October 2011 Issue

Resolving Conflict — Strategies to Mitigate Those Tough Conversations
By Jane Ryan, PhD, RD
Today’s Dietitian
Vol. 13 No. 10 P. 16

As a nutrition professional, how many times have you been challenged by a colleague who doesn’t deliver, a supervisor who rarely responds in a timely manner to an urgent request, a physician who yells at a healthcare team member, and the inpatient who rages that the food’s too cold, the room’s too hot, and the nurses aren’t responding to his every beck and call?

Whether you regularly—or rarely—face difficult situations such as these, it’s important to be prepared and to develop the skills necessary to communicate effectively and develop strategies to help resolve conflict.

Following are five common scenarios you may have experienced or might experience in the future, as well as solutions to handle each. These strategies include tips on how to identify potentially heated conversations, run interference with finesse, and work toward a resolution everyone can live with.

Scenario No. 1: Newly Diagnosed Patient
Problem: “The doctor just told me I have type 2 diabetes!” your hospitalized patient exclaims. “What does that mean?” he demands. “Well, you’ll need to make some dietary changes and …” “My cousin has diabetes,” he interrupts, “and he has to stick his finger to test his blood sugar. There’s no way I’m going to do that. I hate the sight of blood!”

Solution: Because fear, frustration, anger, and sadness are natural emotions patients experience when they’re newly diagnosed with diabetes or any chronic illness, you’ll need to explain compassionately how the disease will impact their lives and the steps they’ll need to take to improve their health. You can say, “I understand this diagnosis is overwhelming. Many patients feel this way. It’s a lot to take in all at once. But I can show you how to take very small steps each day with regard to your meal planning, medications, and testing your blood sugar that will make a huge difference in your overall health. And we can do this together one step at a time.”

Practice pearl: When you find out your patient has been diagnosed with a chronic illness, it’s important to respect his feelings. Showing compassion and giving him small attainable goals will help calm him down and move him away from fear and toward accepting that he can live with the diagnosis. He’ll begin listening to you and slowly agree to the changes he needs to make to manage the disease.

Scenario No. 2: Master of Excuses
Problem: “This is the third time this week you’ve been late for work,” you say to an employee. “I know,” she laments. “I couldn’t get my daughter out of bed this morning. It won’t happen again.” If this is the first time something like this occurs, you can probably let it go, but ongoing excuses like this become unacceptable.

Solution: The key to dealing with ongoing excuses isn’t to address the excuse, but the problem. In this case, you’d focus not on her child but on the need to be on time for work. If an employee says he can’t complete his work accurately because he doesn’t have enough time to do it, focus on strategies he can use to complete his work within normal business hours. Help the employee understand that your discussion is a first step toward a desired behavior change. Develop an action plan the employee can follow to improve the quality and timeliness of his work, and schedule follow-up meetings to discuss progress.

Practice pearl: According to Ron McMillan, coauthor of Crucial Conversations: Tools for Talking When Stakes Are High, it’s important to remain objective when speaking with employees. Before initiating a challenging discussion, stay impartial and focused on the core issues. If an employee violates company policy by using his cell phone and rattles off a list of excuses for his behavior, stay focused on the point of the crucial conversation: Employees must follow company rules.

Scenario No. 3: Overly Sensitive Employee
Problem: “I guess he can’t take constructive criticism,” you think, after calmly giving feedback to a fellow employee, who raises his voice stridently in defense. Stunned by his reaction, both of you sit silently. In this situation, it’s important to address the employee’s reaction immediately before ill feelings have a chance to fester—and escalate.

Solution: You can say, “I don’t want to upset you further, but I feel it’s necessary for us to discuss this.” Describe specific behaviors the employee may be engaged in, and explain their consequences. If the person continues to be defensive, don’t assume the issue will remain impossible to resolve. Explore ways to create an environment that feels safe for the employee. State your concerns honestly and confidently, and then encourage an open dialogue by asking for his feedback. Welcoming dialogue from the employee may move the discussion away from avoidance and anger and more toward collaborative problem solving.

Practice pearl: When talking to employees, pay close attention to body language, emotions, and other behavioral cues (eg, a high-pitched voice, finger pointing), all of which indicate a problem is brewing. In addition, be aware of your emotions and the words you choose, and discern how they may play a role in either worsening or improving the situation.

Scenario No. 4: She Doesn’t Pull Her Weight
Problem: Your healthcare team creates an action plan to improve an important process, but one of your employees doesn’t do her part. Now the team’s at risk for missing a deadline and tempers flare.

Solution: Address the team member in private. Avoid having the discussion in the hallway or cafeteria. Take time to put the person at ease by acknowledging this is an uncomfortable but necessary conversation due to what appears to be the absence of teamwork. You can say, “The team is upset that you didn’t complete the tasks you were assigned. Can you tell me why you weren’t able to finish them?” Avoid speaking for others on the team, and stay focused on the issue at hand. In addition, offer the opportunity to mentor this person and schedule a time for follow-up discussions. Say, “I see you’ve completed four of your action items. Try to complete two more, and let’s meet next Thursday to discuss them. I can help you along the way if you’d like.” If she doesn’t complete the tasks, it may be a good idea to involve your supervisor.

Practice pearl: Always show respect when communicating with colleagues. Even if you disagree with them, make every effort to listen to their point of view to gain insight into their perspective. Your goal shouldn’t be to convince others you’re right; it should be to foster dialogue that will generate a shared pool of ideas and opinions. The more robust the pool of ideas, the better equipped you’ll be to make wise decisions, hold each person—including yourself—accountable, and achieve positive results.

Scenario No. 5: The Hot Head
Problem: “Why was I given this assignment instead of John?” protested an employee on your healthcare team. You’ve had disagreements in the past, but this time he begins to argue with you in front of other team members. An exchange about tough issues can escalate from a friendly dispute to a heated discussion that results in insubordination or disrespect. Regardless of whether the person is a direct report or a colleague, it’s best to show zero tolerance for insubordination.

Solution: Immediately move the conversation to a private office or meeting area. Stop addressing the initial issue and address how the person’s words and actions are unacceptable. You can say, “I’d like to step away from the issue of your current assignment for a moment. The way you’re raising your voice is disrespectful. I want to address your concerns, but I’m going to have a tough time doing so if this behavior continues.”

Practice pearl: Fear of distrust or humiliation can cause people to be defensive or even violent. So creating a safe physical and emotional space for potentially difficult conversations is best. This may include removing an angry employee from a public to a private area to continue a discussion or to at least agree to take a break, calm down, and resume the conversation later.

When confronted with an uncomfortable conversation, we often choose the easiest way out, which is to avoid the conversation altogether. This response is unproductive and detrimental to our work environment and relationships. When we use these basic tools for handling difficult situations, we help create a work environment that embraces mutual respect, collaboration, and effective performance.

— Jane Ryan, PhD, RD, is director of nutrition and diabetes services at Virtua, in Mt. Holly, N.J., and a freelance writer.