Effective Conflict Management Between Multidisciplinary Teams

Editor's note: This text-based course is an edited transcript of the webinar, Successful Conflict Management Within Multidisciplinary Teams, presented by Mira Rollins, OTR/L.

Learning Outcomes

After this course, participants will be able to:

• Identify management personality styles of self others implement the most effective strategies for interaction based on the identified style
• Express effective strategies for handling crucial confrontational conversations
• Identify the main sources of conflicts in healthcare implement specific conflict resolution strategies for each source

Categories of Healthcare Conflict 

Figure 1. Categories of Healthcare Conflict. 

I want to tell you a story that happened yesterday. I went into a gas station for what I thought was be a quick convenience store run. I went to grab myself a Sprite and what I believe was a pack of peanut butter crackers. I am at the counter in front of the person who works at the store behind the register. Then there is a customer I am witnessing a conflict with. The customer is upset because the attendant carded her son. she felt she did not need to continuously card her son because he comes to that store regularly. It was this back-forth interaction, "You carded him twice." She said, "I will card him five times. Oh, are you being rude? I am not being rude, it was you." It was climaxing in front of me. I slid my crackers on the counter and asked, "Can I get these real quick leave?" I quickly take my exit. After I got into the safety of my car immediately, all of these things started to pop into my head, she could have said this differently, or if she had interjected this particular phrase in this particular conflict resolution style, that could have been handled differently, it would have ended it would not have escalated. I go through life looking at situations of, "Ooh, if she would have said this or that could have been different." What I want you to be able to do after we end this particular session is to be able to look at your daily interactions with your coworkers and say in real-time, what can I interject into this situation to make it successful in this conflict that we are having right now? 

When I think about the conflicts the drama that we experience as healthcare professionals, I put them into three categories. The first category is territory, next is technique, then tone. Every conflict we encounter as healthcare professionals can be safely put into one or multiple of these three categories. The territory is the perception, and I will stop at that word perception. I do not know if you have heard the expression "perception is reality." Often, what hinders us from successfully managing conflict is that we only look at the situation from what our intent was. It was not my intent to offend them, or I did not say it like that. That is how they interpret it. What happens is we stop there because that was not my intent. I choose not to look into it deeper. I choose not to look at it from their perspective, but if you want to be successful in managing conflict, you have to be willing to say, I will deal with not necessarily with what happened, but what this person's perception of what happened. That takes a lot of maturity and humility, but I promise you that it is one of the critical factors in successful conflict resolution. How did this person perceive my interaction with them? We can handle it from there. That does not mean yielding to what they say or necessarily giving in, but it does mean being aware of where they are coming from and their frame of mind as you navigate that situation. Perception is reality. 

Territory conflicts arise when there is a perception of infringing on one's job, schedule, or workplace. The next category is technique. The technique category is a lack of competency, efficiency, or compassion. The last one is tone, the perception of inappropriate communication of needs. As we go through each of these, please think about some recent conflicts that you have had and what category they would fall into. Several times, I will ask you to chime in the chat for some quick examples of territory, technique, or tone conflicts. Then, in the end, we may go back to those situations and see how we could use the strategies we discussed today in our personal conflicts.

Now let's go to each one individually. Territory is when you feel someone infringed on your role, job, or time. Let me give you several examples. Let's say I am an occupational therapist, and everyone knows that I do activities of daily living (ADLs) in the morning with my clients. I have five patients. Everyone knows or should know that Mira gets these patients between 8 to 10 o'clock. I have been doing this for two weeks consistently. As usual, I was ready for Ms. Johnson, and when I came down, I saw that the physical therapist had Ms. Johnson on the arm bike. I think you are infringing on my time. Alternatively, let's say I have a schedule that I gave everyone. The schedule says that at 10 o'clock, Mira sees Ms. Johnson, but then the respiratory therapist needs to take the patient from occupational therapy services to do some of their services with them. However, I am like, no, this is my designated time.

The respiratory therapist says this is the time that this treatment needs to happen. Now we have a territory battle, or another example would often be in speech therapy. In occupational therapy, we both can work on cognition cognitive goals, but we cannot both do them at the same time because, frequently, insurance will not reimburse one of us if we both are working on cognition goals. Then I walk into the clinic and start working with my patient. The speech therapist sees that I am doing some cognitive retraining. She feels that I should yield to that goal as the occupational therapist because she has an active plan of care as the speech-language pathologist. These are some examples of territorial conflicts. What I would love for you to do right now is to tell me some examples of a territory conflict, a perception of infringing on one's job, schedule, or workplace. Take a few seconds. I would love to see some examples of territory conflict you have experienced. Please do not go into a long story, but maybe like my coworker continues to put her belongings in my cubby territory.

Territory Resolution Strategies 

Figure 2. Territory Resolution Strategies.

One effective strategy to avoid handling territory battles is establishing roles and responsibilities. This may sound simple, but I have seen many issues amongst coworkers because we do not know whose job it is to do. For example, the hydrocollator is something we put hot pads in moist heat to apply to our clients. It is supposed to be checked and cleaned once a week or daily. No one was doing it. Everyone was bickering over it. I did it last week, yesterday, or two weeks ago until the manager said we would have a rotating schedule.That specific nuance of clearly established roles and responsibilities completely alleviated anyone arguing or bickering. Referring to the example of the occupational therapist and the speech-language pathologist. Both have in their scope of practice cognition training. What I did as a manager is that anytime speech therapy had an active plan of care, if the occupational therapist wanted to address cognition before she wrote the goal, she would have to speak with the speech therapist to ensure there was no overlap. If there were overlaps, the occupational therapist would yield to the speech therapist to address that goal. That was something that established roles.

