“Peace is not the absence of conflict but the presence of creative alternatives for responding to conflict—alternatives to passive or aggressive responses, alternatives to violence.”
Dorothy Thompson, journalist (1894-1961)
Wherever people coexist, conflict is present. There is always a difference between what people desire and the current conditions. This discrepancy is especially true in a crisis-oriented environment such as the emergency department (ED), where thousands of rapid interactions occur among individuals daily. Conflict is intensified in the ED as a natural consequence of urgency, the pursuit of incompatible objectives, stressed individuals, and unmet expectations.1,2 Examples of conflict in the ED include
- An EMT arrives in the ED with an ill patient and expects that an attentive and respectful staff will immediately attend to the new patient. Instead, the EMT finds an overwhelmed and somewhat agitated staff member who expresses frustration and anger upon the new patient's arrival.
- A patient with chronic back pain expects immediate treatment. The busy healthcare worker arrives to assess the patient an hour later and finds a sarcastic and disdainful patient claiming: “I thought you forgot about me.”
- A non-ED medical staff member arrives in the ED after leaving his busy office, demanding that a nurse leave an acutely ill patient to attend to his needs now!
- An emergency physician becomes increasingly frustrated because it seems that nothing is getting done and patients are languishing. He loudly calls out to a nurse who just picked up a phone call, “That's great! You're on the phone while patients are waiting!”
- The mother of a crying child walks up to the triage nurse after waiting for more than an hour and is told, “Ma'am, we have sicker patients than your child … you'll just have to wait!”
- An emergency nurse refuses to give an ordered treatment, as the nurse believes it may be inappropriate.
“Where all think alike, no one thinks very much.”
Walter Lippmann, author and journalist (1889-1974)
Those who ignore the value of conflict may overlook the opportunities to resolve issues and improve processes within their own organizations. Conflict is often beneficial. Highly functioning organizations are not conflict free; rather, these organizations recognize conflict as an opportunity to address unresolved issues and make improvements. Advantages of conflict include3
- Improved solutions: A disagreement voiced and examined allows a deeper investigation into the problem, perhaps incorporating a perspective not yet considered. Attention to alternate views may create more nuanced solutions addressing several perspectives.
- Improved efficiency: A poorly introduced change may lead to resistance, delayed implementation, and perhaps failure. Recognition that change is fluid and requires “tweaking” opens the process to fine-tuning by those responsible for its implementation. Encouraging feedback creates buy-in and early adoption.
- Enhanced morale: Conflicts ignored or poorly managed ...