Applying Conflict Resolution Skills in Health Care PART I: Principled Negotiation Method

By Holly Hayes

Difficult situations arise every day in the health care setting, between staff and patients, between staff and family members, between physicians and nurses, between staff and administration.

In the national bestseller, Getting to YES, a universally applicable method for addressing conflict resolution is offered by Roger Fisher and William Ury. This post, the first in a five-part series, applies this method specifically to healthcare.

For example, a health care conflict over signing verbal orders might occur like this:

Nurse: Dr. I have your verbal orders noted in the patient’s chart. I wondered when you might be in to sign them, since it is the weekend and I know you said you were going out of town. By the way, I hope you have a great time with your family. What I mean to say is, I just wanted to be sure that the orders are signed within 48 hours.

Physician: Nurse, I don’t know why you would question me about signing my verbal orders within 48 hours. I know the rules as well as you do. I would think that knowing me as well as you do, you would know that my patient’s come first and that is what we should both be worried about. Now, I know you don’t want to create any problems, so we can just forget this conversation ever took place.

Nurse: Yes, sir. Have a great trip.

What happened in this situation? The nurse and the physician engaged in Positional Bargaining. The nurse was soft on the problem. Her goal was agreement, she was willing to make concessions to cultivate the relationship. She tried to avoid a contest of will and yielded to pressure.

The physician was hard on the problem. His goal was victory. He demanded concessions as a condition of the relationship. He dug into his position and made threats. He insisted on his position, applied pressure and tried to win a contest of will.

Let’s change the game and try the scenario again. This time, both parties will use the principled negotiation method. They will:

1. Separate the people from the problem.
2. Focus on interests, not positions.
3. Generate a variety of possibilities before deciding what to do.
4. Insist that the result be based on some objective standard.

Nurse: Dr. I have your verbal orders noted. I heard you say you would be out of town, Did you have a plan for signing these verbal orders as required by the hospital bylaws?

Physician: I am out of town, Nurse, and I know your unit has a focused effort on obtaining a signature of verbal orders within the 48-hour requirement. Dr. Y is covering for me and I know he will be on the unit this afternoon. He will be rounding on all my patients. I can send him a text and ask him to be sure to sign the verbal orders this afternoon. Would that be acceptable?

Nurse: I will be here this afternoon, too, and I can be sure to ask Dr. Y to sign the verbal orders you just gave me since he is covering for you. That will work for us. Have a great trip, Dr.

The principled negotiation method in this situation worked in this way:

• The focus was the problem – getting the orders signed within 24 hours.
• The focus was on interests – the nurse wanted her unit to meet the hospital standards; the physician wanted to help her meet the standards and not interrupt his trip.

Together, they generated a possibility before deciding what to do – in this case, they generated only one possibility, but could have generated more to find the best solution to the problem. The result was not based on either party’s position, but rather on an objective standard – the requirement of the hospital bylaws.

The next post will address strategies for dealing with substantive problems in health care while maintaining good working relationships. We welcome all comments on this post and any suggestions or questions for upcoming posts on this topic.

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