I want you to think about these strategies. How could I, in my perspective department or job, what is a way that I can establish a role or responsibility that would bring forth less drama in my current work environment? that is the first step in territory resolution. The second is to be aware respect schedules. As we navigate our day-to-day, we all know that the med nurse needs to give the medicine, and physical therapy needs to get them on a piece of particular equipment at a specific time. The doctor makes his rounds at this time. We need to honor and respect each of our coworkers' schedules. Even more, to put the responsibility on ourselves, how can we communicate our schedules? If you, as a respiratory therapist, come to a particular unit at a specific time, pretty much the same time every day, make sure that people know that. Communicate that to the nurses, to new staff, and as you see them, introduce yourself, "Hey, I am the respiratory therapist. I see you are a new nurse on the unit. I typically come between 8 or 10 o'clock." Make sure that everyone knows that if there is a particular procedure, you have to have them in a specific time window. Do you email that? Do you post it? Is there some internal communication that you have between the units? How can you most effectively consistently communicate your schedule and then ask for schedules from other people, so there will not be territory conflict? Then the third thing is being aware of systems. If schedules tell you when and systems, say how.

Systems are like something as simple as the meal schedule at 8, 12, and 5 o'clock. The system may be that the CNAs complete cleaning checks of the patients, ensuring they are clean and dry after each meal. That is not an exact time, but that is a system that everyone knows. As a respiratory therapist, immediately after meal times come, you may not try to take someone from the unit to do any interventions because on this particular unit all patients get back to bed for a check to make sure that they are clean, dry, so it is not a good time. That is a system that you should be aware of. Alternatively, any day a client has an appointment outside the facility, these things are completed before each client leaves the facility. This may not be the best time to come to try to work with them right before an appointment in the community. Knowing the workings of your department in your facility and honoring those systems can prevent many territory battles. Then there is a big one, be an active team member. I know that as respiratory therapists, frequently, you are assigned to many different units or facilities. Whereas other respiratory therapists are housed at one particular department, those who have a home and do not float can integrate themselves a lot easier into a department and a facility. However, for those who maneuver around multiple areas, it is important to integrate yourself into each of those units. Make sure that you are not seen as a visitor or an outsider, that you get to know people, and even lend your assistance to things that may not necessarily be part of your job. Even if it is simple, I am headed in that direction and will drop that off for you. Small things like that begin to allow people to see you as a part of the team. When you need something or want something, or there is a minor conflict, they will be more inclined to assist or yield because you are seen as one of them, not an external person coming into the department, demanding things. These are four simple, practical territory resolution strategies. I would love to go to the chat right now. Did anyone chime in on a territory resolution or battle they have seen before? 

[Audience question]: My coworker often interrupts my lunch to have me help her with her work. 

[Mira]: Oh, that is a great one. You are infringing on my self-care. I am a respecter of self-care time. I think an excellent way for you to handle this is number one, not at that exact moment. Let's say her name is Katie. I would say to her, maybe as you guys are packing up to leave home, or as you are at the refrigerator, getting your food out, you can say, "Hey, Katie, I enjoy talking to you. You have some great conversations, but I am one of those people that, at lunch, I need to unplug completely. It helps me to get through the day if I can take 30 minutes to not talk about work or talk about anything I like to put on my headphones. That might be another cue you can use to put on your headphones because it sends this soft message, he is doing something and does not want to be disturbed. Even if you do not have anything playing, tell her I need those 30 minutes to unplug. If you would not mind asking me anything work-related during lunch, not that I will not help you at any other time, but I need those 30 minutes of self-care. It may be a little bit awkward for that quick 30-second or two-minute conversation, but it will allow you that boundary that you need going forward. That is a great example. 

[Audience question]: The morning meeting is at 8:45, in the middle of the morning treatments and first rounds. They keep adding items to the meeting, taking up more time and throwing off our scheduled treatment times. 

[Mira]: There is something that I call how to manage up. That means that where you are on the hierarchy, you either have employees under you or supervisors over you. We often do a decent job managing down people under us but have difficulty managing up. In this particular situation, it is going to take managing up. That means asking for a meeting with the supervisor who schedules this meeting. The reason why I am saying asking for the meeting is that you do not want to do it in passing. You do not want to do it during the meeting when you are frustrated, but you want to carve out some time that they will not be rushed and that you will have the time that you need to discuss. Then you want to present to them the problem, give them some examples, actual patient examples of when this meeting runs long. Last week, I could not get to Ms. Johnson; I had to rush. Give them the problem with specific examples, then come up with some of your suggestions. Can we limit it to 30 minutes? Anything that goes over 30 minutes, maybe we can table it for the next day. Can it be sent in an email? Can we have someone that moderates the meeting that keeps us on time? Your suggestions can now be part of a solution. Those would be some of my suggestions, a great example of territory. I also want to throw out this mindset shift. Sometimes people will say this is an unsolvable problem. The person asking that question might say, " You do not know my boss." They will not listen. We convince ourselves that I will have to deal with it. You have this mindset that this is an unsolvable problem. It prevents you from attempting the four steps I have on the screen. Change your mindset. It might not be perfect. It might not be swift, but implementing these practical strategies can change incrementally or over time. 

[Audience comment]: Offer help before lunch and let them know you will eat. Can I do anything for you before I eat? 

[Mira]: That is great. Before I go into my zone, I tell my kids that when I come into my office and close my door, that means do not disturb mom. I ask them, does anybody in this house need anything before this door is closed? I think that the person who posted that comment said it much more gracefully than I talk to my kids, but the heart of it was the same thing, hey, can I do anything for you? I am getting ready to, even calling it fun names like, I am going into my zone. Then your coworkers know that when Mira says her "zone," she does not want to be disturbed. You can say I am getting ready to go into my matrix zone. Small signals communicate a message without awkwardness, great solution, or strategy. I appreciate that comment.

