Use these five tips to help staff handle conflicts

As an emergency department (ED) leader, you should do the following to improve your staff’s ability to avoid conflicts with each other and patients and to manage those effectively if they occur, says Tracy Sanson, MD, FACEP, assistant medical director for the department of emergency medicine at Brandon (FL) Regional Medical Center.

  1. Establish departmental expectations of behavior. A group should develop specific expectations for behavior between staff members and between staff and patients, Sanson says. The group should include the medical director, ED manager, and representatives of registration, nursing, technicians, and clerks, she says. "We may believe that we all know what is expected behavior, but when it is developed by the group, then the team owns’ the normative guidelines." Sanson gives the following examples of expectations: no yelling, no off-color remarks or jokes, and no negative comments about a patient or family member. "Jokes or remarks about a patient’s size, smell, or worth to society are not appropriate," she says.
  2. Develop role-playing educational opportunities. Just as resuscitations and codes are practiced, so should unpleasant or tense ED situations, Sanson says. "Such mental rehearsal improves the retention of new skills and enhances performance." This can be a routine part of staff meetings or can occur at the beginning of shifts, she says. For example, there often was a conflict between a physician’s request to have infants catheterized and parents’ reluctance to allow the procedure, with ED nurses caught in the middle. The nurse manager and pediatric nurses rehearsed describing benefits of the procedure by presenting it in an upbeat, matter-of-fact style to the parents, she says. "We saw a dramatic decrease in the refusal of parents to allow this invasive but necessary procedure for their children." This type of practice is very important when trying to learn a better way of doing something, she explains. "It takes commitment and constant reminders to stay focused on undoing old habits."
  3. Provide informal and formal feedback on behavior with staff and patients. Sanson gives this example of informal feedback: "I heard you handled an angry patient very well during your last shift. Could you present this at the next meeting, and model for us how you handled it and help us discuss what you learned?"
  4. Create opportunities to review lessons learned from specific episodes. Staff meetings are an opportune time to discuss a recent or mock scenario, Sanson says. "Explore how the group feels it should be handled, in keeping with the norms the ED has established," she advises.
  5. Ask the involved parties for solutions. Take these steps when addressing a conflict among physicians and staff: Conduct a thorough investigation, arrange a private meeting to discuss the behavior, and set specific goals to change the behavior, Sanson advises.

Involve both parties and ask what they think should be done, advises Louise Andrew, MD, JD, FACEP, associate director for the Durham, NC-based Center for Professional Well-Being. She gives this example: If a physician reports frustration because written orders are not being taken off the chart promptly, a solution might be a system of colored flags to signal orders that are critical, moderate urgency, or routine.