that approach, it is better to lean in and listen and understand what others are saying before you start dismantling it. Don't push back all the time, but lean in.

Define and display directness. This is so important because often time aggressive people feel that, "I'm just being direct and it's okay to be direct." But people perceive them as being rude and aggressive. Aggressive people need to define and truly accept what directness really is and operate within that.

Finally, don't continue to hide behind what is truly aggression and create opportunities to coach. Oftentimes we find aggressive people have this feeling that other people around them are not as competent.  There is this tendency to say or think, "Just do it!" A better approach is to coach others on how to do it the way you want it done and why you believe that this is the way.  

Again, these are some very practical steps to navigate working with an aggressive or passive person or if you are an aggressive or a passive person. On any given day in your department or clinic with your families and patients, you are coming into contact with aggressive and passive people. Implementing these steps are key to diminishing and mitigating conflict.

The Soft Skills Gap

Consistent studies show that companies are reporting a soft skills gap. Fifty-nine percent of managers and 89% of executives report that there's difficulty in recruiting and hiring candidates who display communication, teamwork, and leadership at adequate levels.

What are soft skills?

Communication. Many of us have different specialties. You may have your doctorate or master’s degree.  We are excellent therapists. But, we may struggle with having conversations or how to be adaptable.

Being flexible is another important soft skill.  Someone could be an amazing SLP that everybody wants on their schedule, but don't change the schedule on that SLP because she might flip out.

How about leadership? We have, especially in healthcare, a lot of leaders who have come up through the ranks of clinic and don't have a lot of business background or a lot of leadership development. We often see leaders who are put in these positions but they have not been trained in key areas of leadership.

Other soft skills include teamwork, emotional intelligence, and time management, which is crucial for healthcare workers who are so taxed with productivity requirements.  The productivity requirement can be very overwhelming and sometimes it seems like the company is putting unfair or undue stress on us. But it's something that we need to look at and manage as part of our soft skills.

Why the Gap Is Growing

Why is there a growing soft skills gap? One reason is the increase in virtual and remote positions. With COVID, we've had a lot of more remote teams and we're interacting with people who, more and more, are working from virtual environments. Because our society is moving towards more virtual and remote, it's providing fewer interactions and fewer opportunities for us to practice soft skills.

I think about our children. I have a 22-year-old and I see the conversations that he has via text, like breaking up with people, is so surprising to me. They don’t call into work, they text it in.  Because of this virtual environment, he's not good at handling conflict because he has not been forced to practice it.

We have fewer touchpoints with our managers and teammates and fewer in-services because we're all spread out. We're not doing a lot of those one-on-one in-services or group trainings as much. We're doing more trainings and in-services via computers and not getting those hands-on components. We need to make sure that we're having a mixture of those.  With in-services replacing trainings, that might mean, "Hey, I'm going to pass around this sheet of paper. Everyone needs to sign it, say that you read it and understand it," versus sitting at a team meeting and having a conversation about that.

There is less organic learning through observation and modeling.  There is also a "should" trap -  "This person should know.” “That person has been a PT for 10 years and she should know not to do that or not to say that." Because we are so strong in the, "she should", we don't provide opportunities to learn and grow and have conversations about it. Because we think, "she should know," then we just ignore it and not address it or not talk to her or train her on that.  It's incumbent upon us, as professionals, to take away the "should" trap. Even our clients say, "He should know that he can't talk to people like that.” Well, let's have a conversation with him on that then.  

Fireplace versus fire mentality. This means handling things when they're brewing before they become explosive. Challenge yourself to say, "I'm going to handle things when they're kind of warm and brewing. I won't wait till they get explosive."

Another big reason for gaps in our soft skills is that we have generational workforce issues. There are so many age groups working at the same time. My 22-year-old son is 22 is working, my age group is working, and there some elderly individuals in their 70’s who are working.  So, we have this mix of people working in the same environment. We often talk about diversity in the terms of ethnicity or gender, but oftentimes, there is diversity in ages in the workforce. We want to be cognizant of that as we work with other employees and our patients.