Technique Resolution Strategies

• Be proficient and efficient at what you do
• Be able to articulate the why of what you do
• Seek understanding of other roles and responsibilities 

Rember that technique is someone's perception that you are not efficient at something that you are doing, or you are doing it incorrectly, or maybe too abrasive. They have a perception that you are not doing something the best way. How do we combat that? The first one is to be proficient and efficient at what you do. It is straightforward. Do your job and do it well. Often in the medical field, we get territorial about our patients. Because we love them, we have the heart of caregivers. As a respiratory therapist, if you come into the physical therapy clinic and see a physical therapist being what you think is rough with Mr. Johnson, then that is a technique battle that will make you infuriated. Alternatively, you may see a physician you do not believe is providing this client the best strategy or intervention. That is a technique conflict. 

If you put that on yourself, what strategies are you using? Are those the most recent current effective strategies? This takes on the responsibility of, am I keeping up with my continuing education? If there is anything that I lack efficiency in, what am I doing to increase that skill set? When people see you as proficient and efficient, it will decrease your interactions that circle around technique resolution. Be able to articulate the why of what you do. Again, this takes humility because it rises up in us. When I get upset, my ears get hot because I feel that I have to explain myself to people after being a therapist for 20 years. I know what I am doing. Why is this doctor asking me about this? Why is this nurse micromanaging this? I know what I am doing. Oftentimes that pride prevents me from having a conversation where I say, "Hey, Doctor or Nurse Jessica, the strategy that I am using with Mr. Johnson is because I have seen in the past that it works better because of this. I will update you on how it is going so that you can feel more comfortable—being okay with having those conversations and not seeing it as if I am answering to someone. 

It is that I am preventing technique conflicts by increasing understanding. When you increase understanding, you also simultaneously increase compliance. Increasing understanding increases compliance. Those are the first two strategies and suggestions, then also seek understanding of others' roles and responsibilities. Occupational therapists often use pegs for fine motor coordination and cognition retraining. We can do a thousand things with pegs. If someone comes into a clinic saying, I need Mr. Johnson right now, he has to go for a swallow study, or he has to go for some other major procedure. They see Mr. Johnson sitting at my table playing with pegs. They are like, that is not important. You are here playing games. Well, if you took the time to understand what I am doing with those pegs, she is working on sequencing because Mr. Johnson has major difficulties sequencing, affecting his ADLs. This is one technique that they are using to help with that goal. Okay, now it makes sense, now I do not see it as pegs, but I see it as a strategy to improve his deficit of sequencing his global cognition. Now that you have taken the time to understand what I am doing, it allows you a little bit more patience when we have a technique conflict. Did anyone comment on a technique resolution they have used before? 

[Audience comment]: Explain your actions in the spirit of education, not validation. 

[Mira]: Absolutely. I love that. I am not trying to justify what I am doing to you, but what I am doing is trying to educate. It will not be in the way of talking down to you or not talking at you. It will give you a little more knowledge of this procedure for your own good. It is not defensiveness. It is not being, , no one is talking at one another, we are two clinicians, two medical professionals exchanging information, wonderful. 

Tone Resolution Strategies 

Figure 3. Types. of resolution styles.

If I had to stack the categories, I think many of our issues come from tone and knowing how to talk to somebody. I am sure you can think about four to five people about how they talk to you. They talk loud, and they talk at you in front of people. The words they use are almost combative. If you could learn how to say that better, it would make people respond much better. I think that you have heard the whole statistics about how much communication is nonverbal versus verbal. Your tone can be in your words, but also in the posturing of your body, in your position. Are you blocking doors when you are talking to another professional? We must be aware of things we do not think about in real-time. Frequently tone reflects itself in our resolution styles.

Some people are passive, others are aggressive, but what we want to achieve and strive for is being assertive. A passive resolution style is when you are avoiding or delaying necessary actions. This person thinks all conflict is bad. It makes you sweat thinking about it. You begin to stuff the things happening to you instead of trying to come up with solutions because you do not want to deal with them. Are you an avoider of conflict? Your tone is almost non-existent because you do not talk about it or discuss it. In the passive style, we see people handle conflict covertly because they do not want to deal with it. It is not that I never deal with it, but I deal with it in almost secretive ways that I will figure out myself. For example, instead of going to your supervisor asking, "Hey, can you not have this meeting this long because it is interfering," what you begin to do is, "Oh, I will sit at the back then quietly leave, thinking she will not notice." Then you end up having a conflict because she will write you up for leaving the meeting, but it is because you are avoiding conflict. The passive resolution style often handles conflict at the height of the behavior or consequence. That means that you avoid, avoid, until you cannot avoid anymore, and you explode. It is incumbent upon you if you see that you are this passive personality to say, "Okay, I either go from zero, I am not handling it all, but then I will go to 10 because I have stuffed considerably." If you are this passive personality, you hold it in your brain. We will discuss what assertive looks like and how we can move you to assertive.

The aggressive resolution style handles conflict, anything, and everything. Aggressive people feel it is incumbent upon them to ensure that the world is always on their "p's" and "q's." They feel they are being helpful but are breeding a negative work environment because they are aggressive in handling all conflicts immediately. They handle conflict overtly, hard, fast, in public, all the time. Alternatively, they address the conflict regardless of the magnitude or the frequency, often with the same technique. I think I will get this saying wrong, "If you think everything is a nail, you'll use a hammer." Aggressive people will come at it with the same energy, no matter how small or large the conflict is. They get labeled as aggressive because no matter the situation, they bring the same high energy to every conflict. We want to be assertive, not passive or aggressive. This is when we carefully consider conflict to decide how and when to address it. Do I even need to address this? Yes, it is an issue, but how small is it? Is it important enough for me to handle this now? If so, when will I do it? The assertive person questions that before acting. They handle conflict appropriately.

