An ambulatory surgery center staff consists of a myriad of different personalities, working closely together in a fast-paced and often stressful employment. There are bound to be individuals who rub each other the wrong way leading to conflict. Employee conflict in turn leads to inefficiency and an unhappy workplace. It is up to the administrator to pour water over a potential fire.
Here, three administrators discuss how they deal with employee conflict and offer tips for successful mediation.
Question: What are some signs of conflict among employees at an ASC?
Amanda Sosnosky, Administrator, Bellin Orthopedic Surgery Center (Green Bay, Wis.): Like in any work environment, employee conflict exists; the ASC environment is not an environment free from conflict. In my opinion, the signs of conflict that occur between staff members are typically a result of differing opinions. At times all of us have the feeling that our way is the "best" way to handle a situation. This causes us as individuals to come across very strongly toward others and [we] can even be offensive toward one another. The perception of those on the receiving end becomes their reality of the situation and can be seen primarily by signs of avoidance or annoyance with the other employee.
Becky Ziegler-Otis, Administrator, Ambulatory Surgical Center of Stevens Point (Wis.): Conflict can appear in a variety of ways. The most obvious is a verbal encounter between two employees about a specific subject matter. Though this is obvious conflict, it does not always occur in this fashion. Typically there is more of a passive aggressive approach. Some examples include one employee complaining to the supervisor about the performance of activities of another employee; or an employee being treated differently by their co-workers, that is, all other co-workers work together to help accomplish the work and don't help a specific employee. Other examples include behavioral signs such as closing the door loudly after a specific employee departs, or tossing down papers in a hard fashion or not being forthright with needed information to accomplish a task, etc.
Jennifer Butterfield, Administrator, Lakes Surgery Center (West Bloomfield, Mich.): It begins with minor complaints generally from the person who was offended by a specific person. The offended person will complain about performance, personality or whatever they can to anyone who will listen to them. Unfortunately, they don't bring the complaint to the person that offended them, but will bring the complaint to all their friends, co-workers and sometimes the ASC's medical staff. It's the typical gossipy type of communication that begins with "did you know" and never ends with anything positive.
Q: How can employee conflict affect ASC operations?
AS: Ultimately, this leads to further signs of conflict, including lack of teamwork and lack of trust between co-workers. When co-workers lose trust in one another, the result is often detrimental to the business. These results lead to a decreased overall satisfaction of employees and will decrease employee engagement and productivity. This lack of teamwork also has a spiral effect on daily operations that in the end affects our number one priority, which is our patient.
BZO: Conflict can affect the smooth and efficient operations of the team, it can increase the cost of labor or the time employees spend at work. Conflict many times involves various discussions with employees in secretive spaces taking them away from their work place as well as from the work to be accomplished to discuss the situations.
Conflict can mean withholding needed information from one another to accomplish tasks, which causes rework or additional staff time to complete tasks, again a labor cost.
Conflict can also affect patient care and satisfaction. If employees are not communicating well and the processes are not smooth, patient care could be affected [due to] not properly communicating necessary information for care. It can also result in lower patient satisfaction. There is a correlation between employee satisfaction and patient satisfaction.
JB: Any time there is conflict between employees, the result is a significant lack of communication. When people stop communicating, they put patients and themselves at risk. Frankly, it's a distraction to be upset at work about anything, whether it's another co-worker, your kids or your spouse. People that are distracted lack focus and when you take your eye is off the ball, it gets dropped.
Everyone has those days, so good teamwork in a department means that some of your fellow co-workers pick up the ball. But if there is conflict between co-workers, then no one wants to help each other out. That's a lonely place for anyone to be so it leads to dissatisfaction, poor attitude and low performance. And because that miserable person doesn't want to be lonely, they take their negativity to the whole group, bringing down the performance and satisfaction of an entire department.
Q: How can you prevent common conflicts?
AS: It is important for organizations to foster an environment of honest, open-ended, two-way communications that are both respectful and direct. The Bellin Orthopedic Surgery Center has an Organizational Development Team that assists with the professional growth and development of the employees. This team engages employees to learn and develop effective communication strategies focused on identifying each individual's unique communication style.
We believe that this strategy proves effective in preventing conflicts from escalating. By fostering an environment that acknowledges that conflict is inevitable, and that it should not always be viewed negatively, it becomes the means of effective communication between all members of the care team on a daily basis.
BZO: Promoting open and direct communication is critical to preventing conflicts. When a supervisor is aware a conflict has occurred, it is best to have the employees work through this together before involving the supervisor. If they cannot work through the conflict, the supervisor needs to address and mediate as soon as possible to avoid escalation. Having fair and equitable expectations is also crucial to preventing common conflicts.
JB: I've found that a lot of conflicts occur because a process is broken; there isn't a process to begin with or a process gets changed without notice. When there isn't a clear way of doing something, then people take it upon themselves to come up with a way, which may or may not work. Conflict happens when one person thinks they have the best solution and the other person disagrees and thinks the solution should be solved their way. The stronger personality type will say their answer with confidence — a sort of "railroading" effect — and the less confrontational personality type will fold and walk away frustrated. This is also why the people who have the most knowledge win over someone who is unsure.
For example, if you change your OR process — in this example the line up — and have a scrub tech that is an expert at shoulder rotator cuff repairs matched with an RN that usually works in endoscopy, you've set up a scenario where a scrub tech will be able to boss around an RN. Now that potentially can go well, if you have an easy going RN or the scrub tech is a good team member and appreciates the help. But if you don't have that in team members, then the result of that process shift will be tension, and both will walk away frustrated. The scrub tech will feel they "had to do everything" and the RN will feel like "the scrub tech was telling me what to do the whole time." It's key to have good processes in place and if you have to unexpectedly change the process, you as a manager [need to] communicate prior to the mix match to each member how much you appreciate them "having to do everything" or them "stepping out of their comfort zone" for the team. It certainly will help mitigate any damages.
