Healthcare Risk Management

Open talk helps diabetes clinic torn by staff conflict

As daily workplace demands rise, overtaxed leaders often target other decision makers – the CEO, a head nurse, technician, or doctor – as the source, says psychologist Anna Maravelas, a conflict resolution consultant and president of Thera Rising in Minnesota.

Maravelas has been resolving conflict for more than 20 years in hospitals, prisons, police departments, corporations, and universities. She says that kind of finger pointing is the root cause of workplace factions and cross-functional tension. When leaders go toe-to-toe in a public display of hostility and blame, even patient safety becomes secondary, she says, because the battle for reputations and careers takes precedent.

Stop it, or else.

Maravelas tells this story she says is typical of how such conflicts can disrupt health care operations and threaten patient safety: Several years ago, she was asked to intervene in a troubled dialysis unit. “Alice,” the division’s vice president, told her, “I’ve tried everything to stop the three leaders of this unit from fighting and you’re my last hope. If you can’t resolve the conflict between the head nurse, the assistant head nurse, and the technical supervisor, I am going to close the unit and tell the doctors to take their patients somewhere else. I can’t allow the unit to continue as it is.”

After gathering extensive background information, Maravelas met alone with each of the three supervisors to get their individual perspectives. During their private interviews, each said to her, “I know I have the majority of the staff behind me because the staff tells me I’m the most competent leader on the unit.”

Obviously that wasn’t possible, so Maravelas knew the supervisors were being played. She also knew her first step was to break through their individual illusions that they had more staff support than their peers.

With their knowledge, she drew up a confidential survey for their 65 direct reports. When the surveys were returned to her office, anger and resentment toward all three supervisors poured off the pages. Assured of confidentiality, the nurses and technicians were passionate and bitter – and their comments were laced with disparaging remarks about the leaders’ immaturity and irresponsibility. Most of their employees were particularly enraged that their management team had compromised their responsibilities to patients in order to play out a private vendetta.

Met with supervisors as a group

Maravelas typed up their comments, removed identifying information, made copies, and asked the three supervisors to meet with her as a group. As they read through the responses, their self-righteousness and smugness evaporated and they shifted uncomfortably in their seats.

The two-hour meeting was a major turning point for the management team. Four months after the first meeting, relations had improved among the clinic leaders enough that they regularly got together for a beer after work.

“Interpersonal staff conflict can cost organizations millions of unmeasured dollars and put a hard-earned reputation for excellence at risk,” Maravelas warns. “Very rarely is the source of the problem the other party’s personality. When leaders want to understand the behavior of another person or department they would be well served to focus on their performance measures, restraints and demands, rather than their personalities.”

Maravelas says blaming people for problems is worse than ineffective; it alienates the people you need to solve the problem. “Turf wars and blame aren’t human nature,” she says. “They are reflexive reactions to frustrations, and they are easily changed.”