Received: 25 August 2022 | Accepted: 29 November 2022

DOI: 10.1002/jhm.13031

PERSPECTIVES IN HOSPITAL MEDICINE

Six steps to conflict resolution: Best practices for conflict

management in health care

Kierstin Kennedy MD, MSHA, FACP, SFHM1 | Teresa Cornelius MD, MPH1 |
Aziz Ansari DO2 | Jeffrey Ring PhD3 | Flora Kisuule MD, MPH4
1
Hospital Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA
2
Division of Hospital Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois, USA
3
Independent Practice, Los Angeles, California, USA
4
Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA

Correspondence: Kierstin Kennedy, MD, MSHA, FACP, SFHM, Hospital Medicine, University of Alabama School of Medicine, 508 Quarterback Tower, 619 19th St
South, QB 508, Birmingham, AL 35249‐5600, USA.
Email: kierstin@uabmc.edu; Twitter: @OhHeyDrKay

I NTR O D U C TI O N to be a negative experience. If handled skillfully, conflict can serve

Conflict is inherent in all interpersonal relationships as individuals
possess their own values, preferences, and cultural norms. Healthcare
systems and hospital medicine leaders are particularly susceptible to
conflict because individuals work on multidisciplinary teams under
1
stressful and high‐stakes conditions.
Consider the following leadership and clinical case illustrations:
As a hospital medicine leader, you are asked by the C‐suite to
provide more coverage with your current staffing levels. Post‐pandemic
finances are worrisome with nursing shortages and increased labor costs.
Patients need to be seen and your group is already being pushed to its
limits.
Alternatively, you are caring for a patient admitted with a diabetic
foot infection, requiring surgical debridement. His pain and insomnia
have been difficult to control, to the point that he began expressing
suicidal ideation. You have been notified by his nurse that he would like
to leave against medical advice because his symptoms aren't being
addressed.
How do you manage this conflict with your executive leaders or your
patient?
Healthcare providers and leaders tend to be averse to conflict
and often do not receive formal training in conflict management,
2,3
including at the executive level. Despite recent emphases on
communication and interpersonal skills as core competencies of
medical education, training in conflict management is rare.4–6
Unresolved conflict in the healthcare setting leads to burnout, job
dissatisfaction, and decreased engagement, all of which negatively
impact patient care and satisfaction.5,7 Although the word
“conflict” often carries a negative connotation, it does not have
to identify opportunities for improvement, spur innovation, and
create alignment toward common goals. While there are many
excellent resources available to navigate conflict,8–10 the time
needed for extensive reading or formal training can be prohibitive,
resulting in leaders remaining unexposed or insufficiently trained
for success. In this manuscript, we consolidated multiple sources
of behavioral leadership to create a stepwise application of
existing approaches tailored to the healthcare setting. Our intent
is to create a pathway, for leaders and teams, with guided steps
(Table 1).
STEP 1: CHECK Y OUR V ITALS
(AND THEIRS)
When conflict arises, we often frame the interaction as a battle of two
opposing viewpoints. This can lead to an emotionally charged state or
“fight or flight” mode in which the amygdala is activated, creating an
inherently defensive position. However, the goal of conflict is not to
battle but to come to a shared agreement consistent with the
organizational mission and values. Therefore, the first step to successful
conflict management is to understand and process your emotions so that
you do not become a barrier to successful collaboration. Begin by
leveraging self‐awareness, or as defined by Daniel Goleman in Emotional
Intelligence, “recognizing a feeling as it happens,”8 to determine your
emotional state and its drivers. For example, assess your feelings, body
language (arms crossed), and physiology (heart rate or breathing patterns)
in the moment. Labeling and processing the emotion allows you to better
control your reactions. Similarly, calming your physiology before speaking

360 | © 2022 Society of Hospital Medicine wileyonlinelibrary.com/journal/jhm J. Hosp. Med. 2023;18:360–363.

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KENNEDY ET AL. | 361

TABLE 1 Conflict management for leaders.

Purpose Clinical example Leadership example

Check vitals Calming your physiology before
speaking increases the ability to
contribute to the conversation in a
productive manner
Anticipating that this might be a difficult
conversation, you stop outside his
room to take some deep breaths so
that you can enter the conversation
calmly and without judgment.
You recognize that you are frustrated and
anxious about your ability to fulfill this
request. You decide not to respond
immediately to allow time to calm your
physiology and think through a
measured response.

