Strategies for Improving Communication and Conflict Management
Several studies have recommended procedural changes to improve communication and/or conflict interaction. One example of a procedural change is the “firm” system,
Improved communication skills
Education and training
Physician training
Nurse training
Patient training
Coaching/mentoring
Dispute system design
which groups providers into teams so that they work with the same people on a routine basis (Graham, 2009).
Some administrators believed that this practice increases trust while reducing ambiguity and the impact of the hierarchy. Graham’s evaluation could not support whether the firm structure was successful, as he surmised that gendered roles and expectations had more influence over communication norms than the team structure. Another proposal for improved team communication was to institutionalize a 1- to 3-minute preoperative team briefing (Gardezi et al., 2009). The authors evaluating this process concluded that the role of the institutional culture and societal relations between doctors and nurses impeded the practicality of attempts to routinize communication in this way.Recommendations for improving communication among interdisciplinary teams treating patients with multiple illnesses included improved information sharing through technology (placing microchips in health insurance cards or improved computer networks) and the creation of written “care agreements” (Kerosuo, 2007). The author and participants noted that limitations of these ideas included diverse professional norms and language, not knowing what information each group needs (and the risk of information overload), and creating cumbersome processes.
Other studies have focused on improving communication through the process of principled negotiation (Kendall & Arnold, 2008). Examining the challenges of communication at end-of-life decisions, Kendall and Arnold advised doctors to learn about the patient’s and their family’s story, beginning the discussion with genuine curiosity and focusing on the individuals’ concerns and narratives.
Within these narratives, doctors should attend to patients’ past relationships with doctors, their sources of medical information, and their life goals. Doctors should also find out how the patient/family wants information to be presented to them. Second, Kendall and Arnold recommended that doctors attend to all emotions—their own, their patient’s, and the family’s. Acknowledging the emotions and allowing them to be expressed was believed to allow the patient to move on to understanding the medical information. Finally, these authors suggested that doctors discuss the patient’s core values and integrate them into development of shared treatment goals.Another study examining doctor-patient- family communication at the end of life suggested a modification in the interaction process (Norton et al., 2003). Rather than simply withholding their prognosis until they reach a certain degree of certainty (which increases family stress due to lack of information), physicians should talk to patients and their families about the difficulty of making an accurate diagnosis. This provides a venue for offering anticipatory guidance in case the situation becomes less optimistic. This strategy may engage patients and their families in a dialogue that can be revisited on a regular basis while they await more specific information. While written in the context of end-of-life decisions, the approach is equally relevant for any doctor-patient interaction in which the patient suffers from multiple illnesses or a difficult diagnosis and is relevant whenever family members are highly involved, such as in pediatric cases.
A final example of improving procedures for conflict prevention and management relates to the omnipresent threat of malpractice litigation. While physicians and administrators may typically practice defensive medicine that limits information disclosure, a program called IACT (Integrated Accountability & Collaborative Transparency; iactprogram. com/) challenges this trend. According to its developers, IACT is a collaborative model that encourages earlier information disclosure to patients as well as expressions of regret or remorse that address emotions for both physicians and patients (Scott, 2011). IACT proponents suggest that early disclosure of information strengthens trust between patient and provider, reduces the number of claims and lawsuits, and reduces legal expenses.