The resolution strategies match the level of the conflict. This is huge. Depending on the level of your conflict, what is your energy, and what is your conversation? How much time and energy effort are we devoting to discussing this conflict? We are measuring that based on the actual incident itself. Passive people believe that they are non-confrontational. They wear this badge as I am the easy one in the office, the easy one in my family when the truth is that they are being passive. They often feel that they are in control of their emotions. Everyone else around me gets riled up, but I stay calm. Are you staying calm, or are you not articulating how you feel? There is a difference. I typically go with the flow. Are you going with the flow, or are you burning up inside and not wanting to discuss it? I am an introvert. That is different from being passive. Now here is aggressive, I am overly confrontational, or I confront things head on. They wear that badge proudly. Are you that person that has convinced yourself that I tackle problems, but are you being overly confrontational? This one takes some self-awareness. Because of the conflicts that we see with our coworkers, we always believe that it is them, but even if it is 25% or even 10%, if you are acting in passiveness or aggressiveness, what if you could change the dynamic of your work environment 10%, would it be helpful? Absolutely. Aggressive people feel that they openly express their emotions. , I am in tune with my emotions. I do not mind articulating those. That is a great quality, but you may be a little too aggressive if you do it often. They regularly challenge other people's opinions. That is a huge word, opinions. If it is a perspective or an opinion, it is often okay to allow someone to have that opinion that is separate from yours if it does not negatively affect the department's operations, but aggressive people cannot let it go. 

Avoiding Aggression

• Practice crucial conversations
• Consider timing, technique, tone
• Listen. Wait. Restate. Validate.
• Provide appropriate outlets
• Don't push back but lean in
• Define and display directness
• Create opportunities to coach 

We will talk about how we do not want to be either of these things. We want to be assertive. If you find yourself in the passive category or working with a coworker or a passive supervisor, these are some strategies you can use to help with that. Practice crucial conversations. If you are passive, you find yourself always avoiding those confrontations. You are constantly letting Katie talk to you at lunch, it is driving you bananas, but you do not want to say, "Can you talk to me in about 15 minutes? I am all yours in 20 minutes." Even that little phrase makes you tense and anxious. Practicing these conversations in the car on your drive home would be best. I am having this problem with Katie. I am having this problem with my boss. This is what I am going to say. This is how I will start the conversation, and she will probably say this in return. If she says that, this is a good response. For those of us who do not have problems with conversations, this may seem like overkill, but trust me, many people struggle with having these conversations. Five minutes of practicing this in your head help you push past being passive.

Consider your timing, technique, and tone. When am I going to address this with this person? I do not want people around because that will make me more nervous. Maybe I should get her in the morning because that is when she is more accessible. Practice, think of how I will say this and my technique. Having this forethought planning helps the passive person have these conversations. Then you want to ask or allow questions. Let people know what you need. Also, get the information from them in those crucial conversations, and do not be afraid to ask for clarification. Passive people will try something two, three four times because they do not want to ask for clarification, but be okay with coming to someone saying, "Hey, I tried it once. I used this strategy, which did not work, but now I need further clarification, okay?" Practice proficiency, and give or provide feedback. When there is something they do not like or agree with or are not benefiting from, the passive person will not want to tell the person, "Hey, this is not working for me because of this." They do not like to give feedback, or when they receive feedback, it pushes them further back into their passiveness. The person constantly acting from a place of passiveness needs to be comfortable practicing a cadence of giving and providing feedback. If you authentically want better conflict resolution within your coworkers or at home, you will say, " what, that is one nugget for me, or this is a second nugget that I want to practice."

You may not remember all the slides, but someone is reading this right now thinking, that is me head on. I do not like to give feedback on things in my department. I allow everyone else to give their opinions. When things change or are added, it is not with my perspective in mind. I need to practice giving feedback, but I also get deflated when I get feedback. It pushes me further away from the team. It pushes me further back from what I need. I will be conscious of being better at receiving critical constructive feedback. Then we need to manage our personal or environmental stress. It does not take much to push a passive person deeper into their passive tendencies. One of the ways that you prevent yourself from falling deeper into that hole, or if you are a manager who has a passive employee, know that the stress level increases automatically and assume that person is retreating, they are going to have fewer conversations and are going to give less feedback. It is going to be more challenging to receive your feedback. How can you manage or reduce the stress level of the department if you are the manager or, specifically, yourself- how can I reduce my stress? I see myself falling into these patterns. If you are aggressive, you should also practice crucial conversations. Not because you have difficulty having them, but because you have difficulty successfully navigating them.

The aggressive person is unaware that the conversation did not go well because they often come away feeling heard because they are the more aggressive person. If you have done a little self-evaluation and have identified yourself as, Yeah, I can be a little aggressive. It will take you understanding that because you came away feeling heard and understood. How did the other person in that conversation feel? If you only give one-way communications in a department, things will not change. You can create an unhealthy work environment. The passive person has to practice it to give it, but the aggressive person has to practice it to ensure that they are not overpowering everyone else in the department.

Listen, wait, restate, validate. If you are more aggressive, you need to practice this strategy in this order. Many of you say I am not an aggressive person, and it is my boss or my coworker. Then you would have to take that strategy of practicing a crucial conversation in your car asking for what you need. You would need to ask your boss about a conversation like this, "When we communicate. I do not feel you fully understand what I am trying to say. It would be better for me or help me if you would allow me time to vet my point entirely. Before you immediately respond, I would like a little time in between for you to think about it and consider it." We must be aware of that crucial conversation as healthcare providers and professionals. That was a perfect example of how you can use a passive person's strategies and know what the aggressive person needs. That is how these all kind of overlap.

People feel that they cannot talk to you if you are an aggressive person. Permitting people to state their points or to talk to you, asking people, "Hey, is there an issue? I see that you did not say anything in the meeting. Is there anything you want to share?" The aggressive person should give people the opportunity, "the safe zone," to express their issues. Do not push back but lean in. A person who operates mainly from aggression will quickly return with a retort, have something to say, or be defensive. If you are noticing that is your inclination, what you want to do is not push back but lean in. That means asking the person in conversation, "Oh, that is how you felt. Tell me more. Can you explain that a little bit? I did not get that from our conversation. Can you tell me how you perceived it?" The aggressive person needs to be willing to lean into someone else's perspective of the situation. 

