June 1998 Bulletin

Dealing with a difficult partner

"Conflict resolution is designed to take disparate ideas, examine them, dissect them and find a common ground..."

How to respond to anger, resolve conflict, and establish "interest-based" negotiation

By Barry C. Dorn, MD

Partnerships in medicine are very similar to those in marriage. Each requires commitment, caring and understanding. In order to be successful, professional and personal partnerships need to be greater than the sum of their individual component. Achieving success requires communication. Here are some key elements to consider when resolving any conflicts that arise in your partnerships:

Listening is one of the most effective communications skills to master. This means accepting without judgment the feelings, thoughts and reactions of your partner. Acknowledging those feelings, even though they may be uncomfortably directed toward you, is a skill you can master with some practice.

Anger is probably one of the most difficult emotions for us to handle. Anger within ourselves and others and especially anger directed toward us requires a degree of self-control and the willingness to confront the uncomfortable. When things are said in anger, we generally react to the anger rather than to the message. Usually, we respond to the attack by counterattacking, defending ourselves or becoming passive. There are more effective ways to get beyond anger and to confront the issue that triggered it.

If your partner expresses anger toward you, acknowledge it. It may be misplaced or misdirected, but the power of this emotion needs to be recognized before either of you can move on and resolve your conflict. Say to your partner, "I hear your anger," or "I know that you are angry with me" or "You are feeling very angry." These words may sound simplistic, but they are the first steps in conflict resolutions. Deal openly with the emotions. If an apology is necessary, apologize. If you believe the anger is misplaced, tell your partner that you hear him, but you are not sure why that anger is directed toward you at this particular time. You want to resolve the misunderstanding and you would appreciate his telling you openly what he is feeling and how you can work it out together.

Another way to diffuse a difficult situation is to designate a time when you can sit together, lay all the options out and then prioritize them. When we are angry, we tend to assign the same weight to our thoughts and feelings. It is difficult to make an informed decision about the important things as opposed to the unimportant things unless we consciously decide which to confront first.

Conflict resolution is designed to take disparate ideas, examine them, dissect them and find a common ground on which the issues can be discussed and resolution reached that is acceptable and fair to each party. If you say, "I know you think you deserve Fridays off, but I disagree," you have not set the stage for conflict resolution. A more effective way to deliver this message is, "I understand you want Fridays off and the company is financially unable to honor your request now." You have heard your partner's request and validated it. You have explained why your action has to be different. The exchange is an example of voiding the pitfall of using the word "but" in conflict resolution; "but" negates a person's feelings or beliefs. The use of "and" recognizes and validates the person's feelings and allows you to express your viewpoint without diminishing that of your partner.

We each tend to view a problem through our own spectrum. Let's say your practice is located in a seaside town that is busiest in the summer. A young partner with young children in school will have different needs than those of an older partner whose nest is empty. To the younger partner, the summer offers special time with his family. To the older one, the summer offers greater opportunity to build the practice as well as his pension and profit-sharing plan. The older partner resents the younger partner's insistence on summer vacation. Resolving the vacation time issue means dealing with each participant's needs and desires in the context of successful practice management.

Conflict avoidance is a common practice when people ignore, rather than confront the uncomfortable. Conflict can lead to anger if both parties are unwilling to face each other and discuss it. Conflict must be expressed in order to be resolved. The way we put the conflict on the table makes all the difference. For instance, if we say, "We differ in this regard," the conflict is put forward, there is no repressed anger and the conflict can be solved. The conflict must be expressed before it eats at the individuals involvedóotherwise it cannot be resolved.

Everyone tends to look at a problem in a specific way. First, they ask, "What is the problem?" and "What process will we go through to resolve this problem?" People bring certain fears and vulnerabilities to the table as well as certain psychological needs. If you are willing to address all of these issuesóthe partner's fears, vulnerabilities and psychological needs, as well as letting everyone have a say in the processóframing the issue usually becomes much easier.

Negotiation in our frame of reference is called "interest-based" negotiation. It's not a "going to the table to see what you can get," but rather a "going to the table to see how you can solve the problems that exist." Negotiation is a "give and a get" and if people go to the table with the idea of giving something and they get something in return, they're more willing to go to the table again and again. We call this type of person a "creator" as opposed to a "claimer." A claimer is a person who goes to the table always trying to get something back. But if you can teach both people to be "creators," they will go back to the table looking to give something. Thus, the negotiation is far more profitable for them both.

When people work together for a long time, it's very helpful for them to have a clear understanding of all the parties involved. In other words, you should know yourself as well as you know the other parties. When you're involved in a negotiation with a partner, you have to know whether you're dealing with the partner or with his or her spouse or significant other, the family background or a certain prejudice the partner may have. You need to be clear on what each person brings to the table as well as what you bring to the table.

Issues of age and gender are important in this rapidly changing environment of managed care. Many older partners or those over age 50 tend to look at managed care as an evil empire that is destroying their lives. Many younger people have grown up with managed care as something they've grown up with and are very comfortable with it. Often, there are pros and cons of how you deal with the organizations with each partner's different viewpoints. Yet, partners must be on the same wavelength when dealing with an outside third party.

Another issue is gender. When I graduated medical school, the vast majority of positions were male. Today, approximately 50 percent of the freshman class at Harvard and at Tufts University are female. This brings a whole new dimension to the health care delivery system. Women often expect to balance their professional health care lives with family life and child-rearing. All of these things can impact a partnership and should be treated openly and honestly.

The point that I often make with most people is that in any negotiation in a partnership, if the negotiation meets the test of fairness to all parties involved, it will certainly meet the test of time.

Barry C. Dorn, MD, an orthopaedic surgeon, is associate director of the Program for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health.


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