Q: What are some important things to remember when mediating conflicts?
AS: In the event that a conflict escalates to the point of ineffective communication, it's important for the mediator to remember the basics. These basics include but are not limited to the following: stay calm; listen and be attentive to all parties; accentuate positives; restate the facts; avoid blame or taking sides; be sure to assist with identifying the problem or process issue and not the people involved; focus on the future not the past and be sure to celebrate the resolution.
BZO: When mediating conflicts it is important to remain objective. Do not favor one employee over another nor take particular sides. It is your role to keep going back to the facts of the situation. Don't allow yourself as the mediator to be drawn into the conflict.
It is also important to make sure there are ground rules before the mediation begins. For example, no elevating of the voice or hollering and no vulgar language as this only escalates the situation. It is important to start out with what is the goal of the mediation and then upon completion of the mediation to go back to determine if the goal was accomplished.
It is sometimes valuable to set up a follow-up meeting in a few weeks to come back together as a group and see how things have progressed since meeting initially. It is best to schedule this follow-up mediation before you depart from the original mediation.
JB: There will always be some conflict, it's how we grow and learn, but when you have two employees that have a conflict it is very important that prior to agreeing to or giving the "plaintiff" an answer about anything, that you investigate what the "defendant" has to say.
There are always two sides of a story, and sometimes three or four sides, and you won't believe the stuff you hear that gets dragged out, stuff that goes back years, to divert/deflect the issue. As a manager, you can give an employee a minute or two to rant, but you have to bring them back to the issue that is of immediate concern. You have to ask the right questions that lead to the motivation behind the complaint — what actually went wrong — before you can even attempt to fix it. Once you have that from both sides you can decide how to mediate the conflict. If it turns out they were in a broken process or non-existent process, then you can use both of them to help fix the process. Then they feel like they are working toward a solution so the next person won't have to go through what they went through.
If you are dealing with a personality conflict, then you can bring the two personalities together because the stronger personality probably didn't intentionally mean to railroad the other, so dealing with that up front and in his or her face gives the less confrontational personality a voice to say "you hurt me" and the other a chance for apology.
There are lots of other things you may have to do from corrective action to letting go a person that just isn't a good team member. As a manger, you almost need a psychology degree or maybe a law degree, to weed through the issues employees bring to the table. None of us are without some kind of baggage and some are better than others at not bringing it to work, not airing it, but others can't separate it and enjoy having their "sounding boards" at work.
Managers should understand that about their employees, communicate with them as to what is professional behavior, and what is not, hold meetings to work on improving how they communicate with each other and be clear about your process as a manger on how you will communicate with them. If that doesn't work or if you have widespread dissatisfaction in your organization, then I suggest calling in a professional and letting your employees speak to a counselor, it's money well spent.
Q: How can you handle conflicts between physicians and employees?
AS: In my opinion, conflict between physicians and employees should be treated the same as those between employees. These conflicts are inevitable. However, a manager or leader must avoid taking sides. Careful consideration in any case must be made to avoid harming the reputation of either party. The primary focus should always remain the patient. The goal with any conflict resolution is to aim for the best possible outcome keeping the patient at the center of all decisions.
BZO: Conflicts between physician and employees should be handled on a timely basis. It is easy to avoid mediating the conflict, but the sooner it is addressed, the better. A mediating meeting is one option and if this occurs it is important to discuss the facts and avoid getting into opinions or judgments. It may be best to have a short waiting period before meeting to allow heightened emotions to settle down. It is important however to address and handle conflict — if not handled the conflict will only continue to fester. If left to fester the conflict is sure to rise again and the next time there could be an even larger conflict.
JB: You still have to get to the root of the problem, so to me it's less to do with rank and more to do with people being people. I will say that a physician gets upset for a different reason and it usually has to do less with a personality conflict and more with a perceived knowledge deficit. A physician may lose their mind and start cursing at the staff members because they can't get what they need fast enough. As a manager, you can commiserate with your staff and say that surgeon is a jerk or you can find out why they lost their mind to begin with. Nine times out of 10 it's probably a broken process. Did the staff not anticipate something? Not pull the right stock so have to run out of the room a million times? Did the RN not know what the surgeon wanted so pulled the wrong item? I'd lose my mind too, if I came across a team that was unprepared.
Staff members also let themselves get sucked into the anxiety of the surgeon. Surgeons are anxious when something isn't going right, i.e. can't get the suture anchor in the right spot, and so when frustrated, they do what everyone else does and start complaining, about the tools, it's too hot, the RN's too slow, etc. Lots of staff get sucked into that and instead of looking at the situation [objectively] begin to take it personally.
I think a lot of surgeons get a bad rap as being difficult, but as a manager you need to find out if it's the situation that was difficult — if it was your staff members that were dropping the ball and deflecting their inadequacies onto the surgeon — or if it's really personality. I've seen a lot of managers take the shortcut and label a surgeon as difficult rather than take the time to find out what your staff needs to learn or what processes needs to be put in place to avoid conflict. And if you're forced to bring in agency or use that endoscopy RN in an orthopedic case, make sure you put the RN with a tech that can tell them the arthroscopic Bovie is on the third shelf, two boxes from the right — mitigate that mess up front!