Defining and displaying directness is a great one. The aggressive person often feels that I am not being aggressive. I am being direct. We have to check that. What does being direct look like? What is okay when it is being direct? What does it look like to move from being direct to being aggressive? If you are on the receiving end of aggressive behavior, you have to be willing to explain to the person that is being aggressive, "Hey, I do not mind you being direct. We are all adults here, and I respect that about you. However, when you do these things (you name them), I feel it moves from directness to aggression. 

Again, someone taking this course could benefit from saying there is a nurse in hall three that thinks she is direct in handling business. I have let her talk to me crazy long enough, but what I am not going to do is go head to head with her. I will tell her, "I appreciate you being direct, but these specific behaviors make me feel like you are being more aggressive than direct. Having the conversation is going to be awkward. It will not feel good, but it will yield positive results. Also, being willing to be more of a coach, not always trying to operate from the "I am the leader, I am the boss," but being willing to give coaching strategies.

The Soft Skills Gap

• Consistent studies show companies reporting a soft skills gap
• 59% of hiring managers and 89% of executives report difficulty recruiting candidates with an adequate demonstration of communication, teamwork, and leadership

Conflict occurs because we do not know how to speak to someone or we are not being efficient. We can be great clinicians, the best doctor, and the best respiratory therapist in the world, but we can have all this drama around us because we have not worked on our soft skills. Consistent studies show that companies report a soft skills gap, 59% of hiring managers and 89% of executives say they have difficulty recruiting candidates with an adequate demonstration of communication, teamwork, and leadership. We have all these people with doctorate degrees and master's degrees. We go on to get certifications in a particular new strategy. We are becoming some of the most efficient, intelligent respiratory and occupational therapists. Still, we have this vast cataclysmic gap in soft skills. As we build up our skill set, we need to ensure that we are not leaving behind these soft skills that make working in departments either great or awful.

Figure 4. Soft skills.

Examples of soft skills include communication, problem-solving, leadership, teamwork, adaptability, creativity, time management, emotional intelligence, empathy,  and flexibility. These are things that you should ask, "Why are we even talking about this?" You look into these boxes, and you could probably put a coworker's name in each box with a gap in one of these soft skills. To be honest, we could probably write our names in some of these boxes. We must commit to working on these skills ourselves to know how to navigate other people who have these gaps. 

Why the Gap Is Growing 

• Increase in Virtual and Remote Positions
• Less touch points
• Less in services
• In services are replacing trainings
• Less organic learning through observation and modeling
• The “should” trap (develop)
• Fireplace vs. Fire mentality (monitor)
• Generational Workforce Issues (Gen Z, Millennials, Gen Z, G.I. Generation, Silent Generation, Baby Boomers)

The gap is growing because we see an increase in virtual remote positions. Our opportunities to interact are decreasing because of how the world is moving. If I am in my car, I do not have to display or work that muscle of teamwork often in this one-on-one environment. If I already have a gap, it is widening if I work in virtual remote environments. We have fewer touchpoints and in-services as much is on the computer now. We do these modules online. Half the time, we may be drinking coffee, multitasking, and not listening. We are going away from these in-person training services, or even virtual engagements, where we are asking people for response real-time feedback. The efficiency of the training is not being monitored as much. Sometimes the things we educate people on are not penetrating as much because of how we structure our learning modules. In-services are replacing training. Say, "We will work on training together. I am going to see how you practice this skill. I am going to give you feedback on the skill. I am going to going to give you adaptations real-time feedback for you." We have less organic learning through observation modeling. 

As leaders and coworkers, an example of the "should" trap is she should know by now not to do that. She should know because she is an adult, is grown, and should know how to talk to someone or keep her schedule. I will not give her resources or feedback on that because I do not feel I should have to waste my time discussing this because she should know. That prevents us from having very crucial conversations. Then we must look at the fireplace versus the fire mentality. That means handling something before it gets out of hand. These soft skills grow because if we had handled it with our coworker or our supervisor or our employee even when we first saw the behavior, we could have given her feedback when the behavior was at a level two, but now that we have let it grow to a level seven, this gap has widened and is creating havoc within our department. Then we also look at generational workforce issues. The technology use or lack of technology and different things that are part of the culture was once important to a generation that now may not be so important. We see clashes there because we do not understand the generational culture gaps, and we need to take the time to dive into them.

Bridging the Gap

• Include soft skills into your professional development strategy
• Make it part of the culture by examples, expectations and emphasis
• Be intentional about increasing interaction with employees
• Less in services and more training (role play, discussion, dissection of videos simulation, etc)
• Change “should” mentality. Make it priority. Have a plan. Be patient.
• Increase check points to avoid “the fire”
• Generational Workforce Issues (Gen Z, Millennials, Gen Z, G.I. Generation, Silent Generation, Baby Boomers)

How do we bridge the gap? Including soft skill strategies in your professional development is the most important thing. Yes, we need to learn about this new cutting-edge equipment that we are using, yes, we need to learn about new strategies, but we also need to have periodic in-service training with our departments on verbal communication. We need to talk about time management strategies, even if everyone rolls their eyes and says, I do not need this. Research is showing that we do okay. Make it a part of the culture through examples and expectations, not a periodic in-service. We infuse our soft skills training healthy work environment into everything we do. 

