Winston Vaughan, MD, founder and director of the California Sinus Centers in the San Francisco Bay area, believes conflict resolution is crucial when dealing with work or personal relationships.
“Sometimes, as surgeons, we are trained as ‘cut the tumor out’ kind of people, and sometimes you just have to squeeze the pimple instead—you can’t overreact,” said Dr. Vaughan, who directly supervises 11 employees and oversees eight different locations. “Think about chilling out, negotiating, instead of going into nuclear mode and overreacting. That is the last thing you want to do. You want to reserve that for when there are nuclear weapons involved.”
Navigating and resolving conflicts involves using finesse, being open to others’ perspectives, and wanting to resolve an issue rather than to be right. Knowing how to navigate conflicts effectively can smooth situations among colleagues, peers, patients and their families, and others, and can build or maintain your role as a leader.
Making CHANGE
Dr. Vaughan cites a mnemonic known as CHANGE to help stay on top of tricky situations and navigate conflict:
- Chill out
- Handling
- Avoidance
- Negotiations
- Getting together
- Ending
He learned about the mnemonic in a self-growth workshop through the Personal Success Institute (PSI), a personal development organization, and says he uses it often when working with staff members, when “I get into a situation where there’s conflict around me or an ‘issue.’”
Chilling out is listening when others want to express themselves. “You are hearing what they are saying, but you are not immersing yourself in their emotional connection,” he said. “You are hearing but not listening intensely. Quite often, that’s all you have to do. Then you can all move on.”
Conflict in and of itself is not the problem; it is whether or not we can engage in effective conflict resolution to achieve the best outcome. —Catherine Hambley, PhDHandling is more assertive. By telling someone, “I can see why you’re saying that,” you’re becoming someone who is more actively involved in the conflict, said Dr. Vaughan.
Avoidance is recognizing that this is a situation you don’t want to get involved in, and you are going to stay inactive. In the office setting, it can mean letting two medical assistants, or two peers, or two vendors, work out their conflict without your participation. Often, Dr. Vaughan will say, “You guys can figure that one out without me. I trust you to, and do it today, thanks.” With this method, “they can learn from their wonderful experience without my being involved,” said Dr. Vaughan. “In a marriage, it can be saying, ‘I’m just going to avoid the coffee cup that is still in the sink.’ It’s just not worth it.”
Negotiation is when “we’re aiming for compromise, and I am now totally getting sucked in,” he said. “Basically, I’m the United Nations and we’re bringing North and South Korea together.” This usually involves time; it may need to be added to an agenda for a staff meeting, or you may have to meet with staff after clinic. “This is something that is not going away, and we are now in drama mode,” said Dr. Vaughan.
Getting together one on one with each individual involved in the conflict means giving your opinion to each side, then hoping those sides work it out together. “This works well with new staff, once a conflict has started out of a misunderstanding,” he said.
Ending the conflict is when things are drastic and/or when you need to clear the issue fast, said Dr. Vaughan. “This can be a divorce, a bad financial deal, or a bad day when we get to the end of it, but it’s when you stop the drama and get off the island. I do this when I am going to draw a line in the sand, cut your foot off, and our relationship is done. I’m going to be emotional and it hurts me, but it clears the conflict for good.”
Using effective conflict resolution may take practice, but is worth it as a way to help others manage a situation and teach others to work together better as a team. As surgeons, Dr. Vaughan said, “We are trained to see blood vessels and cauterize them. But sometimes people can apply their own pressure and control their own bleeding.”
Honesty Is the Best Policy
Tactful communication can be an effective way to keep conflicts from escalating. “Watch your words, especially if you are angry,” said Alla Y. Solyar, MD, an otolaryngologist with the Sinus and Nasal Institute of Florida in St. Petersburg. “There is an appropriate Russian saying: ‘A word is not like a bird. Once it’s out, you can’t catch it.’”
Helping to heal patients should always be a physician’s top priority. “Be careful not to compromise patient care just to appease another physician,” said Dr. Solyar. “You need to be your patient’s champion.”
In a common situation, an otolaryngologist may find that a patient requires urgent or unexpected surgery after hours or on a weekend; this may generate resistance from anesthesia colleagues. “Calmly explain the situation and the reasoning behind after hours surgery,” said Dr. Solyar. “Impress on them that they are doing the right thing for the patient and are an important member of the patient care team” by being available for the procedure.
When interacting directly with patients, honesty is always the best policy, said Dr. Solyar. “Trying to hide or change facts to help in a conflict resolution will not benefit anybody.”
The Importance of Being Open
Catherine Hambley, PhD, is a psychologist and co-founder of the Academy of Brain-Based Leadership, a consulting firm that translates neuroscience into leadership skills and behavioral and organizational improvement. She has worked with physicians since 1991. Her top tip for otolaryngologists about conflict resolution is to be aware of how you are responding to people. “Ask yourself, ‘What am I trying to accomplish with this dialogue? Is my behavior going to be effective in getting what I want?’”
Dr. Hambley recalled working with some physicians who were talking about the technique involved in certain procedures. “One started getting accusatory and critical, and it put the other person in a reactive mode,” she said. They stopped the conversation, and Dr. Hambley asked them to identify their concerns. “It turned out both sides were really concerned about patient outcome and, by talking, they were able to find some common ground. They were able to talk about ensuring the patient’s outcome, and it stopped being a conversation about blame and accusation and became one about best practices.”
As a result, both sides were able to learn something, share concerns, and calm down as each one understood how the other approached the issue.
“Conflict in and of itself is not the problem; it is whether or not we can engage in effective conflict resolution to achieve the best outcome,” said Dr. Hambley. “It’s important to do it in a way so that you are able to be more open, find common ground, ask questions about perspective, and acknowledge the other person’s point of view. Conflict escalates when we hold firm to our position.”
For some physicians, it can be challenging to be open to input. “Doctors are expected to be experts, and a lot of times, it’s contrary to saying ‘Maybe there are some things I don’t know or haven’t considered,’” said Dr. Hambley. “It can be seen as a threat, like, ‘Am I not competent?’” If people are asking, it’s not that a physician is doing something wrong. Those who are more open to learning have less difficulty with conflict.”
It is part of being a human being, not just a physician or a surgeon.
“Conflict resolution is often just being a regular guy, and not being a leader or a surgeon or a boss,” said Dr. Vaughan. “It’s realizing you have a relationship with the individuals around you, whether they are other professionals or family. It’s using some of the skills you have as a family member, child, sibling, parent—things you would do at home to have a happy home. If you don’t have the skills at home, you’ll have five divorces, and if you don’t have them at work, you’ll have five ex-employees.”
Cheryl Alkon is a freelance medical writer based in Massachusetts.