Conflict is an unfortunate reality that healthcare professionals must navigate daily. Whether you're running a busy GP practice, managing a clinic, overseeing a pharmacy, or working in primary care, the ability to handle challenging situations effectively is crucial.

This post delves into key strategies for managing conflict and ensuring the safety of both staff and patients in healthcare settings, with a particular focus on the relationship between staff and patients.

Why are strong conflict management skills so important for healthcare professionals?

Recent years have seen a concerning trend in healthcare-related conflicts. A BBC news story from 2022 reported a doubling of incidents in GP practices over five years. This increase is not isolated to general practice; it's a phenomenon observed across various healthcare settings, including pharmacies and clinics.

The reasons for this surge are multifaceted. Ger O’Dea, CEO of Dynamis training, notes, "People aren't getting kinder to each other anytime soon. It seems to be the trend."

Factors such as the aftermath of the COVID-19 pandemic, rising cost of living, and general societal tensions have contributed to a population that's "wound pretty tight." These stressors often manifest in healthcare settings, where patients may already be experiencing anxiety, pain, or frustration.

What causes patients to become aggressive and violent?

To effectively manage conflict, it's essential to recognize the various types of challenging situations you might encounter. Two models used in conflict management are particularly useful as we seek to understand a patient’s distress and prevent escalation of conflict: the Kaplan-Wheeler model and the SCARF model.

Types of challenging situations

While it's important not to label patients, understanding common patterns can help in developing appropriate strategies. Some categories of difficult, distressed, or dangerous patients include:

• The "Gimme X" patient: Often seeking specific medications or treatments, sometimes in an intimidating manner.
• Patients with complex comorbidities: These cases can be challenging due to the intricate nature of their health needs and potentially unrealistic expectations.
• Self-destructive patients: Requiring a delicate balance of care and boundary-setting.
• Angry or aggressive patients: Those who may become verbally or physically threatening.

Remember, these categories are not exhaustive, and each patient is unique. The key is to approach each situation with empathy and professionalism.

The Kaplan-Wheeler Model of crisis behaviour

Understanding the progression of a conflict situation is crucial for effective management. The Kaplan-Wheeler Model of crisis behaviour provides a valuable framework for this. This model describes several phases of escalation:

• Phase 1: Calm
• Phase 2: Trigger
• Phase 3: Escalation
• Phase 4: Crisis
• Phase 5: Recovery

Recognizing which phase a situation is in can help you choose the most appropriate response. For instance, in the triggering phase (Phase 2), your focus should be 100% on verbal de-escalation techniques. However, as the situation moves into Phase 3 (Escalation), your approach may need to shift to prioritise safety.

The SCARF model to understand triggers

When dealing with triggered patients, the SCARF model can be particularly useful. This model identifies five key areas that, when threatened, can trigger a stress response:

• Status: A person's sense of importance relative to others.
• Certainty: The ability to predict future outcomes.
• Autonomy: A sense of control over one's life.
• Relatedness: A sense of safety with others.
• Fairness: The perception of fair exchanges between people.

By addressing these areas, you can often defuse potentially volatile situations.

What is the single most important conflict management principle for healthcare professionals to remember?

The foundation of effective conflict management in healthcare is the principle of treating all individuals with dignity and respect. This approach should be maintained any way, every time and every encounter, even in challenging situations.

To put this into practice, consider five key strategies emphasised by our colleagues at Vistelar, a US-based workplace conflict management specialist:

• See the world through their eyes: Empathy is crucial in healthcare. By understanding the patient's perspective, you can often find a path to resolution.

• Listen with all your senses: When interacting with patients, especially those who are distressed or difficult, use all your senses to gather information. This includes listening to their words, observing body language, and being attuned to other non-verbal cues.

• Ask and explain why: Compliance with treatment is a big issue ****in healthcare. When asking patients to do something, always explain why it's necessary. This clarity can significantly reduce resistance and uncertainty.