What does that look like for your particular department? Be intentional about increasing interaction with your employees. No avoiding. No, I will stay in my corner, you stay in yours. We are going to increase our interactions. It forces us to practice and build those muscles. As I discussed earlier, moving back into training where we are role-playing, discussing, and dissecting videos, not doing point-click modules. Change the "should mentality." We have to make it a priority. If a negative behavior exists, how do we address it? Having the "should mentality" does not fix it. It makes the behavior worse because it is allowed to grow and fester. Increase your checkpoints. If you have a problem with your boss, and you feel they have a communication soft skills gap, for example, he tends to never talk to me, but when he does, he explodes because I did not do something he wanted. Well, what I am going to ask for with my particular supervisor is, can we have a one-on-one every Wednesday for 15 minutes? If there is anything I am not doing correctly, or you want to counsel or give me some feedback, let's do it weekly, so it does not build up and explode. That is exercising professional maturity. If you have someone in your department with a time management issue, for example, they will have a patient for an hour, but their sessions always run long, how can you have a conversation with them to express that there is an issue with their time management? Do it in a friendly, professional way. Work together to come up with solutions, not allowing them to fester and then understanding the generational workforce issues, knowing things that are prevalent in some age ranges that are not as prevalent in some, and being respectful of those differences.

• Be strategic when employees on projects and task forces
• Switch collaboration teams when necessary
• Growth plans over performance improvement plans
• Provide opportunities for employee implementation of skills
• Provide resources, articles, books, etc based off your observation of employee 

To bridge the gap, be strategic when you put them on project task forces, like who needs to be on this committee. Maybe not even committees. Sometimes departments have work teams where there is team one, and they see these patients. Do these employees need to be on the same team? They do not play well together. Is my strategy, I am going to put them on the teams they can hash out their issues and figure them out, or I am going to put people who work better on specific teams, certain committees, certain projects, or knowing yourself, I do not work well with this person. Instead of saying, I do not like her. She gets on my nerves, be able to say to your supervisor using terms from this particular session to say, "Susie is a little bit more aggressive. That does not gel well with my personality. I work better with Mary because Mary does this." You are giving your supervisor tangible, specific things to point back to say, "It is not that she does not want to play nice in the sandbox. She has assessed herself and her coworkers to make some accurate assessments. I agree. Let me shift the teams." 

You can have those discussions on awareness and switch the collaboration teams when necessary. Performance improvement plans are saying you are not performing. I have you on paper. If you do not meet these goals by this time, you will be demoted, fired, or transitioned. Performance improvement plans are the fire out of the fireplace mentality. However, growth plans happen before that. They say, "I am noticing that you are not doing this or that." Alternatively, I am noticing that you have a problem with my performance. Can we talk about what your expectations are? Let me give you my expectations. Let's have a conversation. This is what I would like to see, or what do you need from me? What do you want to see? Growth plans are the fire in the fireplace; if you are a manager or even an employee, you can ask your supervisor. I am noticing some tension. Let's talk about it so we can clearly expect what is needed. This conversation often prevents a person from being put on a performance improvement plan. 

There is less anxiety around it. It is not fear-based, but it is growth based provides opportunities for employees to implement the skill. If you see someone struggling with the time management issue, or if you are struggling with time management, how do you put yourself on your own growth plan? It comes down to professional awareness. I am a great occupational therapist, but I am not good at communicating with my coworkers. What is my plan to implement soft skills? I do not play well on teams. I am an independent worker. I work much more efficiently in my mind by myself, but I am noticing that it creates an issue with my team. How will I put myself on a growth plan to practice working better within teams? Provide resources, articles books that will help that person with that particular soft skill. Get online and Google on how to have better verbal communication. That might be your issue. Will you devote 15 or 20 minutes to work on that? Whether you are the boss or yourself in seeing this gap. If you say, It is not me. It is my coworker. Then no, I do not expect you to walk up to your coworker and say, "Here is a pamphlet on better time management." Maybe you talk to your boss and say, "Hey, I know we have in-services that are all great. However, do you think we can spend five minutes talking about soft skills in every team meeting?" Just pick one. Some of you are like, I do not want to be the teacher's pet, but I promise you the small things we bake into our culture can cataclysmically change a department.

Conflict Resolution

• Resolving a disagreement by communicating conflicting opinions or strategies and engaging in collective compromise
• One of the most essential soft skills
• Can instantly and intensely improve most of the others
• Assists with self-awareness
• Fosters collaboration 

More conflict resolution, resolving a disagreement by communicating conflicting opinions or strategies engaging in collective compromise, is the definition of conflict resolution. It resolves a disagreement by communicating conflicting opinions or strategies and engaging in collective compromise. It is one of the essential soft skills because it incorporates almost all the others. It can instantly intensely improve most of the other soft skills. It assists with self-awareness it fosters collaboration, which is crucial as we work in multidisciplinary teams.

What is Conflict?

What is conflict? We think of conflict as battle, strife, disagreement, screaming unsettled. An example was the people at the gas station from my earlier story arguing and angry. You may immediately get this adverse reaction when I say the word burp like it is gross. However, as a respiratory therapy team, what is burping? It expels the extra gas we need to get out of our bodies. If we did not, it would have many adverse reactions. Burping, even though at first, it is like, ugh, but when we think about it, it is natural and necessary. If I said sweat, we might think sweat is gross, but we know it is how our body cools and regulates our body temperature. If we think of passing gas, we may think it is gross. Again, we know that we are expelling gas from our bodies. As adverse and gross as it sounds, it is natural and necessary. Like conflict, we often think of it as adverse I do not want to deal with it, but as we navigate relationships, conflicts are naturally necessary. They can be positive, mature, healthy, communicate, productive, and helpful. It is necessary. It is good. One of the main ways we can successfully navigate conflict is by first changing our mindset that all conflict does not have to be awful. Implementing strategies effectively could be natural, necessary, mature, and productive.

Successful Conflict Resolution: Step One

Figure 5. Conflict resolution steps.

The first thing you must ask yourself with a conflict is, What is causing this? Is it the catalyst, the pop-off? It is the thing that brings the conflict into manifestation. We are sharing the same office space. We have the same patient you want this time, and I need this time. We cannot avoid conflict. Some catalysts happen every day, all day. However, you must first ask yourself whether this should even be addressed. Chucky Cheese is a small indoor amusement park for kids. They have a whack-a-mole machine where you hold a big club, monsters pop up from random holes, and you hit as many monsters with your stick as possible to get points, tickets, and prizes. Many of us handle conflict that way.

