Conflicts stand in the way of providing excellent care, hurts hospital reputations and costs money.

By Melanie Wolkoff Wachsman

Your patients expect (and deserve) excellent care, and the vast majority of the time they get it. But what happens during those other times—when a mistake, misunderstanding, or some other type of grievance or conflict leaves patients feeling that your organization didn’t take good care of them that can make or break your reputation.

In an age of transparency, when low HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) ratings and online complaints can have serious fallout, it’s crucial that your physicians and staff members know how to properly handle unhappy patients.

Dangerous Risk
If you just assume they already know how to manage conflict with patients, you’re taking a dangerous risk, said Steven Dinkin.

“This is one of those areas in which you can’t take chances,” said Dinkin, co-author with Barbara Filner and Lisa Maxwell of both The Exchange Strategy for Managing Conflict in Health Care: How to Defuse Emotions and Create Solutions When the Stakes Are High (McGraw-Hill, 2012), and The Exchange: A Bold and Proven Approach to Resolving Workplace Conflict (CRC Press, 2011).

“When emotions run high, people get defensive and either shut down or lash out,” he added. “They need professional training to override their instincts and say and do things that calm patients down and lead to a positive resolution for everyone. Otherwise, if they follow their instincts, the outcome can be disastrous.”

Quality of care patient perception of care are intertwined and inseparable, Dinkin continued. Satisfied patients are more likely to get well, for a variety of reasons. For one thing, they follow doctor’s orders if they’re open and receptive rather than anxious and resentful. And it’s no secret that stress in general impacts the immune system.

Hurting Hospitals
Conflict isn’t good for a hospital’s health either. Poor HCAHPS scores can cut into reimbursement. Angry patients can post online complaints that harm reputations and erode market share. And of course, litigation can cost millions.

“Teaching employees the right way to handle patient conflict is not just a matter of giving good service on principle; it’s a matter of your organization surviving in an incredibly tough environment,”Dinkin said.

In his book The Exchange Strategy for Managing Conflict in Health Care provides healthcare organizations with a way to productively handle patient conflict. It details the four-stage conflict resolution process also known as The Exchange, which is derived from the mediation and conflict resolution practices used for thirty years at the National Conflict Resolution Center.

Four-stage Conflict Resolution Process
1) Hear out the patient and the family. When a patient or a patient’s family member makes a complaint about a conflict, it is important for them to know right away that the hospital staff has heard them and understands their situation.

“Feeling heard helps them move forward,” noted Dinkin. “By hearing the patient or family member out, you are saying, ‘We’re listening. We understand you’re upset, and we’re here to help.’”

2) Talk to the healthcare provider.
Before the patient and healthcare provider are brought together, an Exchange facilitator should meet with the provider one-on-one.

“Often you’ll find that providers are just as frustrated and upset by conf licts as the patients,” said Dinkin. “Meeting  one-on-one with providers gives them the chance to air their own frustrations without being judged, which can lead to much more productive conversations between all parties as the process moves forward. It also provides the patient relations staff member a valuable opportunity to coach the provider. At these sessions, facilitators can give providers tips about listening and talking to patients and their families in a way that acknowledges their pain and tips on not sounding defensive.”

3) If all agree, have the patient and provider speak directly to one another. For patients, the chance to speak to the provider with whom they have a conflict is often a relief. Dinkin recalled the case of one female patient. During a periodic checkup for endometriosis, her gynecologist recommended a biopsy, and then an ultrasound showed thickening of the uterus. As was the standard of care at the time, she was given a total hysterectomy. Following the surgery, the tissue was examined by a pathologist who found no signs of disease. The patient was devastated and furious. Unable to speak directly to her surgeon to discuss what happened, she felt stonewalled and began to wonder about the doctor’s competence. She consulted an attorney about filing a lawsuit.

The ombuds at the hospital persuaded both the surgeon and the patient to participate in an Exchange. The chance to speak directly to her surgeon came as a relief to the patient. She asked questions about his decision-making, his past experience and how the situation had affected him. She found out he was haunted by the biopsy but felt that he had done the right thing, based on the information he had at the time. Each saw the other as a human being affected by a common experience.

“Mistakes, errors of judgment or whatever may give a patient concern are not necessarily ‘shoddy’ treatment but may be interpreted as such if not addressed,” explained Dinkin. “Our experience is that most patients can understand and accept mistakes or lapses in the quality of care as long as their concerns about the negative experience are acknowledged and any consequences addressed.”

4) Use the process to implement tangible changes. In another example, Dinkin described a patient who had been staying at and receiving care from a hospital where he was also a major donor. During his stay, he had several roommates, and his current one was a problem. The roommate, who appeared to have dementia, argued with people who weren’t there. He was so loud that the other patient couldn’t sleep. This patient put in a room transfer request, which was endorsed by his doctor, but the nurses hadn’t moved him. He felt his request was deliberately ignored.

The hospital’s patient relations representative spoke with the night nurse supervisor and found another exhausted person. The hospital was undergoing construction, and this, along with an unusually large patient load, took a toll on the nurses. The night nurse supervisor explained that under normal circumstances the room change request would have been easily accommodated, but that day there were fifteen admissions, and she didn’t even have beds for all of them.

“In the end, the patient and the night nurse supervisor agreed to meet,” said Dinkin. “Both apologized and explained their feelings about the situation. They discussed how to make future communications easier between nurses and patients. Since then, a new intercom system has been installed that allows patients to immediately communicate their needs to staff. In addition, as a result of the joint meeting, the hospital instituted a patient ombuds program.

“When patients aren’t happy with the care they’ve received, usually they all want the same things,” continued Dinkin. “They want an acknowledgment that a problem has occurred, an apology, a redress of their grievances, and an assurance that the same thing won’t happen to another patient. The Exchange provides the structure to facilitate this kind of communication with the patient. It offers patients and providers an opportunity to move past conflict and provides a respectful, helpful way to begin the future.”