Some of the professional work I do involves mediation and consultation within healthcare systems. It’s within the context of some of my work that I recently had the opportunity to attend an annual conference directed to increasing quality and safety in healthcare delivery. The more narrow focus of the conference was on the concept of reliability.
The conference presenters highlighted two major areas of thought that is actually familiar to some of us:
1. Culture always eats strategy. It is essential to change the organizational culture to achieve patient safety. Changing culture requires a high level of sustained Board commitment to excellence; it requires transformative and resonant leaders who will act the talk they are giving, and who are committed to this shift for the long haul.
2. Design drives outcome. If each step of the process isn’t reliable, the outcome will not be substantially one of reliability and safety. To create a reliable process means it must be known and simply understood by the people who use it. If five frontline users can’t explain the procedure, it’s inherently not reliable. Reaching a reliable design requires group collaboration on the design, testing, re-design, re-testing, etc. It can be an exciting, yet arduous process. To achieve reliability, this group effort must include, as vital members of the group, those who will be using the procedure being created.
This particular conference has me thinking again about how much mediators and consultants with conflict management experience have to offer healthcare systems. I suggest one reason it’s been difficult to create particular changes within healthcare organizations is that the level of conflict competence within those organizations is relatively low.
Even though, several years ago, the Joint Commission created a leadership standard that recommended healthcare organizations create programs designed to deal with abusive physicians, and that offer ways to resolve internal conflicts, very few healthcare organizations have known how to design effective conflict management programs. Too often, people working in the system have little skill and confidence, themselves, about being in conflict situations. Thus, the suggested Joint Commission standard remains on paper, but rarely shows up within healthcare organizations. Even though conflict competence is now a recognized leadership competency, we see few executive job competency requirements that include competence in conflict management. If executive leaders have not developed conflict management insight and skill, how can they lead others to be fully engaged in cultural change that, by necessity, includes push, pull, and tension alongside excitement and hope?
Achieving procedures that are inherently reliant requires active and engaged exploration by a diverse group within the system. Within that engagement will be moments when differences, disagreements, feelings of judgment and fear will emerge. Creating reliable procedures requires human engagement that can promote and sustain challenging conversations, self-reflection, compassionate interaction and intelligent, critical inquiry. It takes a robust process to achieve a reliable process. And, what is experienced as a robust process to some feels like an entrenched conflict to other group members. People who lead process design must be, again, hopeful, resilient and transparent, and they must also have certain competencies in conflict management – they must know themselves within the context of emerging conflicts.
From my own work, and the work of others I know in the fields of mediation, coaching and organizational consulting, all of whom are adept in conflict engagement, I see many ways professionals in our fields can make active contributions to healthcare organizations that truly want to embrace and activate patient-centered care and safety:
• Coach executive leaders to become resonant leaders with highly skilled development in conflict competency
• Train physicians, risk managers, directors of nursing, department managers, front line staff and others to engage in informative and transparent conversations with patients and families after unanticipated events
• Design sustainable programs that implement training in transparent conversations, leading to reduced litigation and customer satisfaction
• Provide conflict coaching to both supervisors and direct reports to manage and work through conflicts that arise within the relationship
• Facilitate enriching and highly engaged process design groups leading to the design, development and implementation of reliable procedures
• Coach physicians and others in the system who are identified as emerging leaders to build emotional and conflict competency at earlier stages of leadership development
• Mediate long-standing internal conflicts between and among staff, and conflicts between departments and groups
• Design internal conflict management systems that provide non-adversarial processes to resolve staff conflicts, and conflicts between patients and providers
• Train the trainers in building staff resiliency to help manage the stress involved in the sacrifice syndrome familiar to many who work in healthcare organizations.
Healthcare organizations are some of the most complex organizations we know. The responsibility for the care of human beings generates intense emotion, requires consistent alertness, needs constant compassion and demands a high level of technical knowledge, training and skill. Creating a culture of safety can only happen when people are not afraid to speak, when people can rely on each other and when the culture is infused with hope, resiliency and a passion for purpose. Fear of conflict, conflict avoidance and constant internal tension and fear work against everything needed to achieve a healthy workplace, and superior patient care. Conflict consultants can make great partners in these efforts.
John Paul Lederach explains that those who preach pacifism should put themselves in a context where the practice is most needed, not talk about it from a safe distance.
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