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Resolving Conflict Within the Dental Office
Conflict is inevitable. As long as people possess the capacity for independent thought, there will be differences of opinion. One of the keys to resolving conflict is the ability to listen to and respect the viewpoint of the other person. For, as my law professor put it, “Reasonable people can differ.”
Presented below are models, tenets and skills which can be applied to resolving conflict in your office.
Conflict Resolution Models
Conflict resolution can be classified into four types: the Primitive Model, the Legal Model, Arbitration, and Mediation.
Under the Primitive Model, the major tenet is might makes right. “If my rock is bigger than yours, I’m right.” The advent of civilization is tied very closely to humankind’s ability to resort to other methods for resolution of conflict.
The Legal Model is more “advanced” than the primitive model in that its weapon of choice most often is words rather than violence or physical restraint. However, the relationship of the parties to the dispute remains adversarial. Americans have raised this form of conflict resolution to new heights, earning us the dubious distinction as the world’s most litigious society.
Arbitration and Mediation are two models of what is called alternative dispute resolution (ADR). Under arbitration, the arbitrator has authority to render a decision based on his or her assessment of the facts as presented by each party to the dispute. If the arbitration is binding, then both parties agree in advance of the proceedings to be bound by the arbitrator’s decision. In non-binding arbitration one or both parties has the option of accepting or rejecting the arbitrator’s decision.
Mediation involves a facilitator whose role is to help the parties communicate and explore, then generate options for resolving the situation that brought them to the mediation.
The basic Mediation Model consists of the following phases:
Mediator’s Opening Statement
This is where the mediator explains the procedures to follow, and confirms his impartiality, inability to force a decision and his commitment to confidentiality, and receives confirmation from the parties of their understanding and agreement of the procedures and his statements.
Parties’ Opening Statements
Each party is given the opportunity to present his or her case. The mediator is, for the most part, silent, except to remind the parties, where necessary, of their agreement to be respectful of each other and not interrupt.
Cross Talk I
The mediator opens lines of communication between the parties by saying, for example, “Okay. Thank you both for presenting your stories to me. Now, what are your thoughts on how we can arrive at a mutually agreement outcome to this matter?”
Caucus
This tool is simply a private meeting in which certain procedures and rules are agreed upon, paramount of which is a guarantee of confidentiality, so the party feels safe in sharing his or her feelings with the mediator. The caucus is where much progress in the way of generating possible solutions to a dispute is made. It’s also a great place for a party to “vent” their feelings. Use caucus whenever you feel an impasse is reached during your mediation, or when emotions flare. Fairness dictates that, if you caucus with one party, you should caucus with the other for the approximate same time.
Cross Talk II
Following the caucus the parties should see what new options they are now ready to present.
Parties’ Closing Statements
This is where each party has the opportunity to revise and (with hope) soften their positions.
Agreement
Depending on how well the mediation has gone, an agreement will be proposed, drafted and signed by both parties and the mediator.
Tenets of Effective Conflict Resolution
Before a fruitful discussion of how conflict resolution techniques may be applied in the dental office, it is important to recognize those factors that offer the greatest likelihood of a positive outcome. Factors that, for our purposes, are most important are Environment, Balance of Power, and Impartiality.
Environment
The setting in which mediation or another attempt at conflict resolution occurs can be critical to the outcome. Is it quiet? Is there privacy? Ideally, the meeting should occur outside the office, so no one is distracted or perhaps reminded of why they are having the dispute.
Balance of Power
When one party perceives that they are not in control of a situation, it is more difficult to reach an agreement or, if an agreement is reached, it is less likely to last. For this reason, any meeting attempting to resolve a dispute should be structured in such a way that both parties perceive they are, for purposes of the meeting, equal, and that both will be heard and respected.
Impartiality/Neutrality
When you become aware of a conflict between two members of your team, it is vital that you appear neutral with respect to the issues. This is often easier said than done. To help you, remember that, while on the surface an individual’s position may seem unreasonable (or incomprehensible), there are often underlying causes that are responsible for that person’s position. Only in an environment of trust, and through active listening (see below), can you hope to “get at the heart of the matter.”
In the case where you are a party to the conflict, your impartiality is naturally in question. Even if you believe you can remain impartial, it is the perception of others, especially, but not only, the person with whom you have a dispute, which must be considered. If it is not feasible (or you are not comfortable) to have another party preside over a mediation, it is still possible to assume a somewhat more neutral stance. To do so, you should not attempt to have a discussion about a situation when you are emotionally involved. Take a breather. Then, invite your team member to meet with you, preferably outside of the office (see above Environment Section). At this point, you can apply techniques taught by such books as The One-Minute Manager, whereby you use the following approach:
“Mary, today you lost your temper in front of a very important patient of ours. And I was embarrassed. I was embarrassed! I also know you’re much better than that. Yesterday, I saw you attend to the needs of three patients at once. That was beautiful. That’s what we want to see more of. Now let’s have our coffee and get back to work.”
This approach is a cut-and-dried method for resolving an issue by illustrating the problem and the consequence, then ending on an up-beat note. Where I feel it falls short is in not allowing for the team member to express why she lost her temper. In that respect, the above may only act as a “quick fix” that leaves the root cause to smolder until something triggers a similar or greater outburst with more dire consequences.
Therefore, I suggest the following verbiage be used:
“Mary, I wanted to take time out from our day to let you know I’m concerned. Something seems to be bothering you. If you’re comfortable sharing it with me, I’ll be happy to listen and see what we can do about it.”
Depending on this person’s history with the practice, she will be more or less open to expressing herself. Most people will respond to a request phrased in such an open-ended manner. Once the concern is expressed, options can be explored as to how best to address Mary’s concerns (see Tools section below).
