Work on conflict resolution

The different backgrounds and training of medical staff and hospital administration often make it hard for physicians and hospital leaders to work together without conflict. However, both groups must make every effort to cooperate; such disagreements slow down the decision-making process and complicate quality improvement initiatives.

The chief executive officer and the board are concerned about the hospital's overall performance and financial well-being. The medical staff and medical staff leaders tend to focus on individual patients. Yet both are clear about their foremost goal: to provide quality patient care. It might help to reiterate this common goal before controversial meetings or during heated discussions. Doing so could possibly reduce the tension and lead the discussion in productive directions.

Creating an environment of trust and respect is the first step to alleviating conflicts. Both sides must be willing to overlook past grievances, personal feuds, and pet agendas. Executives and managers must be aware of and avoid common mistakes when talking to and working with physicians, such as:

• Seeking an approach to the medical staff. Physician support is gained only when effort is expended to understand the motivation of individual physicians.
• Depending on "cronyism." Playing favorites usually generates a significant number of disenchanted outsiders.
• Being unavailable. When one physician calls another, he or she is put right through. When a physician calls a member of the hospital management team, he or she is told, "He's in a meeting; leave your number and I'll have him call you when he gets around to it."
• Conflicts in communication. It is up to management to provide leadership training opportunities for the medical executive committee and other physician leaders, including how to communicate management goals and decisions to physicians, and how to transmit physician concerns to management.

In addition, physician leaders must be aware of and avoid common mistakes when talking to and working with executives and managers, such as:

• Failure to recognize higher authority. Input in the form of demands is unlikely to frighten or influence management or the board.
• Failure to take time to learn strategies necessary to influence management decisions
• Stubbornly resisting change. Questioning the need for change is not bad, but the Gloria Patri mentality ("As it was in the beginning, is now, and ever shall be") is counterproductive.
• Generalizing. Some physicians seem ready, if not eager, to believe the worst about all hospital administrators.

From there, they can start with a clean slate and acknowledge mutual dependence for success, develop a shared vision and goals, clarify roles and responsibilities, develop clear expectations and ground rules, design and implement structures that ensure ongoing communication and joint problem-solving, and agree in advance on how conflicts will be addressed.