A crash course in conflict resolution. (In the Trenches).

Is there a health care group anywhere that doesn't occasionally get caught up in conflict? When uprisings aren't acknowledged, addressed, and resolved, the effects will range from suppressed tension that lowers productivity to open warfare. The grapevine goes into battle mode but often the medical director will have no idea of the cause. Why haven't Kathy and John spoken to each other in two years? Who decided that some subjects won't be discussed in meetings? Why are the unknowns exerting negative control?

Given the fluidity--some might say instability--of work groups now, quick conflict resolution is vital. Employees aren't motivated to work things out. Why should they be? Many are continuously job hunting and plan to be gone in six months.

Many physician managers think a conflict is a crisis, even though the Chinese character for crisis Is made up of danger and opportunity. They opt for a quick fix by soothing the participants and burying the source of the problem. It smolders and resurfaces every time anyone gets irritated about anything. Knowing how to resolve conflict with finality establishes positive changes in coworker relations, prevents drops in productivity, and frees a manager's time for more important issues.

Conflict arises from four sources: (1) Real or imagined differences In values, (2) dissimilar goals, (3) poor communication, and (4) personalizing generic or organizational issues. Right now health care is full of the latter. It's possible--and useful--to make conflict productive rather than disruptive. The secret is using a process that produces a solution acceptable to everyone. This requires three steps: (1) Value differences must be addressed, (2) communication styles must be established, and (3) everyone must commit to mutually satisfactory resolution of the issues.

Here's an example: Some members of the laboratory team had worked together five years. The newest recruits had been there only six months. It wasn't long before the newly hired were complaining that their ideas were dismissed, if they were listened to at all. The support staff complained the new hires were rude.

The manager did everything he could think of including issuing written warnings. HR provided the group with rules of acceptable behavior. Nothing changed. The CEO became so exasperated he issued an ultimatum: "Solve your problems or I'm outsourcing the department!" An outside consultant was hired.

The consultant and manager worked together and decided that these questions should be addressed:

* Do employees agree on the extent, nature, and seriousness of the problems?

* What are the root causes?

* How do people communicate? What styles do they use?

* If we teach conflict resolution skills, will they be used?

* Can we change the climate to promote more openness and learning?

* Can the laboratory's image be changed within the organization?

Each person in the laboratory was interviewed and a questionnaire was developed. All were asked about personal and professional values, management style, conflict resolution style, and acceptance of new ideas. They were asked for suggestions and comments.

The survey revealed that almost everyone agreed on the major problems and wanted a change. A major source of conflict appeared to be miscommunication: Both the 40-somethings (Boomers) and the 20-somethings (Busters) complained they were misunderstood. The questionnaire confirmed that they didn't know how to communicate their wants and needs to each other without offense. The Busters, whose communication style is direct (That's not my problem"), enraged the Boomers. Boomers, with their euphemistic style--"Would you mind taking care of this?"--were considered manipulative by the younger workers. The good news was that the questionnaire revealed a belief that change was possible. Nobody had given up on coworkers.

Training began. Both groups learned the importance of acknowledging shared responsibility for problems and solutions. They learned how to make clear, non-confrontational and non-judgmental statements. A Buster offering technological help to a Boomer would say, Here's the trick to It" instead of "Don't you know how to do that yet?" Tact can be taught-once it's seen as an organizational necessity rather than a social skill.

They learned to express opinions, needs, and requests unemotionally by waiting five seconds before speaking. They learned to offer constructive and supportive suggestions, feedback, and criticism with questions such as, "Have you tried that?" or "Could this work?" Most important, regardless of age, each learned that the time it takes to process an idea and become comfortable with it is longer than 30 seconds. One radiology tech said, "It never occurred to me that changing the way I talked would produce such positive results. It's as if I'd gotten a new job with all new coworkers!"

Instead of the accusatory "Why did you do that?" both groups were taught to ask "What was your strategy?" which couldn't be perceived as an assault. "Why" questions always offend because the hearer doesn't just hear the question. He or she hears, "Why did you do that, stupid, even though the word was never said. Since everyone learned the same techniques at the same time, no one felt manipulated.

What amazed the manager was how much of a difference the change in communication styles made. As people practiced the simple techniques, much of the heat disappeared from their disagreements. True, there were still some value conflicts. The Boomers could not understand why the Busters evaporated at exactly 5:00 p.m. The Busters couldn't understand why the Boomers didn't. Issues of differing goals and a continuum between "Do the job right" and "It's got to be perfect" continued, but no longer exploded into open acrimony.

Good managers know the best technique for addressing conflict is prevention, or when that's not possible, early intervention. They establish a reliable listening post on the grapevine because that's where conflicts first surface as complaints: "Mary's not getting the work out quickly enough" or "I hate dealing with the surgeons." The manager who confronts an issue and resolves it before a formal complaint is filed will have far fewer full-blown conflicts. He or she will also make it clear to everyone that the boss hears and acts on early warnings. The grapevine will carry tales of the department's improved morale and working relationships--all the way to the CEO.

Marilyn Moats Kennedy is Managing Partner, Career Strategies, Inc., Wilmette, Illinois, and a long-time member of the ACPE faculty. She can be reached at 1150 Wilmette Avenue, Wilmette, Illinois 60091, 847/251-1661, via fax at 847/251-5191, and via email at [e-mail].