American Association for Clinical Chemistry
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July 2011 Clinical Laboratory News: Confronting Conflict in the Lab

Confronting Conflict in the Lab
How Lab Managers Can Curb the Effects of Disruptive Behavior

By James S. Hernandez, MD, MS

We all probably have known one: the lab staff member whose disruptive behavior affects not only her own performance, but also keeps her co-workers from doing their best.

Disruptive behavior can include verbal abuse, sexual harassment, yelling, profanity, vulgarity, and threatening words or actions, according to Gerald B. Hickson, MD, director of the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center in Nashville, Tenn. He says disruptive behavior can negatively affect both lab operations and the level of respect and camaraderie among lab staff (1).

Disruptive behaviors, such as sexual harassment, 
create tension in the laboratory 
and threaten its safe operation.

Why is it so important to stop disruptive behavior? Because such conduct not only can lead to medical errors, but failure to curb it also can cause team members to adopt the disruptive person’s negative behavior, which in turn can reduce the level of trust and respect among co-workers, says Hickson. Inappropriate attitudes and actions also reduce productivity in the lab because staff are distracted by the perpetrator’s behavior. As this environment affects how efficiently a lab operates and has negative repercussions for all involved, lab managers should continuously monitor the offender’s disruptive behavior (2).

Multiple sources of conflict in the workplace exist, according to management expert Louellen Essex, president of Louellen Essex & Associates (See “Sources of Conflict,” below). Essex has worked extensively with healthcare organizations, including laboratories.

Sources of Conflict in the Workplace

  • Goals and/or values conflict
  • Ambiguous jurisdictions; role ambiguity
  • Competitively fueled reward systems yielding divisiveness
  • Weak communication capabilities
  • Perceived power imbalances
  • Personality style differences
  • Difficult behavior patterns

Adapted from reference 3.

When Conflict is Good

Not all conflict is dysfunctional, according to management guru Charles Dwyer, PhD, academic director for the Aresty Institute’s Leading and Managing People Program at the University of Pennsylvania Wharton School of Business. Although some people actually enjoy conflict, the lab director’s goal should be to manage, rather than squelch, conflict. (4). In fact, getting to the root of the conflict has several benefits for laboratories, including raising important and unresolved issues, resolving deep-seated problems, and helping the lab to evolve better group cohesion. Overall, such resolution can lead to productive changes in lab culture and output.

Managing Conflict

As unsettling as disruptive behavior can be, some individuals thrive on conflict. Today, it seems that conflict among co-workers is rooted in American culture, which often times rewards and encourages bad behavior. In fact, some co-workers may even instigate or encourage conflict. It takes courage, discipline, and practice for lab managers to learn how to de-escalate conflict in a healthy way.

What should lab managers do when they observe conflict in the laboratory? Barbara Linney, vice president of career development at the American College of Physician Executives in Tampa, Fla., offers a few pointers (5). First, avoid teasing subordinates about the behavior. This only makes the lab manager an equal with the disruptive staff member. Second, avoid big shows of emotions, such as angry outbursts or crying. This merely escalates the problem. Linney also advises lab professionals to be mindful of their body language, since 55% of what we communicate is through body language, 38% is from the tone of our voice, and only 7% is due to the words we are speaking (6) (See “Tips,” below).

Tips for Confronting Disruptive Behavior

  • Prepare by writing down and practicing what you are going to say.
  • Make sure you are in the right mindset.
  • Document and stay calm at all times.
  • Be objective, not judgmental.
  • Get help when you need it.

Adapted from reference 5.

Listening skills are essential to resolving conflict, according to Essex (3). Lab managers should listen and avoid being defensive when managing conflict. It helps to paraphrase the concerns of the other person or team members and to ask questions to clarify your understanding. If you are at fault, don’t be afraid to admit it, and if you’re not at fault, explain your point of view to clear up the misunderstanding. Finally, thank the person or team for bringing the matter to your attention.

Being Prepared

Hickson urges laboratories to have an infrastructure in place for addressing unprofessional behavior (7). Key components of such a system include commitment from the organization’s leadership, supportive institutional policies, surveillance tools to capture complaints, a model to guide graduated interventions, and a process for reviewing allegations. It also may help to institute a training program for employees and develop resources to aid both those being disruptive and the staff members affected by the behavior.

Even with limited resources, by taking tips from other areas in healthcare to guide policies and procedures, laboratorians can confront and combat disruptive behavior. In the end, experts agree that the ultimate goal is to eliminate poor behavior in the clinical laboratory in order to ensure patient safety.

REFERENCES

  1. Hickson G. Dealing with Disruptive Behavior among Health Care Professionals, CLMA audioconference, Gerald B. Hickson, MD, director, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center.
  2. Felps W, et al. How, when, and why bad apples spoil the barrel: negative group members and dysfunctional groups. Res Organ Behav 2006;27:175–222.
  3. Louellen Essex and Associates, www.louellenessex.com/contact.html, accessed May 12, 2011.
  4. Dwyer C. The Shifting Source of Power and Influence, ACPE Publication, 1991
  5. Linney, Barbara, Conflict and Cooperation, American College of Physician Executive course, 2008.
  6. Malandro, LA, Barker, LL, Barker, DA Nonverbal Communication, 2nd Edition, New York, Random House (1989).
  7. Hickson GB, Pichert JW, Webb LE, Gabbe SG. A Complementary Approach to Promoting Professionalism: Identifying, Measuring and Addressing Unprofessional Behaviors. Acad Med. 2007; 82: 1040–48.

Patient Safety Focus Editorial Board

Chair
Michael Astion, MD, PhD
Seattle Children's Hospital
Seattle, Washington

Members
Peggy A. Ahlin, BS, MT(ASCP)
Consultant
Salt Lake City, Utah 

Corinne Fantz, PhD
Emory University
Atlanta, Georgia

James S. Hernandez, MD, MS
 
 Mayo Clinic Arizona
Scottsdale and Phoenix

Brian R. Jackson
ARUP Laboratories
Salt Lake City, Utah

Sponsored by ARUP Laboratories, Inc.
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