Bridging the Gap

To bridge the gap, we need to include soft skills training in professional development. If you are a manager and are looking for words to mitigate conflict in your department, ask if they can bring in speakers and trainers to talk about professional development and soft skills.

Make soft skills part of the culture through examples, expectations, and emphasis. It's that idea of "practice what you preach." If you see a co-worker who is aggressive or rude, you can interact with them in a way that is non-aggressive and not rude. The more they see that "I'm the only one in this department that is acting and talking like this," the more likely they are to become aware that this is not the culture of the department.

Be intentional about increasing interaction with employees and have fewer in-services and more trainings. Change the "should" mentality, make it a priority and have a plan for interacting with patients, families, and staff on some of these soft skills.

Also, increase the checkpoints by asking questions like, "How are you doing?" Ask your patients how they are doing because some of our patients are passive and we may be working with them in a very vulnerable place. They are not well, they have a disability, they have a new injury and they are being told what and how to do things most of the time. So many times, we see them hide their emotions.  As a clinician, are we checking in with our clients before they request a different therapist out of the blue and you're thinking, "I thought we were doing great?" But when you really think about it, you may realize that maybe you were a little aggressive with this client and you didn't know it because they weren't saying anything. That's an example of how we need to have checkpoints to make sure that that fire stays contained and doesn't become explosive.

Also, get out of your office as much as you can, especially if you are a manager.  Make sure that you are on the floor, in the gym, and in the clinic to see what's going on. On the flip side, if you are an employee and you realize that the culture of your department is not very healthy, say to your manager, "I would like for you just to see what goes on because I feel that I'm coming to tell you a lot. If you wouldn't mind, especially at this time of the day, walk around and see what's available." Practice those crucial conversations that communicate the need to bridge that soft skills gap.

Know the do's and don'ts of different generations. What makes one generation tick versus another? What are the tendencies of one generation versus the next? I am not suggesting to become an expert on all generations, but be more observant of what is a part of the culture of one generation versus the next.

Another way to bridge the gap is to be strategic when employees are on projects and task forces. For example, if you have teams in your department or if you're a manager, make sure that you are putting yourself on teams or putting your employees in groups of people who work well together.  That takes some observation and some awareness of those passive, aggressive, and assertive characteristics.

Switch collaboration teams when necessary. Sometimes, this is as simple as changing wear you sit.  If you need to move around that space because you work better when you're not so close to a person, that is ok.  If you are working with a PT and an OT and you just aren’t gelling, maybe say, "Hey, do you mind if we put this OT on the team? We've seen that she works better with lower-level cognitive patients and we know your strength is more with higher functioning patients. We seem to be struggling a little bit. Let's switch that around." Have those crucial conversations.

Incorporate growth plans versus performance improvement plans. This applies not only to managers, but also employees, and this is huge when it comes to asking for what you need. Have you ever been blindsided at a performance review and your supervisor comes with this litany of things that you need to improve and goals that you need to meet in the next 6-12 months? You are thinking, "You never said any of this to me." As a manager and as an employee, we need to be providing or asking for growth plans. Meet on a more regular basis, rather than annually, to see if there is anything that needs to be addressed.  It could even be a conversation before you leave for the day, "Hey, just doing a check in. I know my last review wasn't great, so I wanted to see how we're doing on those things." If you're a manager, make sure that you're providing consistent checkpoints and growth plans for your employee. I believe that it is unfair, as a manager, to have this massive and revealing performance improvement plan for an employee when we have not afforded them time to improve nor the resources to do so.

One thing that I want to implore all employees to do is what I call “manage up”. If you think that you are being held to a standard without being given the proper resources, then you need to practice that conversation and say to your manager, "I understand that our productivity requirement is 90% and I don't mind meeting that. But one thing I see is that we all hover around 2 computers and we have 2000 therapists. I don't mind striving for that 90%, but can we talk with corporate about getting some more computers?" So, manage up effectively.

Next is to provide opportunities for employee implementation of skills. For example, you have an employee that is not very good at communication.  Maybe ask them with enough time to prepare, "Do you mind presenting something in our next staff meeting?" That gets them in a rhythm of talking in front of their co-workers. Think about instances where you, as a manager, can provide opportunities for your employees.

