209 - Conflict Resolution in Emergency Medicine

outcomes. However, conflict also serves as a creative force, providing both initiative and incentive to solve problems. This chapter describes conflict in general, identifies contributing factors, and offers several examples specific to EM. The importance of effective communication in conflict resolution is presented, as well as its role in de-escalating, limiting, and preventing conflict. This chapter offers strategies to facilitate successful conflict resolution. Conflict resolution ultimately benefits patients, staff, and EPs by optimizing patient care, decreasing patient morbidity, improving patient safety, and maximizing an individual’s or health care team’s overall satisfaction. Communication, in the form of language and interaction, and power, in terms of how conflict is managed (or mismanaged), are tremendously important in the dynamics of groups. EM is very much about group dynamics because physicians, nurses, and other staff members must consistently demonstrate successful teamwork to offer patients the best possible outcomes. Louise B. Andrew, MD, JD, stated “... conflict is often the result of miscommunication, and may be ‘fueled’ by ineffective communication.” Three important sources of conflict have been identified: resources, psychological needs of individuals or groups, and values. Resource-based conflicts relate to limited resources, common in EM. Psychological needs include power, control, self-esteem, and acceptance. These needs often exist under the conflict’s surface and can be difficult to identify or address. Values (beliefs) are fundamental to conflict. Core values, such as religious, ethical, financial, or those involving patient care are difficult to change and therefore generally assume a large role in conflict. Value differences among people or groups (e.g., health care professionals and physicians with different training) may result in repeated conflicts. The expectations that EPs have of hospital and emergency department (ED) staff regarding work ethic or efficiency, for example, often result in conflict (perceived or real). Under these circumstances, people feel as if their integrity is being questioned, and this is one reason that value-based conflicts are extremely difficult to resolve. • Conflict is the result of discordant expectations, goals, needs, agendas, communication styles, and backgrounds between or among individuals. At least two perspectives contribute to conflict. • Conflict in emergency medicine (EM) may occur with patients, family members, nurses, consultants, residents, students, hospital administrative staff, or agents inside and outside the emergency department. • The goals of effective conflict resolution are to optimize immediate outcomes and to establish a solid foundation for subsequent interactions. Success depends on one’s communication style, awareness of other’s needs and psyche, and understanding of relationship dynamics. • Successful conflict resolution requires a systematic and structured approach. Recognizing each participant’s principal interests and underlying positions is important. Having a strong BATNA (best alternative to a negotiated agreement) is beneficial. Possessing a “win-lose” attitude interferes with successful conflict resolution. • Not all conflict in EM can be resolved immediately, if at all; some resolutions require the assistance of a third party. • Efforts to prevent conflict before it happens are recommended whenever possible. KEY POINTS