Whenever someone says something that I do not like, such as when someone is in my area, they take my pen, or whenever the doctor interrupts me, will we address every conflict the same way with the same intensity? That is not a successful conflict resolution. We must pick our battles, asking ourselves, should this even be addressed? We need to look at the other three things. What do you look at? What is the more significant issue? Is this going to distract or take away from something else? Is this the right time? After we ask ourselves those questions, will it distract from a more critical issue? Once you determine if it needs to be addressed by looking at the three Ps, it goes to your priority. Is this the main thing at this moment that I need to discuss? Is this the most important thing? Will it yield a good result? Will it yield something that I need to see results in? Is it personal? Is this me? Am I being too sensitive to make sure you are checking yourself? Those are the three Ps. Is it a priority? Will it be productive? Is this my issue? Once you ask yourself those three questions, should this even be addressed, if the answer is no, then keep it moving.

Successful Conflict Resolution: Step Two

Figure 6. Conflict resolution steps.

You do not have to be a real-life whack-a-mole machine. Then if it does need to be addressed, the next question you have to ask yourself is, am I the person that needs to address it? You want to know that there are four categories of people with whom you will be in conflict 1) a stranger, 2) the same level as a coworker, 3) Subordinate, when you have someone under you, 4) as the leader, you have employees underneath you, or you are the team manager or a superior, that you have to manage up. The "stranger" is the riskiest. When you engage in conflict resolution or engage in conflict with a stranger, you do not know them. You do not know what they would do. The picture I get in my mind is in movies, where someone walks up to a stranger who looks a little shorter and is having conflict. The guy tells them, "You are talking to my girlfriend. Do you know what I would do to you?" Then the person scoots back from the table with this screeching sound on the floor. He stands up and is seven feet tall. That is the stranger dynamic that you have to be aware of.

You have to be more careful in implementing these strategies with the stranger because you do not know their level of how angry they get, what kind of language they use, how intelligent or not intelligent they are, or whatever you do not know. This takes the most humility because there are not necessarily rules that govern who is in charge. It is incumbent upon the two people in conflict or the two groups in conflict to use their strategies. At some point, there will have to be an agreement that I will yield, not because you are over me, but because I am choosing to yield because I feel this is the best result and takes the most maturity. The next is subordinate. Someone is under you, and this takes the most respect because we often can use our power or position over people. Then the last one is superior, which takes the most strategy, being very specific and transparent with how you engage with the people you are in conflict with if they are superior. You ask yourself, am I the person to address this? Is it my or my boss's responsibility if my coworker is doing the wrong thing? You ask yourself that question then you make a decision.
A stranger, is this behavior affecting me enough to address it? Do I need to get their supervisor involved? Maybe you see an occupational therapist doing something incorrectly. They are not your superior or subordinate, and you are unfamiliar with them. You go to your supervisor to maybe ask them to talk to another supervisor. It is always best to handle things at the lowest level possible. If this is a stranger dynamic, it might involve getting someone else in the loop. Alternatively, even if it is the same level, maybe you, as a coworker, do not have the clout or the position to bring that particular issue to your coworker.

You get your supervisor involved, but only after you have considered can I go to them directly. Each situation will have a different result, depending on your assessment. If you say, what, I am the person to address this. Then the next question you ask yourself is, is this the time to address it? You have to ask yourself about urgency, audience, and atmosphere. Do I have to do it right now,, or can I wait for a time when it may be received better? The audience, are there people around? If there are people around now, both groups involved in the conflict will now have to save face, think that I would say in private, I am going to say something different or how I say it because I do not want to be embarrassed or I have something to prove when people are watching. If you notice that your boss is constantly having conversations with you in public, this might be a situation where you ask them when you give feedback. I would prefer it if you did it in private. You are taking some of these conflict resolution strategies and applying them to yourself, as well as asking people what you would want.

Successful Conflict Resolution: Step Three

Figure 7. Conflict resolution steps.

Then you also look at the atmosphere, meaning that if I bring this up right now, it will change the atmosphere in this direction. If I am okay with changing the atmosphere of this, then I will go ahead and address it. If you determine the appropriate time to have this conversation with urgency, audience, and atmosphere, then your next step is implementing these ten strategies. You mentally role play. You ask permission. That is simply saying, "Hey, can I have a conversation with you about...." When I say a warning statement, it is not like you better prepare for what I will say. However, it is like, this is what the conversation is about. Giving them some context of what you want to bring up, ask for permission if it is an appropriate time to have the conversation—set expectations. It got heated the last time we had this conversation; it ran long. If we try to limit it to 10 minutes, we should keep our voices and tone in check. You are setting those expectations. Do not compete, but a partner. Returning to that definition of conflict resolution, it talks about being collaborative and coming to a compromise. It is not always about what you need when in conflict, but I am not competing. I am partnering with this person or this group to meet our objectives as best as possible. Be clear, concise, and thorough in your conversation. that is why it is good to mentally role play, know what you want, know what you need, and be able to state it without going on on on.

Addressing head-on, not head up. That means not avoiding confrontation, do not be passive, but be assertive, saying, I am not going to beat around the bush. However, I will be transparent in my communication, telling you what behavior I did not like, what I did not need, and what I would prefer going forward. Address your specific need. We often get caught up in, I know how I feel, I know I did not like it, but we do not know what to ask from that person, from your supervisor, like they are torturing you, you hate your job. You are going to leave because of your supervisor. Have you had a conversation asking them, can you talk to me in this tone? Can I not have many patients? You consistently assigned me to this schedule. Can we rotate?
Be clear on the behavior you are struggling with and what you need from the person. Use more facts than feelings to tell them. It is making me feel unheard and unsupported. Maybe 10-15% of your conversation is about your feelings, but you want to spend most of your time on what is happening. I feel that you do not support me. That is one thing, but the facts are that when I asked you for assistance these two times, you have not given it to me. That is a fact. When I asked you for more time to complete a project on this particular issue, you declined to give me more time each time. That is a fact. When you have these conversations, it is okay to say, "I feel unsupported."