• Offer options: When faced with resistance, provide the patient with clear options. This approach opens up the field of possibility and gives the patient a sense of control.

• Give an opportunity to reconsider: If a patient is making a poor decision, offer them a chance to rethink. A simple phrase like, "Is there any way I could get you to do what I've asked?" can be surprisingly effective.

What practical strategies should healthcare settings implement to reduce conflict?

Set the Tone Early

When entering a potential conflict situation, introduce yourself carefully and set the tone for the conversation. A calm, professional demeanor can often prevent escalation.

Use Clear Communication

Always strive for clarity in your communications. Clarity is really good for people. When we look at what triggers people into escalation, they often are experiencing a lack of clarity. Explain procedures, waiting times and next steps clearly to reduce anxiety and frustration.

Maintain Professional Boundaries

While empathy is crucial, it's equally important to maintain professional boundaries. This is particularly relevant when dealing with patients who may have unrealistic expectations or demands.

Train Your Team

Ensure that all staff members, from receptionists to clinicians, are trained in conflict management techniques. A unified approach can significantly reduce the likelihood of escalation.

Create a Safe Environment

Design your healthcare space with safety in mind. This might include clear sightlines, easily accessible exits, and a layout that minimises potential confrontations.

Develop Clear Policies

Have clear, written policies for dealing with abusive or threatening behaviour. Ensure all staff are familiar with these policies and feel supported in implementing them.

Use De-escalation Techniques

Learn and practice de-escalation techniques. These might include using a calm tone of voice, avoiding confrontational body language, and acknowledging the patient's concerns.

Know When to Seek Help

Recognise when a situation is beyond your capacity to manage safely. Have clear protocols for when and how to involve security personnel or law enforcement.

Why is the ‘doctor-patient’ relationship key in conflict prevention?

While the strategies above are crucial for managing conflict when it arises, the best approach is often to prevent conflict in the first place. This is where the doctor-patient relationship becomes paramount.

Build Trust

Trust is the foundation of a strong doctor-patient relationship. Be consistent, reliable, and honest in your interactions.

Practice Active Listening

Give patients your full attention when they're speaking. Listen to them with all of your senses. This not only helps you gather important information but also makes the patient feel valued and understood.

Involve Patients in Decision-Making

When appropriate, involve patients in decisions about their care. This can increase their sense of control and reduce feelings of helplessness that might lead to conflict.

Manage Expectations

Be clear about what you can and cannot do. If you can't meet a patient's request, explain why and offer alternatives if possible.

Show Empathy

Demonstrate that you understand and care about the patient's concerns. A simple acknowledgment of their feelings can go a long way in preventing frustration from escalating into conflict.

Educate Patients

Take time to explain diagnoses, treatments, and procedures. An informed patient is often a more cooperative one.

Be Culturally Sensitive

Be aware of and respect cultural differences that might affect the doctor-patient relationship or the patient's approach to healthcare.

How can health settings best care for individual teams after conflict has taken place?

Even with the best prevention strategies, conflicts may sometimes occur. It's crucial to have post-incident procedures in place to support staff members who have experienced a difficult or traumatic incident.

1. Immediate Debrief: Offer an immediate opportunity for the affected staff member to discuss the incident with a supervisor or colleague.
2. Professional Support: Provide access to professional counseling or support services for staff who have experienced traumatic incidents.
3. Review and Learn: Use each incident as a learning opportunity. Review what happened and identify any changes that could prevent similar incidents in the future.
4. Ongoing Training: Regularly update and refresh conflict management training for all staff members.

How can Dynamis help improve safety in our healthcare setting?

Dynamis Training have over seventeen years’ experience supporting healthcare settings to prevent conflict and effectively manage conflict when it does arise.

By prioritizing dignity and respect, fostering understanding of conflict escalation and demonstrating practical strategies for prevention and management, we help healthcare professionals to create safer, more positive environments for both patients and staff. To find out more, schedule a call with us.