By Melinda Young

There are times when best practices and calming techniques might not work in resolving conflicts involving case managers. These situations are trickier and more complex because of behavioral issues or the people involved.

When this occurs, case management leaders need to be more proactive and take charge of the situation.

These are examples of complex conflicts:

• Bad behavior. “Sometimes, individuals just don’t get along,” says Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM, senior director of care management nursing at Cleveland Clinic. “They can resort to hurtful behavior to one another. It’s important to immediately put an end to that.”

A manager must immediately intervene in those situations. For example, a manager could ask the employees to talk through their differences to learn what caused the conflict. They can help the employees understand how their words or actions might have been hurtful.

“We can get so much more accomplished if we’re working as a team,” Davis notes. “We can solve a lot of problems as a team vs. trying to singularly work on an issue.”

Managers can teach staff that part of developing a good team is to have respect for one another. “There’s a line one of my old case management bosses said to us, which was, ‘We don’t all have to go to cocktail parties together, but we do have to respect each other,’” Davis says. “That stuck with me. You don’t have to be the best of buddies, but the respect has to be there.”

There might be certain staff behaviors and situations where the manager has to call in human resources. “You can’t let bad behavior continue,” she says. “If my staff can’t work it out themselves or they’re afraid to, then it’s our responsibility to step in. If we can’t resolve it, then we do call in human resources.”

• Festering conflicts. Sometimes, conflicts involve managers and employees. They might not be resolved by simply listening to each person’s point of view, Davis notes. When this happens, the manager will have to find a different tactic for resolving the conflict so it does not fester.

“I think managers on the frontlines really have difficulty with that,” Davis says. “Conflict management or resolution is not a favorite activity because it can be unpleasant and stressful for the manager.”

Leaders need to address these conflicts head-on, knowing they have the tools they need. For instance, they could even role-play on how to work out a conflict between case managers and patients, or an employee and the manager, Davis says. Staff should take advantage of any conflict resolution opportunities.

“Don’t feel like they’re an exercise in silliness, because they’re not,” Davis adds. “They’re designed to be helpful.”

• Conflicts with physicians. “Sometimes, you get mixed messages as a case manager,” Davis says. “You’ll be told to move this patient to a more appropriate level of care, then everyone says you can’t send them there because you don’t have the right supports in place.”

This is why case management is difficult: It requires constant negotiation. “You’ll take 10 steps one way, then you have to go down a few steps, and then sideways,” she notes.

Case management leaders should teach other case managers about how to practice speaking with physicians and not taking things personally.

“If a physician says, ‘Are you kidding? You’re not sending the patient there,’ you have to just take a step back and think about what they’re really saying,” Davis explains. “Do they not understand this level of care? Or, did they have an experience with this facility and not like it? You have to find out what the barrier is and why they would not want to move their patient to this level of care.”

The more complex a patient’s case, the more layers of individuals the case manager will have to go through. This can be frustrating, Davis notes.

“The case manager just needs to take a deep breath and say, ‘OK, let’s find another angle for this,’” she explains. “Or, they can just listen and say, ‘I didn’t realize that; we don’t have all the answers, either.’”

The best tactic is to listen to everyone’s concerns. There probably are legitimate reasons behind them.

“Case managers need to take care of themselves and not take disagreements personally,” Davis says. “Nine times out of 10, if you’re trying to negotiate arrangements for a patient, it’s not personal.”

Case management leaders need to remember there is a give and take in their relationships with staff.

“Trust has to be there,” Davis adds. “The old saying of ‘principles above personality’ applies here. They should keep that front and center.”