If you are an employee, how can you seek out opportunities to brush up on a particular soft skill? I would like you to identify two soft skills that you need to work on. Personally, I need to work on time management.  I have the squirrel mentality and am easily distracted.  I want to be in conversations and explore ideas and oftentimes my priorities are overshadowed by time constraints that I have in projects. So, I struggle managing my time.  So, it's incumbent upon me, as a professional, to work on those things.

Conflict Resolution

Conflict resolution is resolving a conflict or a disagreement by communicating conflicting opinions or strategies and engaging in collective compromise. That's a long statement, but there are so many words that are important. Conflicting opinion or strategies means that we think differently about the issue or we think we should handle it differently. We want to engage in collective engagement – working together - not, "Fine, whatever you say." That is not conflict resolution.  It’s a collective compromise. It's not, "Fine, do whatever," or "This is what we're doing.” Neither one of those are collective.

Conflict resolution is one of the most essential soft skills. It embodies you successfully using all of the other soft skills. It can instantly and intensely improve most of the other soft skills. It assists you with self-awareness and fosters collaboration.

What is Conflict?

We could use words like: battle, strife, disagreement, screaming, unsettled, arguing, war, anger, and fight.  When we think of conflict, we normally think of all of these negative words.  But let’s think of it this way. I'm going to say some words that might have some negative connotations. When I say “burp,” your immediate reaction is gross. Negative, right? And I'm sure when I said that word you heard an audible sound that a teenage boy makes because he thinks that it's cute. So, burping is gross. If I say “flatulence” that’s even worse, right? When we think of those terms, we automatically think of them negatively. But as healthcare providers, we understand that burping/belching is the release of gas from the upper digestive tract through our mouth. We understand that flatulence is the opposite end and is the release of gas from our lower digestive tract through other areas.

We also know that if it wasn't for burping and belching, we would have pain and cramps and bloating and other conditions. What if I said “sweat?” Think about somebody coming from the gym and laying a big hug on you. Gross! Negative, right? But we know that sweat is nothing more and nothing less than an important strategy for our body. It is moisture from our pores that we use to regulate our body's temperature to prevent us from fainting, overheating, having heatstroke, and discomfort. So, at first glance, it’s pretty negative.

Similarly, conflict, at first glance is negative, but conflict is natural and necessary. Many of us avoid conflict because we think that it's bad or negative. But think about the environments in the clinics, the hospital systems, and the healthcare systems that we work in. We work every day in environments that are high stress, have lots of time constraints, have high productivity, and require high levels of emotional energy and involvement. We work in Petri dishes of conflict and it's okay.  We just need to be aware of that and change our mindset as to how we reflect on conflict.

Successful Conflict Resolution

Step One

I want to share a matrix for how and when to handle conflict.  First, there is the catalyst. This is what I like to jokingly call the “pop-off”.  Something happens and it could be as simple as the PT is in your space or it could be something very unsafe such as seeing someone give a hamburger to a patient who is NPO.

Then, you have to ask the first question, “Should this issue even be addressed?”  Many of us, unfortunately, look at conflict in such a way that no matter how small or how large the conflict, we are going to hit it aggressively. However, there are some of us who don’t want to deal with the conflict at all.   But as assertive, healthy conflict resolution individuals, we ask ourselves, “Should this even be addressed?” To answer that question, ask yourself, "Will it improve productivity or policy?  Am I doing it just for principle?" If it will improve productivity and policy, then it needs to be addressed. But if it's because, "That's just not fair. She shouldn't do that," then maybe it doesn't need to be addressed. You have to pick your battles.   

Ask yourself what is important. We have a lot of emotional energy and a lot of time constraints. Within the time constraints and emotional energy that we have to expend, wisely choose which conflicts you are going to address.  Test the three P's: productivity, policy, or principle.  Will it distract from a more important issue? By asking yourself, “Will it help productivity or policy?” No? Then, keep moving on.  “Will it distract from a more important issue?” No? Then, keep moving on.  If you say yes to either of those questions, then the issue needs to be addressed.  At that point, you ask yourself, "Am I the person that needs to address this issue?"

