Try these strategies to avoid conflicts
Keep conflicts from happening in the first place by being prepared for them, suggests Tamara Thomas, MD, FACEP, associate professor of emergency medicine at Loma Linda (CA) University and attending physician in the ED at Loma Linda Univer sity Medical Center and Child ren’s Hospital.
"Anticipate potential conflicts and set appropriate expectations early," she recommends. "Decide how you are going to react before the conflict happens. This keeps you from behaving in ways that you later regret."
Here are strategies to minimize the number of conflicts between the ED and other departments:
• Form a continuing quality improvement (CQI) team.
A CQI team can identify quality improvement concerns and establish common goals, says Colleen Bock-Laudenslager, RN, MSN, a Redlands, CA-based consultant with Bock-Laudenslager & Associates, which specializes in ED issues. "If you explain to the leadership of the medical staff, radiology, the nursing division upstairs, and any other significant department heads such as housekeeping or security that you are working on improving the service to customers in the ED, all the team members are better educated."
The process can be mutually beneficial, stresses Bock-Laudenslager. "We can understand the frustrations that radiology has to deal with to accomplish a quick turnaround time. In turn, they understand the frustration we experience with a backlog of patients."
The process changes made from CQI teams can have dramatic results, she says. "When department heads meet every week or month, focusing on specific improvements such as decreasing turnaround times, the positive outcomes create an impressive impact."
An improvement team is the best way to educate others and develop strategies for better conflict resolution, Bock-Laudenslager recommends.
A CQI team can identify areas of mutual need. Thomas suggests, "Work together to find win-win solutions for daily issues that arise."
For example, both ED and floor nurses are encouraged when they see delays reduced in the time it takes to get a patient placed in a bed upstairs. "Likewise, when radiology sees the time reduced from when they receive a specimen to results shortened by 15 minutes, the team celebrates in the improvement of quality of patient care," says Bock-Laudenslager.
• Get to know others on a first-name basis.
Developing a caring, professional relationship can reduce conflicts. "When I can call nurses in the ICU by their first name and thank them, it fosters a relationship," she says. "I find they are much more willing to accept a patient quicker next time." The goal is to establish a relationship so they will accommodate you in the future, she adds.
When ED and intensive care unit nurses hold regular meetings, it provides an opportunity to see each other in person, network, and share common frustrations, she suggests. "The interchange creates an understanding of each nursing unit’s model of working. This forum also may offer a chance for educational development, whereby a case study can be presented by both areas."
• Serve on hospital committees.
EDs traditionally have operated as a separate entity at the hospital and have not always integrated themselves within the larger system, Bock-Laudenslager says. "The ED needs to establish a presence in committees within their facility. Your presence will provide an opportunity to educate committee members about the ED. Be punctual and offer solutions to the issues brought up at the meeting."
• Make sure the care you give is consistently excellent.
If service in your ED is a chronic problem, others may get the impression that your standard of care is not up to par. "If you deliver a quality product, they will view you as an exemplar department," advises Bock-Laudenslager.
• Develop healthy relationships with colleagues and co-workers.
Provide validation and feedback to those you work with, urges Thomas. "Thank consultants for their assistance," she suggests. "For example, tell a colleague, This patient deserves and needs your expertise beyond what can be accomplished short-term in the ED.’"
• Set your own personal goals.
Evaluate your priorities and reasons for being in the ED, Thomas advises. "First and foremost, you are there to give the best care for the patient. You also need to help the system that cares for the patient to run smoothly and efficiently. Unreasonable conflicts between services do not result in good patient care."
• Pick your battles.
Don’t bother battling small or trivial conflicts, Thomas recommends. "There are some things that are irritating but not threatening to patients. The sarcastic comment that is made as someone is walking away from you may not be worth your energy and time."
• Be considerate of others.
Treat others like you would like to be treated, she advises. "There are small things that you can do in consideration for a tired, stressed, and sleep-deprived colleague."
If your ED has limited physical space, give consultants a place to sit and do their work, she suggests. "Or say, Thank you for seeing this patient.’ Do a favor when you can, since these can often be cashed in’ on a day when you need one."
• Set limits for what you are responsible for.
The ED is your turf, and the patient is yours. Take responsibility for this, advises Thomas. "However, there is no reason to take responsibility for a consultant’s bad day. Their job is also to take care of the patient."
• Learn to recognize your early signs of anger.
Don’t allow resentment to build and then overreact to a future insignificant incident, she warns. "Don’t let your anger work against you. Stop and analyze why you are angry. This may help you put the incident into perspective."
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