Applying conflict management strategies to the pediatric operating room
Overall, this was quite a useful paper. The strengths included sensible observations about the relevance of communication failure and conflict to patient care, and a very useful list of specific suggestions for managing conflicts, illustrated with well thought out examples.
From the introduction:
- Communication failures are regularly identified as a root cause of sentinel events or intraoperative errors.
- Physicians receive little formal education in conflict management and instead model their behaviour on role models at home and at work, which has the potential to perpetuate stereotypes.
- Conflict is usually viewed as negative, but with a change of perspective, it can be viewed as positive if it highlights potential areas for improvement – especially if team members are willing to reflect on and change their own behaviour.
- Acknowledge and manage one’s own emotions, including ‘going to the balcony’ – ie imagine one was watching oneself and the conflict from outside on the balcony;
- Using statements that begin with ‘I’ to move the focus from the other person’s actions, which we cannot control, to ourselves;
- Active listening, where one listens to the content and the accompanying emotions with empathy and curiosity; and
- Identifying shared goals that may help the parties to move beyond entrenched conflicting positions.
These excellent points came with a fair bit of padding. The stated goal of the paper was to provide anaesthesiologists with ‘the framework and tools to successfully manage conflict in a culturally diverse health care system’. This is a good enough goal to stand alone. Instead, the authors used the introduction to suggest that we are in the midst of a crisis and that ‘improvements in anaesthesiologists’ communication and conflict management skills are urgently needed to improve patient safety and increase job satisfaction.’
The title of the paper focused on the paediatric operating room and the examples involved paediatric cases, but the observations and suggestions seem equally relevant to the adult operating room, or for that matter any work environment.
There was perhaps an overemphasis on classifying behaviour. The authors state in the introduction that ‘a successful physician should be able to identify the phases and types of conflict to use the conflict management approach most suitable for the given conflict’. The reader is then led through a series of models that analyse and classify types of conflict, phases of a conflict and various responses to conflict. References range from Steven Covey’s ‘The 7 Habits of Highly Effective People’ to a cluster of papers from the same author, journal and year. The lowlight of this paper, as with many papers about behaviour or personality type, is that these models are theories, but are presented as if they are facts. I would suggest that ‘a successful physician should be able to distinguish useful information from the padding it is wrapped in’ (giving myself away as typical of the ‘impatient judgemental solution focused’ personality type).
In the discussion, the authors presented a realistic scenario of conflict arising from a surgeon questioning why the anaesthetist was taking so long to get the patient on the table. The suggested response included what some might call a ‘dirty question’ – i.e. a statement disguised as a question. Before trying this out at home, one might benefit from flicking through Jenny Rudolph’s excellent article on giving feedback (1).
1. Rudolph, J., Simon R et al. There’s No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment. Simulation in Healthcare 2006:1(1), pp 49-55
Reviewed by: Dr Peter Howe