Team Conflict
Nancy Ghanayem, MD
Professor of Pediatrics (Critical Care)
Director, Cardiac Critical Care
Disclosures
• No financial disclosures
• I have engaged in conflict
• I have facilitated conflict
• I am not an expert in conflict, but I do have experience
Number of Quality and Patient Safety Publications by Year
10000
9000
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6000
Quality related
5000
Safety related
4000
(Pub Med)
3000
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Borrowed from M. Scanlon
Denotes PNPs, PAs, trainees
Ancillary Staff
RN
RN
RN
RN
Doc
Anc.
Doc
Anc.
Doc
Doc
-
Anc.
Patient
and
families
Anc.
Respiratory
Laboratory
Blood Center
Pharmacy
Radiology
OR Staff
Transport
Therapists
Dietician
Imaging techs
Environmental
services
The Group Mind
Each of us has only part of the information or expertise to
get the job done.
Crucial to a team is the right mix of intelligence (“really
smart people”) and emotional intelligence.
D. Goleman, Working with Emotional Intelligence
Emotional Intelligence
Emotional intelligence is the ability to monitor one's own
and others’ emotions, to discriminate between different
emotions and label them appropriately, and to use
emotional information to guide thinking and behavior.





Self-Awareness
Self-Regulation
Motivation
Empathy
Social Competence
Team Intelligence
Capacity of the individual members of a team to learn, teach,
communicate, reason and think together, irrespective of
hierarchical position, in service of shared goals.
• Team members must:
 Have shared identity to articulate common goals
 Be willing and able to share information
 Understand one another’s roles
 Must have trust and support one another
Gordon, Beyond the Checklist
Adapted from Crew Resource Management
Communication is central element in effective teamwork
• Establish common language, both terminology and
meaning
• Establish interpersonal relationships
• Establish predictable behavior patterns
• Maintain attention to the overall situation, to task, to self
and to fellow team members
• Manage the team
Conflict in healthcare arise from a clash of
perceptions, goals and values in an area
where people care about the outcome.
Denotes PNPs, PAs, trainees
Nursing Leaders
- Inpatient (ICU, acute care), OR
RN
RN
RN
Doc
Physician Leaders
-
Surgery
Critical Care
Cardiology
Anesthesia
Neonatology
Ancillary Leaders
RN
Anc.
Doc
Anc.
Doc
Anc.
(assume within
group arrows)
Patient
and
families
Doc
Anc.
Indirect Patient Care Stake Holders
Academic Leaders
- Dean
- Dept Chairs
- Section Chiefs
(assume within group arrows)
Hospital Leaders
-
CEO, CNO, COO, CFO, CMO, CIO, CSO
(assume within group arrows)
Opportunities inherent in conflict
• Early identification of problems
• Promotion of proactive responses to problems
• Provides understanding of issues
• Encouragement of a culture of mutual respect, open
communication and problem solving
• Means of working toward potential resolution
Importance of conflict resolution…
• Conflict that is allowed to fester doesn’t resolve itself
• Combatants become more entrenched in positions
• Co-workers feel compelled to take sides
• Morale suffers
• Less innovation and talent may leave
• Patient/family outcomes and satisfaction suffer
The Stacey Matrix: Challenge of Complexity
Innovation
Creativity
Debate
Serendipity
Trial & Error
‘Simple’
Conflict Resolution
Competing
(Win/Lose)
Assertive
Collaborating
(Win/Win)
Compromising
(Low form of Win/Win)
Unassertive
Avoiding
(Lose/Lose)
Uncooperative
Accommodating
(Lose/Win)
Cooperative
My Experience
Assertive
Patient rescue
Formation of CICU
Complex patient
decision making
Competing
(Win/Lose)
Collaborating
(Win/Win)
Formation of a CICU
Patient placement
Compromising
(Low form of Win/Win)
Giving feedback
re: performance
‘conflict averse’
Unassertive
Avoiding
(Lose/Lose)
Uncooperative
Carry out directives of
others that placed me in
vulnerable position
Accommodating
(Lose/Win)
Cooperative
Conflict management process
• Schedule time alone to think
• Identify and own the emotions related to conflict
• Try to look at conflict from the other’s perspective
• Analyze the probable sources of conflict
• Assess the importance of issues to you, the other person and the
organization
• Determine the probable outcomes of avoiding or addressing the
conflict
• Decide upon and execute a specific course of action
Force functions for conflict management
• Patient-centered focus
• Regular multi-disciplinary, multi-specialty conferences
• Consistent handoffs with clearly delineated goals
• Pre-intervention plans especially in complex patients
• Develop trust – modeled by leaders
* Each employed at CHW
Conflict Management Leadership
Strength in negotiating & resolving disagreements
• Handle difficult people and tense situations with
diplomacy and tact
• Spot potential conflict, bring disagreements into the open
and help de-escalate
• Encourage debate and open discussion
• Orchestrate win-win solutions
Goleman, Working With Emotional Intelligence
Stages of Team Development
Performing
Norming
Storming
Forming
Maturation
Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work”
Forming
Member Behaviors
• Excitement, optimism,
suspicion, anxiety
• Comments directed at leader
• Direction and clarification
sought
• Failure to listen resulting in
nonsequitur statements
• Issues discussed
superficially
Leader Behaviors
• Hold regular meetings to
establish goals and mission
• Clarify roles
• Encourage participation and
questions by all
• Facilitate learning about one
another’s expertise
• Share all relevant information
Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work”
Storming
Member Behaviors
Leader Behaviors
• Defensive, competitive
• Arguments among members
• Attempts made to gains
solutions
• Subgroups and coalitions
form
• Leader is tested/challenged
• Members judge and evaluate
one another resulting in tasks
being shot down
• Task avoidance
• Engage in joint problem
solving
• Establish a norm in supporting
the expression of different views
• Discuss and share decisionmaking process
• Provide resources needed for
members to do their job
Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work”
Norming
Member Behaviors
• Attempt to achieve harmony
• Begin to confide in one another
• Ground rules, group decisionmaking and team activities
standardized
• Members can support one
another and disagree with
leader
• Confidence increases as
energies directed at team goals
• Progress noticeable
Leader Behaviors
• Talk openly about your own
concerns/issues
• Have members manage high
stake items
• Give and request feedback
• Assign challenging problems for
consensus decisions
• Delegate as much as members
capable of handling
Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work”
Performing
Member Behaviors
• Roles clear and contributions
distinctive
• Take initiative and accept one
another’s initiatives
• Open discussions and
acceptance of different modes of
operation
• Challenge one another to
creative problem solving
• Seek feedback from one
another and leader to improve
• Close to team
Leader Behaviors
• Jointly develop a vision and
goals that are challenging
• Question assumptions and
traditional ways of behaving
• Develop mechanisms of
ongoing self-assessment
• Appreciate each member’s
contribution
• Develop members to their fullest
potential through assignments,
feedback and training
Adapted from: Team Building. “Developing a Productivity Team: Making Groups Work Work”
Thank you