Step Two

When you ask yourself, "Am I the person to address this conflict," there are different categories of people with whom you'll be in conflict. The first is the stranger.  This is the patient's family member who you don't know or someone that you have not come in contact with. Because you don't know their history, their communication style, or anything of that nature, this is the riskiest conflict to take. By risky, I don't necessarily mean dangerous, I mean you don't have any good predictors of how this conversation will go. You just need to be much more cognizant and prudent when you have these conversations with strangers.

The next category is your peers. These are OTs, PTs, and SLPs, a peer-to-peer relationship, not SLP to SLPA. This category requires the greatest level of self-governing because there are no rules or ranks necessarily that govern this conversation except each person's professional maturity.

Next is a subordinate. This level actually shows who you are at your core. This is the most self-reflective and self-aware because when you are in a position of authority over someone else, that reflects who you are when it comes to your own ethics and how you treat people.

The fourth category is a superior.  This is where you are in relation to someone who has more authority, power, and position over you.

Each of these categories requires a different strategy. Therefore, when you are in conflict with a person, you need to identify if they are a stranger, same level, subordinate or superior. If you are in a conflict with a peer, it's often best to handle something at the lowest level possible. So, peer-to-peer normally is the best way. But depending on the magnitude of the issue, it might be necessary for you to say, "I need to take this to our supervisor."

You always want to explore, "Who is my conflict with? Am I the best person to handle it?" If you are not the best person, then report it to the most appropriate person. You report it. If it's an issue with the CNA that needs that to be reported, "This is not my area to handle. I need to go tell the nurse manager." "I'm in conflict with an OT. I think she's doing something that's unethical. This one is for the supervisor." Or, "The OT and I are just having some problems with territory issues. I can handle this with her."  Ask yourself if you are the best person to handle the conflict.  If the answer is no, report it to the most appropriate person. If it's yes, ask yourself, "Is this the time?"

Step Three

Asking yourself, “Is this the correct time to address the issue,” is one of the most critical questions you can ask yourself.   I want to share a quick story.  I have three children who are 22, 12, and 9 years old.   About five years ago, my very mild-mannered daughter, who was four at the time, and her brother were sitting at the table eating dinner.  I told them to take one sip of their drink and they can't have any more until they finish their food, and my daughter goes to drink some more. I said, "Danielle, don't touch that drink until you finish eating." She was four years old at the time.  She took her finger, looked me in the eye, and slowly with her finger touched the glass. I was amazed! My son said, "Uh-oh," and looked at me. So, now I had an audience and I could go into detail about this whole battle that ensued between my four-year-old daughter and me because I chose to handle it at the wrong time when I had an audience.

The point is, you want to ask yourself about urgency, audience, and atmosphere.  Ask yourself, "Who's around? If I handle this, should it be in a one-on-one meeting? Will it be effective if I really want to be heard? Do I want to handle this conflict in front of all the other employees and coworkers? Can I have this conversation without an audience?”

Then ask about urgency, "Do I handle this right now or do I wait until they calm down a little bit and I calm down." If it's something that it's a safety issue or anything of that nature, then you may have to handle it right then and there.

Atmosphere is that question of, "If I handle this, how will it change the atmosphere of this event? Is this conflict worthy of the atmosphere change that would ensue?" Sometimes that is a yes and sometimes that is a no.  The best example that I can think of is having a team meeting because there have been some cultural issues and you want to kind of feed positivity and breathe positivity into your clinic. So, you have this litany of things that you need to address. The best advice is to pick and choose because if you're trying to do this whole positive, engaging team-building activity, is it a good idea to address all these issues and try to resolve all these conflicts in this meeting? It would be better to pick one or two issues and focus on creating a better culture and then slowly infusing those other issues.

When it comes to timing, always consider urgency, audience, and atmosphere. If you look at those three things and say, "None of those are right," then you don't want to handle it at that time. But if you look at those three things and can say, "Yes, it is appropriate that I handle this conflict at this time," then implement the following 10 steps.