Understand the Allows for focus on what is at stake
issue for both sides, what both parties
stand to gain, and perhaps how an
institution's shared mission and
vision (or shared goals of
improving patient well‐being) can
illuminate a path forward.
You calmly ask the patient to offer his
perspective. You seek more
information about how he would treat
his symptoms at home if he were to
leave.
Using reflective listening, you offer your
perspective on his safety at home.
Once in a calm state, you realize that the
request doesn't consider the current
state of your group. However, you also
understand that finances are limited
even with increased patient volumes.

Be vulnerable Entering a high‐stakes conversation
with humility and vulnerability can
disarm the other party and
decrease defensiveness
You express empathy, acknowledging
how frustrating his experience
has been.
You acknowledge that you don't fully
understand the pressures they face and
ask that they provide insight. You also
admit that, while you want to be
accommodating, you are struggling with
group morale and worry about retention
if asked to cover extra shifts.

Create alignment Advances the goal of moving both
parties from defensiveness to
collaboration
You reiterate your common goal of
improved symptom control and
ultimately treatment of his infection.
In discussing his suicidal ideations, he
identifies his grandchildren as a major
reason to continue living. You align
treatment of his infection with the
goal of quantity and quality of time
with them.
Toward the goals of patient‐centered care,
quality, and safety, you decide on a
shared mission to creatively resource
the team to meet increased demand
with fiscal stewardship and retention as
priorities.

Define the new Provides the opportunity to co‐create
path forward your working (or patient)
relationship and agree on the
problem‐solving approach for the
future
He stays for continued treatment of his After reaching a mutual decision, both
infection with some mutually agreed parties agree that future problem‐
upon changes to his medication solving should be collaborative and with
regimen. Together you agree that consideration for burnout.
future areas of dissatisfaction should
be discussed openly before
considering leaving.

Have an exit If emotional conditions are not
strategy conducive for collaboration it is
better to exit the conversation
(but always with a clear plan to
resume the discussion later)
Instead of the interaction above, the
patient begins yelling at you
immediately upon entering the room.
Despite attempts to diffuse the
situation, he is not in a state to have a
productive conversation, and you feel
a rising anger. You clearly state your
desire to help but that this is not the
right time to have this conversation.
You let him know that you are going
to excuse yourself but that you will
return in 1 h to discuss how you can
help him.
Instead of the interaction above, the
executive is insistent, and tensions
continue to run high. You remind them
of your shared goal for patient safety
and institutional success and ask to
pause the conversation to allow both
parties time to think of ways to work
together toward your goal. You ask to
meet again in a week to share thoughts.

increases the ability to contribute to the conversation in a productive
manner.
It is also important to assess the emotional state of your counterpart
through these same verbal and nonverbal cues. This assessment can help
determine if the person is in a state that will permit active listening and
collaboration. If emotions are running high on either side, an appropriate
response may be to postpone the conversation. If the conversation
cannot be delayed, it can be helpful to practice mindfulness exercises
such as deep breathing, which reduce the feeling of stress at the moment
by reducing the “fight or flight” response.11 Another option is to mentally
repeat positive affirmations of your intentions, which can help project
positivity in your words and behavior.

