Editor's Note: This article is part of a series on the future of healthcare work. All stories in this series can be found here.
Provider organizations have known for years that a diverse workforce is necessary for success. While many companies have hired diverse staff — except in the C-suites and boardrooms, but more on that later — retaining that staff and knowing how to defuse tension and solve conflicts is key. That is especially true in settings like hospitals, where mistakes can mean life or death.
Poor communication is one of the leading causes of medical errors, according to the Joint Commission. Some instances have nothing to do with interpersonal conflict, but employees at odds with one another are less likely to spend time making sure they understand each other during crucial events like a patient hand-off.
Dianne Austin, workforce diversity program manager at Massachusetts General Hospital, told Healthcare Dive creating robust support networks is key to helping employees identify and deal with tension or potential discrimination from other employees. They also need to be able to talk freely with others who may be in similar situations.
“There’s a lot that we do to really try to help employees feel that they have a voice and that they’re important,” she said.
How conflict happens
Susan Woods, a workplace consultant, says there are a few major dynamics in diversity-related conflict, including respect and disrespect, and recognition and identity.
Disrespect can be subtle and couched in many ways. An employee may express surprise at a coworker’s accomplishments or hint that affirmative action is at work for a promotion. An example of frustration relating to identity can come when a person is asked to frequently appear in promotional photos and view themselves as being used for public relations purposes, Woods wrote in an academic paper on the issue.
Research shows that conflict can be frequent in healthcare organizations because of the high workload volumes, pressures to move quickly and the importance of decisions being made. These conflicts can affect companies in many ways, including high staff turnover rates, reduced productivity and litigation costs.
Cheryl Patton of Grand Canyon University wrote in a literature review of conflict in healthcare that while some conflict can be good, dysfunctional conflict can result in lower quality patient care as well as reduced employee satisfaction and wellbeing.
Some of the most frequent conflicts arise between physicians and nurses. The biggest issue is usually blurred job boundaries, particularly with nurse practitioners who have many of the same education requirements and credentials as physicians, Patton wrote.
Dealing with conflicts
The best processes start early and attempt to prevent conflict. Austin said Massachusetts General has an orientation where new employees attend a program on diversity and inclusion and learn about various resources available to employees, such as a citizenship program, careers days and school admissions officers. There are also multiple staff committees focused on improving diversity and inclusion.
Healthcare managers can help ease conflict by listening carefully to employees, quickly addressing the source of the problem, instituting strict and clear policies and educating staff about those policies, she wrote.
“Though elimination of dysfunctional conflict in the health care field is impossible, proper management of such conflict is feasible,” Patton wrote. “Managers should keep themselves aware of the work dynamics and address negative conflict as soon as it is recognized. Education is advisable so that health care workers can learn effective conflict resolution techniques.”
Massachusetts General has multiple ways for an employee to bring any concerns to light, including an anonymous hotline, Austin said. The HR department will review whatever is submitted and the relevant department head is told the details. “We really try to pull managers and the appropriate people in so we can get to the bottom of it based on the information provided,” she said.
Sometimes, the problem starts with a patient who refuses to be cared for by a certain nurse or doctor, and may use racial slurs or other inappropriate language. The nurse manager will respond and tell the patient all providers are equally trained and capable. The patient is then told they can go to another hospital if they will not be respectful to all employees. The affected employee can decide whether or not to continue working with the patient.
Focusing on diversity is also important for the hospital’s recruitment efforts. “We do a lot to let our applicants know through our website and through our recruitment efforts that diversity is a No. 1 priority for us for many reasons,” she said.
Diversity is needed at higher ranks
One major way hospitals can prove they are serious about inclusion is making sure their C-suites and boardrooms are also diverse and reflective of the surrounding community.
While diversity and inclusion have increased in some ways at healthcare organizations, a glaring discrepancy remains in the executive ranks. Deborah Bowen, president of the American College of Healthcare Executives, told Healthcare Dive research on the issue began in the early 1990s, but still only 9% of hospitals and healthcare systems are run by diverse executives.
Austin said executive diversity is key to recruitment and retention, as well as the ability to properly identify and treat the health needs of the surrounding community.
“What I hear when I meet with staff is that it’s just very basic,” she said. “We want to see people that look like us in senior leadership. It sends a message that the organization walks the talk, so to speak. The proof is in the pudding.”
Bowen said the best ways to remedy poor diversity in C-suites is to start cultivating a diverse group of people who have an interest in leadership early on in their careers. Post-graduate fellowship programs and scholarship for mid-level executives can be helpful. Hospitals should provide leadership development and training as well as other career resources, she said.
“It’s a matter of finding mentors, for example,” she said. “Have a mentorship network to find somebody who has gone through something similar.”