  1. Mentally role play.
  2. Ask permission.
  3. Give warning statement.
  4. Set expectations of conversation.
  5. Don’t Compete. Partner.
  6. Be clear, concise and thorough.
  7. Address head on not head up.
  8. Address their specific need.
  9. Be able to clearly state what you need.
  10. Use more facts than feelings.

We’ve talked about mental role-playing already. But I can't stress enough how important it is. It may seem corny but practice the role play so that you can be prepared for the opposition and the things that might trigger you.

Ask for permission. You don't want to stop a person, like a nurse, when she's wheeling a patient down the hall and say, "Hey, can I talk to you?" It's not the time. Instead, you want to wait until you see her at the nurse's station, for example, and say, "Hey, Nurse Betty. What's a good time for me to grab about 10 minutes of your time? I just want to talk about that incident that we had last week. Okay?" You want to give them a warning statement. By warning statement, I don't mean, "You better...!" kind of thing but more of a, "I want to talk to you regarding this issue or this conflict." Then, they are also prepared for what's coming.

Set the expectations of the conversation. This is simply saying, "It'll take up about five minutes. It'll take 10 minutes. You know, last time we kind of got a little heated. I definitely want to assure you that I'm going to be nice and considerate, and I would ask the same for you.” So, in a very non-confrontational environment and tone, set the expectations of the conversation.

Don't compete, but partner. This is huge and is that whole compromise idea. I've really learned that most people are rational in rational environments. Therefore, if we can set up the environment, even the most difficult person, will have some desire to get resolution.  If you come to it in a spirit of partnership, it will help in that resolution.

Be clear, concise, and thorough. I like words and I love to talk. But when it comes to conflict, get in and get out. Practice being clear, concise, and thorough. If you find yourself being long-winded, especially in conflict, address head-on and not head up. Head up is, "I'm coming for you. I'm angry, I'm upset, and we're going to get to the bottom of this."  But head-on is different. Head-on says, "I'm not going to beat around the bush. I'm not going to turn other things into issues that aren't really issues. I'm going to talk about the priority issue in a way that seeks resolution, but I'm not going to be aggressive or rude with it."

Address their specific need. Be able to clearly state what you want. This is very important as well. Sometimes we know that there's drama and we don't even know what to ask for. We just know, "She rubs me wrong." Well, you should not go to that nurse or that doctor and say, "You know, you just rub me wrong." You're not ready to handle the conflict. You want to be able to say, "I often feel that when we communicate, I have to double-time my conversation and I feel kind of rushed. I think it would be better for me if you come to me when you aren't in between meetings and you have a little bit more time to talk with me."

Now you have clearly articulated what you want, which is one of the key components of successful conflict resolution. Also, be sure to display empathy for their need too. For example, a doctor is going to 10 different buildings and seeing so many different patients.  Try to understand that even though he's coming across to me as rude, I can understand that it's because he's rushing. When you have that give-and-take understanding, that can help with finding a resolution.

Finally, use more facts than feelings. Again, I am a very emotional person. I like to tell people all about how I feel. We want to make sure that we’re not saying, "This is how you made me feel." We can say that. But the majority of the conversation, the remainder of that, needs to be on the facts of the situation. The fact is, "I need this note for insurance purposes, even though it feels to me like you're undermining my leadership. I may focus on that a little bit, but my main issue is that I need this note at this time, because if not, it starts this domino effect of these causes."  I'm focusing on the facts of the issue.

I like to use the 80-20 rule. We definitely want to make sure that we let people know how it's affecting us 20%. But we spend 80% of the conversation on the facts and on resolution.

Again, as clinicians, we need to be proficient and be on the top of our clinical game. But, remember, nearly 70% of all of our issues, including those things that affect our patient outcomes, are because of tensions and conflict between co-workers and employees.

Questions and Answers

A supervisor asks for input and answers to questions but then doesn't want your answers, just corrects you and tells you what she wants to hear. What should I do?

