This is the sixth in a series of columns on EMS leadership. Each month, Dr. Breaux will cover leadership applications such as behavioral, managerial, situational, path-goal, leader-member exchange, full-range transformational and transactional leadership. Other areas like conflict management, effective communications and organization structure will also be addressed.
Ralph, who is director of Shade Tree County EMS, has a lot of conflict regarding his crews, and especially their interfacing with hospital staff at the local emergency room. He has had to reschedule crews because certain individuals don't get along with their fellow crew members, which has been a problem since he took over this EMS organization two years ago. Additionally, his crews are increasingly getting into heated arguments with emergency room staff. He has been putting this crisis off, but things are getting worse and he must address these issues now.
Ralph recently met with a professor at a local university to ask for suggestions on how to address these issues. The professor told him about a book titled Managing Conflict in Organizations by Dr. Afzalur Rahim, who defines conflict as an interactive process manifested in incompatibility, disagreement or dissonance within or between social entities.1 Dr. Rahim recommends the following preventative conflict management processes:
- Separate anger from situations
- Attack problems, not persons
- Focus on issues, not your position on issues
- Develop common agreement
- Communicate feelings assertively, not aggressively
- Focus on common interests and agreement
- Accept and respect individual opinions
- Avoid jumping to conclusions
- Listen without interrupting
- Ask for clarification.
Dr. Rahim also recommends the following conflict management actions:
- Be impartial and strive to be fair
- Clarify the problem and focus
- Restate what is said
- Confirm the accuracy of the re-statement and give opportunity for corrections or clarifications
- Identify mutual needs or goals
- Encourage sincere and practical solutions
- Actively check for agreement to solutions
- If no agreement, analyze alternative solutions
- Review to ensure accepted solution is working and there is agreement.
Ralph is using both the preventative and action checklist to resolve conflicts, and the operational environment is becoming more calm. He met with individual crews to identify and resolve conflicts, as well as to identify problem crew members. Ralph then met with the individual problem crew members using the same aforementioned checklist and has experienced conflict resolution with all but one or two crew members, with whom he will meet again to better understand the situations and possibly resolve further conflict.
Ralph also met with emergency department leadership to ascertain what issues they were having with his crews. He shared that information with the ambulance crews and established solutions and agreements on how to handle conflict with ED staff. He also shared the solutions and agreements with ED leadership, who shared the information with their staff. There has been significant improvement in building professional relationships between ambulance crews and hospital staff that has in turn significantly reduced conflict to one misunderstanding over a three-month period, which was resolved without negative personal feelings between involved ambulance and hospital staff. This does not mean that Ralph does not need to continually monitor and manage conflict in his organization. Conflict management will always be a top priority for Ralph and his crew chiefs; however, the operational environment has improved significantly, and the EMS crews are providing much improved health care for their patients due to less conflict in the operational environment.