Continuing and Professional Development Blog 

CONFLICT:  from the Latin:  con - together and fligere - to strike

While teaching teams of resident physicians or interprofessional health professionals, I often use an article by Rozemarijn Janss: What is happening under the surface?  Power, conflict and the performance of medical teams. Med Educ 2012;46:838-49. 

This article almost always prompts reflections and discussions about the challenges of working in healthcare teams and the impact of real or perceived power differentials on the team’s function.  Sometimes these conversations devolve into detailed explanations about professional accreditation requirements that mandate specific approaches to learning, or profession-specific values that are historic and must be defended (even if those values are nearly universal across professions), or liability fears that maintain medical hierarchies of decision-making.

When these explanations for power differentials become strident and siloed, I ask, “If our patients were sitting around this room listening to this discussion, what do you think their opinions might be about the healthcare training and care system we are describing?”  I doubt that the intricacies of accreditation or liability are primary worries when a person becomes ill or wants to stay well.

Power and conflict on interprofessional healthcare teams are not new topics of discussion. In fact, interprofessional teams probably represent a micro-system of larger societal relationships that are explained through the lens of conflict theory.  In brief, conflict theory analyzes the interactions of relationships that are characterized by differential power and resource allocation and hierarchies and stratification that organize persons and groups.  Conflict between groups can promote solidarity and sociability within “same” groups but limit conversational exchange and sharing of ideas or values in “different” groups. R. Collins in: Frontiers of Social Theory, ed. Ritzer, Columbia University Press, NY, 1990.

Not surprisingly, conflict on interprofessional teams can result from role-boundary issues, disagreements about scope of practice, accountability, respect and recognition.  Patients are probably not interested in interprofessional squabbles about power and accreditation and liability. They expect us to work as a team that includes them on the team and at the center of the team purpose.

Strategies for resolving interprofessional team conflict?  How about any of the following:

  • Co-leadership of teams
  • Safe environments for direct, open problem-solving communication
  • Shared and equal responsibility for finding solutions
  • Respect for others and humility in the face of our individual limitations
  • Trust that respect and humility can help us cross professional boundaries
  • Reframing con - flict as a normal and expected characteristic of dynamic, intelligent groups of persons who bring different expertise and ideas to solving complex problems

How about it?

Brown J: Conflict on interprofessional primary health care teams: can it be resolved? J Interprof Care; 2011;25