So she's asking for input but not really taking it. Again, this goes back to being in conflict with four different levels of people. This would be your supervisor. So, you want to come to this in a way of letting them know the strengths of their leadership by saying something like, "Hey, I appreciate you having the weekly meetings that allow you to hear our opinion." What you started out of the gate with was acknowledging a positive of her leadership. "Thank you for having these meetings." Then you go to, "I appreciate you asking the question." The next thing I would say is, "Looking back on the previous meetings, I really haven't seen any specific suggestion that you've implemented, that we've given you. So, is there a better way for us to submit these suggestions to you?" You haven't accused her of anything. You haven't name-called. You haven't even gotten emotional, but you've dealt with the facts. You've said we have these meetings, but I'm looking back on history and I really can't point to any suggestion that's been implemented. Then you ask her, "Is there a better way or a more efficient way, that we can submit these to you?" If she says, "Well yeah, you know, if you guys write them down or send it to me in an email, sometimes I'm in the meeting and I forget what you all say." So, now you have a plan. Then, if it doesn't happen, you can go back to her and say, "Hey, I put this in writing, but I still haven't seen it." That's just one way that I would handle that.

I am experiencing a conflict with a classroom teacher who does not support implementing specific communication strategies and AAC devices. The teacher refuses to set them up for the students, despite our speech therapy department discussing the necessity.

When I think about it in more of a healthcare setting, my mind goes to when we ask for certain diet modifications or diets that need to be implemented and aren’t.  The first thing you want to do is acknowledge the level of the conflict. This scenario would be that same level, that peer-to-peer level.  You are not the same discipline, but you are at the same level when it comes to working within the school system and with the child. You want to handle things at the lowest level possible. Start with going to that teacher, and asking for permission, "When is a good time?" Once she gives you that time, make sure that you say, "You know, I see you working with the kids. Your kids love you."

(Whatever positive you can start with to give her some type of acknowledgment of her role in the plan of care.) Then say, "I just wanted to know if you had any questions?" This goes back to explaining your “why” of what you do and being proficient. "Are there any questions or is there anything I can explain about the device or the plan?" Maybe it's a lack of knowledge and once you can explain the benefit of the technique or the tool and how it will benefit her and the student, then there may be some movement from that. Once you do the education piece, give her a specific ask. Is it a schedule? "Can you implement this twice a week with, with the student, maybe not every day? Can you do this after lunch or something?" So, give her a very specific ask.

If after educating and giving her a schedule of your specific needs, it's still not being done, then you would have to go a level up. Is it a level up from her? Would it be the assistant principal or the person who's over disability services at the school? Who is the person who could assist you and has a little bit more authority over this relationship that can help you implement that plan?

I am an SLP and work for a non-profit with adults with developmental disabilities. I'm in a department of two and the other SLP is very defensive and combative. She takes everything as a personal attack. I've been working with her for 11 years and it's wearing me down.

That definitely sounds exhausting and I commend you for hanging in there for 11 years. I'm sure that you are there because of your clients and the other dynamics. What we want to do with that situation, going back to that aggressive personality, one of the things to do with aggressive personalities is to practice crucial conversation. If you're working with an aggressive person, practice having that conversation with them. Understand that aggressive people are not going to have good timing, technique, and tone. So, you almost want to give them the grace and understanding that they're not good with timing, technique, and tone. Then ask this person for what you need. For example, "Hey, Susie. I often feel that when you and I talk, you don't really listen to me." (And I know that you're thinking right now, "She's going to blow up.") But we have to try. You could go on to say to her,  “We have two options. We can implement the strategies and maybe get 10, 15, or 20% improvement or we don’t implement and then there is no improvement. Oftentimes when we deal with especially aggressive people, we have the tendency to say, "Nothing's going to change," so we don't do anything. But I implore you, even if it only helps a tiny bit, to try because it might make your next 11 years a little bit better. Again, I would tell her, "I just really don't feel that you listen to me. So, what I would ask is that when we have conversations that you just allow me, and I'll be sure to be quick, to get all of my thoughts out before you begin to talk, alright?" With that kind of response, you've given a specific ask.

We also typically see that an aggressive person often doesn't provide environments for other people to express their needs. So, if we know that the aggressive person creates anxiety amongst people, and there's not a good outlet, then you may ask her, "If I have an issue, when and where is a good time to bring up that issue?" Maybe she’s not good in the morning and if you go to talk to her before she has had her coffee, it might not go so well. But maybe Susie will say, "You know what, typically I find myself a little bit lighter between 1:00-2:00.  So, if you ever have an issue, just let me know and maybe we can talk in the afternoon."