362 | CONFLICT MANAGEMENT IN HEALTH CARE
S T E P 2 : U ND E R S T A N D T HE I S S UE
Controlling your physiology (Step 1) is critical before moving on to
Step 2 because high emotion can inhibit critical thinking and make it
difficult to gain clarity on the issue. Theorists argue that conflict
arises from unmet human needs and one's drive to have those needs
12
addressed on an individual or group level. In a calm state, you are
well‐poised to identify the unmet need that may be driving the
conflict. This sharpened perspective allows for focus on what is at
stake for both sides, what both parties stand to gain, and perhaps
how an institution's shared mission and vision can illuminate a path
forward. One may find, after calm reflection and ensuring that an
inner discomfort with facing conflict is not driving the decision, that
the other party is not the source of the conflict, or that the issue is
not significant enough to necessitate a conversation. If a conversa-
tion is deemed necessary, however, the ability to concisely articulate
the issue clearly, in a one‐sentence statement, can indicate adequate
clarity and preparation for discussion.
STEP 3: BE VULNERABLE
Once you have clarity on the issue and have determined that it merits
a conversation, it is important to engage with genuine vulnerability as
established in Patrick Lencioni's “The Five Dysfunctions of a Team: A
Leadership Fable.”10 Imagine being in a grocery store and someone
running into you with their shopping cart. Your initial reaction may be
anger, but when you turn around, you see that the individual is
unstable on their feet and leaning onto the shopping cart to avoid
falling. This image may cause you to react differently than initially
planned because the person is in a vulnerable state. Similarly,
entering a high‐stakes conversation with humility and vulnerability
can disarm the other party and decrease defensiveness.
One approach is to admit what you do not know and ask the
other person to share their perspective. Seeing an issue from the
other party's point of view can set the foundation for a productive
discussion and increase collaboration as well as emotional connec-
tion.13 Vulnerability provides space for your counterpart to be heard,
conveying humanity, and is a prime factor in building trust in
10
relationships. It also allows you to better understand their needs,
which further humanizes the person and the issues. Shared
vulnerability builds a bridge to the next step in the framework,
creating alignment.
STEP 4: CREA TE ALIGNMENT
You have calmly stated what you believe is the issue at hand, you've
admitted what you don't know, and you've listened to understand
what matters most to them. Now you can use that understanding to
create alignment. This step is critical because it advances the goal of
moving both parties from defensiveness to collaboration. As
established in “Getting to Yes: Negotiating Agreement Without
15535606, 2023, 4, Downloaded from https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.13031 by Maria Jose Conejero Muller - Cochrane Chile , Wiley Online Library on [04/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Giving In.”9 identifying shared alignment shifts a conflict from “you
versus me” to “us together on a shared mission.” Mission alignment
fosters more collaboration and creates an enhanced environment for
problem‐solving, moving from attempting to best the other party to
collectively besting the issue. This collaboration is where both parties
have the potential for positive rewards.
S T E P 5 : D E F I N E T H E N E W P A T H F O R W A RD
Alignment with a shared goal to solve a problem invites collaboration
toward a new path forward. In this step, you can collectively
brainstorm on how to resolve the issue at hand and prevent a
recurrence, which may involve process changes or increased
awareness of shared commitments. This step also provides the
opportunity to co‐create your working relationship and agree on the
problem‐solving approach for the future.14 Reflecting together on
successful navigation through conflict provides a strong foundation
for future collaboration and conflict navigation skill‐building.
STEP 6: HAVE AN E XIT STRA TEGY
Conflict can be difficult and complex requiring an iterative and
nonlinear revisiting of the six steps. It is not uncommon for the
conversation to start positively, with both parties engaged, only to be
thrown back into “fight or flight.” When this happens, you must have
a prepared exit strategy.
First, attempt to walk back through the initial steps—calm your
physiology, and if possible, make your counterpart aware of rising
tensions so that they can calm their own. It may be appropriate to ask
permission to continue or to allow them to pause the conversation
and revisit the discussion at a more productive time. Remind them of
the problem you've defined and of your shared alignment as
teammates working together. If revisiting the steps is unsuccessful
and collaboration becomes elusive, it is better to exit the conversa-
tion. However, there should always be a clear plan to resume the
discussion later as unresolved conflict has the potential to negatively
impact work performance.15 When exiting the conversation, empha-
size your commitment to collaborative problem‐solving. That willing-
ness to return to the topic reflects the importance of overcoming
conflict as a team with a shared mission.
CONCLUSION
This framework allows for a systematic and streamlined approach to
conflict management and can be applied in any venue ranging from
interpersonal relationships, managing patients or colleagues, and medical
center interactions with senior leaders. Controlling our emotions,
leveraging vulnerability, and having a clear understanding of the issues
sets the stage for mission‐driven solutions. This approach fosters true
collaboration ultimately allowing us to better serve our patients.

KENNEDY ET AL.
CO NFL I CT OF INTERES T S T ATEME NT
The authors declare no conflict of interest.
ORCID
Kierstin Kennedy https://orcid.org/0000-0001-8076-741X
TWITTER
Kierstin Kennedy @OhHeyDrKay
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How to cite this article: Kennedy K, Cornelius T, Ansari A,
Ring J, Kisuule F. Six steps to conflict resolution: Best
practices for conflict management in health care. J Hosp Med.
2023;18:360‐363. doi:10.1002/jhm.13031