I do not feel that this is a great team atmosphere, but you want to spend most of your time giving situations things that cannot be argued with because they are facts. Those are ten very specific strategies for helping you to navigate conversations and conflict. Much information, I want to say, none of this is groundbreaking. None of this is new deep research, but I promise you, these are strategies that are not being implemented daily in clinics, hospitals, and across the world. I think that this is twofold. Which of these strategies do I need to practice? Then it goes, which strategies are my coworkers or boss not implementing? Now that I see what I need specifically, will I have these conversations? Be able to articulate what you would prefer from your interactions. Conflict is natural because we move and live around people it is going to be unavoidable. We are going to have conflict, but conflict does not have to be looked at as something bad, it is going to, it is going to happen. These strategies can be used in any environment for sure.

Questions & Answers

What would you suggest for handling a coworker constantly telling everyone what they feel another coworker is doing wrong?

A coworker has appointed themselves as the boss or the person who will ensure that everyone knows the error of their ways. I would say this is a know-it-all coworker. We are going to give the person that title. The first thing I would do is, go back to handling conflict at the lowest level possible. That is important. being able to go to that coworker in a non-confrontational time, when they are not any audience, no one else around, asking them for permission, say, "Hey, can we have a conversation about 10 minutes before we each go home." Now you have carved out the time, no audience. Then you say, "I respect you. You are a very smart person." Even given specific examples, "When you helped me with that or this, it benefited my patient, thank you." That is called the sandwich method, where you start out positive, are not lying, and pick something that you appreciate that is relevant to the conversation. Then you say, There is one thing that would help me in our interactions. Now that is an I statement. You are not saying, I do not like when you do this or whatever, but you are putting it back on you. It would benefit me and help me to work better with you. You are putting these I statements if you would. You tell them clearly what you want. If you would sometimes reserve some of your feedback, because I feel that even though your feedback is often great, it seems to come a lot more often than I would prefer, that is being very direct. Oftentimes we do not have conversations because we are looking for the perfect non-offensive or non-confrontational way to have a conversation. Often, waiting on the perfect language or what will not happen because conversations can be awkward. Do not wait on how can I say this for it not to be awkward, how can I say this, not to necessarily upset her? She may be upset, not at how you said it, but at the information. Once you tell her what you appreciate, the behavior you do not like, and what you need, you put that other piece of bread back on it. I appreciate you listening. You have ended it and started with something positive, but you have been very clear on what you need. If that does not work, you have to go to your supervisor and say, "She is causing problems in the department being clear about what that looks like, can you speak with her about it?"

What do you do when you have got a colleague or anybody else that you are speaking with in trying to address use some of these strategies, but they are very confrontational and get very defensive. What do you do at that moment?

It goes back to knowing the resolution styles, is this person passive or aggressive? If you see that they are aggressive personalities, then you would make sure that number one, you handle it with no one else around, because if there are people around, they will get defensive. You also want to let them know that you respect their position and who they are because if they get that sense, they are not coming for me. You have kind of lowered their guards a little bit. Also, be clear on what you need. It will not take it away, but that helps to set a ripe environment to be more receptive. If you are interacting with a passive person, know they get defensive because they often do not state what they need. They feel that I am getting kind of walked on. Before you ask for behavior training from a passive person, give them the floor first, say, Hey, can we have a conversation? I wanted to know if there are any observations you have of me or anything you need from me that I can do better. Now you have given them this safety to can state what they need. Then you can say, "Great, I will work on that. This is how I am going to work on that. If you do not mind, can I give you some feedback? That helps, but it depends on which person you are dealing with. That is why it is important to know which category they fall into. Then you can approach it from that direction. What I want people to know is that this is not going to alleviate it. It will not eradicate it, but even if this helps incrementally in those situations and conversations, it will be more beneficial than not implementing these strategies. Do not go back into the unsolvable problems scenario.

Any advice on setting a good example to foster a better environment for communication?

Lots of suggestions. Number one, having a communication box. I know that sounds silly, but people want to be heard but do not want to be highlighted. Because of that, if you allow a suggestion box around your office, a work environment, people will use it. Also, asking people and giving them permission on the platform to give feedback. Something as general as, Hey, what did you all like about today? What happened at work today that you enjoyed? They may say, Hey, I like that we got the new Coke machine in the office, or I like that we moved. Give them the platform to say what they like and then say, I appreciate that feedback, but I would also love some opportunity areas. What are some things that we can do better as a department? What are some things that we can do better as a manager? Oftentimes putting people in groups to discuss and then positioning a spokesperson so that it is not coming from one person being highlighted. It is safer to speak in groups than in front of everyone. Email communication is good. Invite people once a week, I want everyone to send me opportunity areas and highlights of your experience. It goes back to creating a culture of that. It is not a one-time in-service. It is how we can strategically and intentionally create an atmosphere where we encourage communication daily. If you are the employee that feels that we do not have safe communication, it is going to your supervisor and HR asking for some of these specific things saying, Hey, I sat on a call. Some suggestions I want to bring is can we have some check-ins and implement them weekly or daily. Ask for what you need.

References

Doyle, A. (2021) “Top Soft Skills Employers Value with Examples." The Balance Careers. July 22, 2021. https://www.thebalancecareers.com/list-of-soft-skills-2063770

Goleman, D. (2008) Working with Emotional Intelligence. Bantam Doubleday Dell Publishing Group.

Maxwell, J. (1997) Becoming a Person of Influence. HarperCollins Leadership.