Aggressive people like to push back. Meaning, that they're going to solve it for you or do it for you, "These are all the things that I want you to do and I want you to do it this way." When working with that aggressive person, you may want to say, "Hey, this is an issue. If you don't mind, can I go first?" That way you take away their ability, even for a slight time, to push back. Then you get out the issues or suggestions you have.

"What approach would you take if a supervisor is constantly watching or critiquing you and not giving you space?"

This goes back to those soft skills and not waiting until performance improvement, but do check-ins and things. This is the managing up approach. You ask a specific question, "When can we meet?" So, you have meeting #1 prompted by you. "Hey, I may be wrong, but sometimes it feels like there is a little bit of distrust in my skillset (or whatever) and I want to make you comfortable with that. So, can you give me any specific issues or areas that you think I need to improve?" Now you’ve put the onus of responsibility on them and they have to give you something. Maybe the reply, "Well, I don't think that your productivity is where it needs to be." So, you can say, "Okay, so what's the standard amount of productivity that you want?" You're getting specifics. When they tell you what that is you can say, "Great. Can we meet in the next 14 days to see if my productivity has improved?"

And once again you are putting the onus back on your supervisor. If it's a skill set that the supervisor thinks that you need to sharpen, they may say, "I don't think you're proficient at this." Then, ask them, "Based on what observation?" If they give you something valid, then you need to say, "Thank you for bringing that to my attention. This is what I'll do in the next 30 days or 60 days to remedy that."

But, if you don’t think that it's valid, say, "You know what, why don't you sit in on a session with Mr. James and me? Then, if you see that I have it under control, maybe you'll feel better about it." This is, again, just having those crucial conversations, managing up, and not shying away from some of these uncomfortable conversations.

Would you talk about jealousy? Many teachers or coworkers may be jealous of SLPs and our great job and great schedule.

Yeah, I definitely get that and oftentimes that happens with CNAs for me. I've had so many conversations with them about that.  You want to say, "Well, go to school for what you want to do and leave me alone." That's what you want to say. But because you are in a team environment, the first thing you want to do is gain allies. So always make sure that you are coming from a place of, “How can I get this person on my team?” So, one thing that I would do is show appreciation for them however that looks. It's this whole killing-with-kindness, "Hey, thank you for having him to the session on time. I appreciate the work that you're doing with them."   That makes it harder for them to be mean to you. You're not kissing up, but you're validly finding areas to show appreciation.

You also want to acknowledge the difficulties of their job. You are in a way coming to their side by acknowledging the thing that they're jealous of. I may say, “You know, I see that you're working two jobs and I think you deserve more.” I can't do anything about it, but I have validated the issue that's making her jealous of me. If it's a flexible schedule, acknowledge it to some degree under the umbrella of appreciation. Again, in order to gain an ally, show appreciation and acknowledge the issue that's causing them jealousy.

References

Doyle, A. (2021) “Top Soft Skills Employers Value with Examples”. The Balance Careers. July 22, 2021. https://www.thebalancecareers.com/list-of-soft-skills-2063770

Goleman, D. (2008) Working with Emotional Intelligence. Bantam Doubleday Dell Publishing Group.

Maxwell, J. (1997) Becoming a Person of Influence. HarperCollins Leadership.

Citation

Rollins, M. (2022). Successful Conflict Management Within Multidisciplinary Teams. SpeechPathology.com. Article 20517. Available at www.speechpathology.com

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mira rollins

Mira Rollins, OTR/L

Mira Rollins has been an occupational therapist for over 20 years. The majority of her career has been spent treating geriatrics in rehabilitation skilled nursing facilities. Her clinical experience also includes spinal cord injury and acute care hospital settings. Mira has also had the honor of leading successful rehab teams in her role as director of rehab and regional manager. She now uses her 20 years of experience as an adjunct professor for OTA programs and as the owner of Mira j. Rollins Engagement Programs, a training and consulting company.



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