Conflict Resolution Skills
Following are skills that once mastered, can greatly assist you in managing and resolving conflict in your office.
Active Listening
Showing with your body language a sincere desire to know what the person is saying. This is further demonstrated by the following techniques.
Mirroring
Restating what is said to you to confirm your understanding. Care should be taken to “neutralize” statements by eliminating or changing words that are emotionally charged or are accusatory. Mirroring also refers to assuming the physical posture of the person with whom you are speaking. This is a basic example of what has been termed Neuro-linguistic Programming (NLP).
Pacing
Another example of NLP, pacing means getting into the rhythm of a person’s speech pattern, then slowing it down, the goal being to calm the person so a more productive conversation may take place.
BATNA
This is an abbreviation for Best Alternative to a Negotiated Agreement. It involves asking the person to consider what the best possible outcome will be if a mutually agreeable settlement cannot be reached. An example of the use of BATNA is, “Joseph, I know you don’t like making reactivation calls in the evening. But you’re the only one on our staff who is capable of doing so. And you remember the mess we were in before we brought you on. What do you think will happen if we just stop doing this?” Embedded in this sentence is another technique called stroking (see below).
Reality Test
Similar to BATNA, reality testing attempts to get the person to see that his or her proposed solution is unrealistic, or at least, not optimum.
Blame Yourself
A great way to neutralize tension during the mediation session is for the mediator to take responsibility for any misunderstandings or uncomfortable situations that might arise. For example, if a party grows impatient while the other party is speaking, you might say, “I’m sorry for not giving you an opportunity to speak, Sam. Just as soon as Bill finishes, you’ll have your chance.”
Ask “Harmless” Questions
Ask “leading” questions, especially when the parties seem to have reached an impasse. Ask “safe” questions that get the parties talking again. For instance, you might say, “Whose turn is it to get lunch today? I’m starving!” or “By the way, did I remember to thank you both for helping me juggle those four patients this morning? I owe you for that one!”
Stroking
Let the parties know that they’re doing a great job in the mediation, and you really appreciate their willingness to sit down and talk things over. It’s too bad more people are not willing to talk and listen.
The goal of all the above techniques is to get people to see for themselves why resolution of the conflict is in everyone’s interest, including their’s. If someone feels that they are being manipulated, or that a solution is being forced upon them, the parties to the conflict will be less likely to adhere to the proposed agreement. Remember that agreement is not the sole criterion of success. In fact, if either party feels the agreement is “forced on them,” it may do more harm than good.
An Ounce of Prevention
One way to deal with conflict is to create an environment where it is less likely to arise. One way to do this is to anticipate the kinds of conflict between staff members, doctors and patients, then implement systems and training to prevent these situations from arising.
Examples include:
“Personality Conflicts” Between Staff
Implement a compatibility assessment into your employee screening procedure, as well as for current employees. Doing so can help you understand who is most suited for working with whom. Employ active listening and caucus tools (see above).
“Trust is an essential ingredient of a productive and profitable environment,” says Dr. Ira S. Wolfe, D.D.S., president of Success Performance Solutions. “The willingness of people to exchange ideas and collaborate is thwarted when people are selected and promoted on the basis of skills and experience alone.” Wolfe’s SMARRT management process encourages and facilitates matching people who are compatible with the job, the team and the practice culture. This results in less conflict and stress, and higher practice productivity.
Patient Complaints About Being Kept Waiting
Implement a policy of notifying patients in advance if the doctor is running late. Promote a “no waiting policy” as part of your mission statement or declaration of principles. When the occasional complaint does occur, be prepared to use disarming verbiage such as, “The doctor asked me to apologize to you for not being able to see you. He is busy with a procedure that has proven more involved than we anticipated. He assures me he will do everything he can to see you as soon as possible. Is that acceptable to you, Mr. Jones?” Doing this before the complaint arises in the first place is a great way to show your sincere concern for your patient, and respect for their time.
Staff Member Refusing to Implement Changes or “Grow With The Practice”
Caucus with that person employing active listening, BATNA, and reality testing to get at the true source of this team member’s unwillingness to work with the team. In many cases, you may discover something more fundamental going on that has far reaching implications for the practice.
Another way of preventing conflict is to hire, then educate and motivate staff members to recognize the value of the work they do, and the value of the practice to its patients and the community. Involvement in charitable groups, for instance, can give the practice team a sense of shared pride and “higher calling,” and perhaps even serve to illustrate the disagreements as self-indulgent exercises that are beneath the practice and staff members.
As I am writing this, I am experiencing a poignant example of potential for conflict. I am working on my laptop on a return flight from a conference I’d attended. A rather ample gentleman is seated in front of me. As he reclines his seat, my laptop is thrust into my abdomen. I struggle in vain to position the laptop in a way that will not restrict my breathing. Out of desperation, I at last say, “Excuse me sir, I’m sorry to disturb you, but I wonder if it would be possible for you to bring your seat back up just a little bit, and still remain comfortable. I realize these seats were not designed with the use of a laptop in mind, but it would be a great help if I could continue working on this article as I am under somewhat of a deadline.” He was immediately accommodating.
In addition to my choice of words, the fact that I had earlier helped this same gentleman avoid a bump to his head by pointing out the open overhead cargo bay no doubt set the stage for his cooperation. As to what I said, I was careful not to use accusatory or demanding language that suggested blame or that I was entitled to anything. I also showed a respect for his comfort, and directed the cause for the situation to the design of the seats. Finally, I offered a reason why I needed to continue my work.
Final Thoughts
Remember, an agreement needs to last, especially if it is between people who must continue to work together.
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