Saturday 29 July, 2006

How to manage workplace conflict

Posted in Emergency Dept., General Practice, May Su, Wards, Workplace at 20:44 by May Su

Original article by: May Su :: Printer friendly

Bullying and other workplace conflict is a common scenario as a medico – from patients, from nurses and from other colleagues. There has been increasing media coverage on this regarding in particular the NHS medical system in the UK, and our own more close to home situation in Queensland (1). In a study of the National Health System (NHS) in Britain released in 2002 specifically of junior doctors, 37% of respondents identified as being bullied in the past year and 84% had experienced one or more bullying behaviours (2).

Bullying should not be accepted passively

In a study by the Australian Psychological Society (3) on bullying in hospitals, they found that the most commonly reported form of bullying behaviour was verbal. This includes: put downs, insults or sarcasm to regularly humiliate, and being spoken to in rude, foul or abusive language.

Psychological manipulation in the workplace was also acknowledged as a serious form of bullying including: requests for help or advice being ignored, being deliberately left out of workplace activities, and excessive scrutiny of work.

The hierarchical nature of the hospital system can in some ways encourage a system where it is difficult to pick up individual areas of conflict. For many trainees, there is also the fear that if they complain it will negatively impact on their training, which they have likely already invested years of their life (4). Unfortunately in the majority of cases where there is bullying behaviour, the most common response is to have “no action” or change jobs (3).

The reality is that although workplaces do have policies in place about bullying in the workplace, it is very difficult to know what to do as an individual who is being bullied. Certainly as a fresh intern starting out this was not something that I had learnt very much about until being put in the situation of being bullied by a supervisor.

Bullying should not be accepted passively. If there are other people also having difficulties with the person then you speaking up may help improve the team dynamic for other interns or registrars to follow you. Be aware that there may be other stressors happening in the person’s life and their behaviour towards you may be a reflection of that. This does not make it acceptable, but it does mean that if there are further underlying issues, the person may need support themselves. A typical example of this is the new registrar who is not coping with their heavier workload and deals with this inappropriately by being verbally abusive towards their intern or resident.

Your response to bullying behaviour should be effective, not aggressive. It is not always constructive to be unnecessarily aggressive/angry in response to conflict, and may be counter-productive to your cause.

Questions to consider

Every situation will be a little bit different. Here are a few questions to consider. Try to remove emotive terms when considering these questions. It will be useful to record any specific events.

  1. Who is the conflict with?
  2. What is the form of conflict? Be specific. For example, different forms of conflict are:
    • Sexual inappropriateness
    • Lack of supervision
    • Inappropriate criticism
    • Inappropriate management and/or difference of opinion in management
  3. Under which circumstances is the conflict happening?
    • Is it only in relation to a particular patient or setting?
    • Why do you think that this may be so?
    • Are there particular stressors (for the both yourself and the other party) that seem to be exacerbating the situation?
  4. Why do you think this conflict is happening?
    • There may be aspects of the person’s behaviour that you would like to change, but be aware that they may also be interpreting or misinterpreting your behaviour as well.
  5. What is the best means of resolving the conflict?

How to resolve the conflict

Advise the person to cease the behaviour (if you feel safe to do so). If not, then address the issue with a supervisor, or the person’s supervisor.

Some people may not even realize that there is conflict happening, and they may even be surprised and embarrassed. Commonly the conflict can be resolved after a simple discussion.

At some point there will have to be some communication either with the person in conflict or with somebody that you feel will be helpful in resolving the conflict. If your problem is with your registrar, then complaining to all the nurses on the wards is probably not going to help your situation. It may actually worsen the team dynamic.

1. Choose the Setting

It should be a quiet place where you will not be disturbed or overheard.

Arrange with the person beforehand that you would like to meet with them to try to ensure that they are not rushed during the meeting.

2. Write down beforehand what you would like to change in the relationship.

Try not to attribute blame. Be specific. This may include things like:

“I feel uncomfortable when I am doing this particular procedure or managing this particular patient by myself and feel that I require additional supervision from you during this time. This increased level of supervision would involve you observing me while doing the procedure until I feel comfortable doing it by myself.”

or

“When you yell at me in front of patients I feel belittled and embarrassed. I do not feel that it enhances my learning and in fact makes me less productive at work. I would prefer that if you do not feel that I am performing adequately in a task, you take me aside privately and let me know how I can improve so that we hopefully can learn from the experience.”

3. Be polite but firm.

The agenda of the discussion for change in the working relationship needs to be clear. Bullying is not acceptable, however, this is not the time for unhelpful anger or blame.

People to contact and approach

Pending on how the situation resolves (or does not resolve), you may have to speak to one of the following people below (usually in the order mentioned):

  • Registrar
  • Supervisor/ Consultant
  • Head of Department (of the particular team you are on)
  • JMO representative
  • Director of Clinical Training (DCT)
  • Director of Human Resources
  • Postgraduate Medical Council
  • External bodies: WorkSafe, JobWatch, Equal Opportunity Commission

In the workplace you may have a workplace bullying policy and procedure, a contact officer, human resources manager, or manager who can assist and can assist to resolve the matter either informally or formally.

It may also be helpful to approach the person’s supervisor, for example the Nursing Unit Manager (if the problem is with a nurse) or the consultant (if the problem is with a registrar).

They may arrange a mediation session between you, speak privately to the person in question, or suggest other options that you might try. At the very least it makes management aware that there may be a problem that they will need to deal with.

If still not being resolved, then a formal letter may be your next option to the people who you think can effect change. Usually by the time it has gotten to this point the people involved are usually your supervisor, JMO representative and DCT and copies of letter should be sent to all the parties involved.

Be mindful of your own health

Always remember that there is help available. Workplace bullying is always stressful. If you are finding that it is starting to affect your performance and health, then make sure that you address the issue. If you need professional help such as with your local doctor or psychologist, then seek it.

The Australian Psychological Service provides a free referral service on 1800 333 497 for the general public who are seeking the advice and assistance of a qualified psychologist (3).

Reference articles

(1) Denholm A. Hospital staff bullied at work. The Scotsman. 5 November 2001. [Link]

(2) Quine L. Workplace bullying in junior doctors: questionnaire survey. BMJ. 324(7342):878-9, 2002 Apr 13. [download PDF :: 204 Kb]

(3) Workplace bullying still a major issue according to new research [media release]. Australian Psychology Society. 11 November 2004. [Link]

(4) Turney L. Mental health and workplace bullying: The role of power, professions and ‘on the job’ training. Australia e-Journal for the Advancement of Mental Health (AeJAMH). Vol. 2, Issue 2, 2003. [download PDF :: 156 Kb]

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