Patient advocate: Tips for resolving conflicts in the hospital

There are few places more stressful than a hospital room. And where there’s stress, conflict almost always follows.

Here’s the thing about conflict: Yes, it can be destructive and hurt patients and families alike. But it can also be productive, with the right approach.

I recently spoke with mediation expert Steve Goodstein, whose expertise is alternative dispute resolution (ADR). A former nurse and hospital administrator, he has worked in conflict resolution in health-care settings for a number of years. Now based in Winston-Salem, N.C., he is launching a consulting business, HealthyConflicts LLC.

With a master’s from Columbia University in negotiation and conflict resolution, Steve has refereed plenty of conflicts among hospital staff, but the principles he uses can also apply to situations involving patients and families.

This is an excerpt from our conversation.

Teri: Steve, how does conflict arise in health-care settings?

Steve: It arises naturally in stressful situations in which we’re significantly invested, such as with a loved one in the hospital. Disagreements occur when a perceived threat exists to the needs and interests of the involved groups and individuals.

It also occurs when expectations are not met. I think a lot of the time that’s the patient/family-health professionals’ conflict dynamic. We expect the best care, service and communication, and we expect the patient to get better. Conflict is also influenced by past experiences, gender, race, language and ethnicity.

Teri: People’s response to conflict can make the issue worse, I have found.

Steve: Absolutely. You stop trusting the other person. You interrupt, or stop speaking altogether, you fight over who’s in charge and block ideas. In a nutshell, how you handle conflict is almost a reflex, and if we want to improve our response, it is all about self-evaluation and constantly looking at yourself. Why are certain things bothering you (pushing your buttons), why you’re behaving in a certain way.

Teri: Are there different types of conflict resolution?

Steve: Yes, mainly four in all. Avoidance is where I say “oh, whatever.” Resulting in: I lose, you lose, because the issue does not get addressed. There’s Competition: I tend to interrupt because I must get my way. Resulting in: I win, you lose. Also, Adaptation: This is when I give in. I lose, you win.

The fourth type is cooperation and collaboration, resulting in a win-win. I use sculpting as a metaphor. Instead of starting with a big block of stone and chipping away from it, try starting with clay and building from the inside out, together.

Teri: What are some good first steps?

Steve: The visual I like is the letter “V.” Think of the top of the left side as the stimulus and the right as your response. Our goal is to create more space between the two sides of the V, more time between the stimulus and the response.

So, really, the first step is a simple one: Pause. Count to 10. Create that space between the two points of the “V.” Mutually try to identify what the problem is. Why are we here? When hearing what the person is saying, try to be listening instead of thinking about the points you’re going to make.

Believe me, I’m no Pollyanna — this stuff can be really hard at first. But the goal is to keep making progress even if you’re not reaching perfection.

Teri: I think you want to avoid putting the other person on the defensive because that may stand in the way of cooperation.

Steve: Our natural reaction is to ask why: Why did you do that? Why didn’t that work? And that automatically tends to put the other person on the defensive. In asking why, it’s as if you’re the one who’s trying to solve the problem, as opposed to the person who was trying to solve it. You’re taking away their authority and perspective, and it prevents healthy communication.

A better strategy is to ask questions that start with “what”: “What was the result you were hoping for?” or “What made you choose that course of action?”

Teri: What if these steps don’t work?

Steve: Congratulate yourself. Making an attempt at conflict resolution is a big step forward.

A final note from Teri: Steve’s advice is very valuable, even if it is challenging to begin. If you can remember to pause, ask “what” questions, actively listen to the other person and then seek a resolution, you will have made a difference in how a conflict around the care of a loved one is resolved.

Steve Goodstein will be speaking at the inaugural New England Patient Advocacy Conference on Tuesday, Oct. 14, at Assumption University in Worcester. For information, visit nurseadvocateentrepreneur.com/nepac.

• Teri (Dreher) Frykenberg, a registered nurse, board-certified patient advocate, is the founder of www.NurseAdvocateEntrepreneur.com, which trains medical professionals to become successful private patient advocates. She is the author of “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” available on Amazon. Frykenberg offers a free phone consultation to readers. Contact her at Teri@NurseAdvocateEntrepreneur.com.