Daniel A. Bobrow, MBA
President, American Dental Company

Coping with Conflict
A layperson's guide to resolving conflict in the dental offiee...and beyond.

Conflict is inevitable. As long as people possess the capacity for independent thinking, there will always be differences of opinion. Conflict can be difficult to resolve, but there are resolution techniques that, when applied, can make a major difference in your dental practice. Two of the most important conflict resolution techniques are the ability to listen and the willingness to respect other people's points of view. However, it is also important to recognize additional factors that offer the greatest likelihood of a positive outcome from the conflict. These factors are:

Environment
The setting in which mediation or potential conflict resolution occurs can be critical to the outcome. Is the location quiet enough? Is there privacy? Ideally, this type of meeting should occur outside of the office so that no one is distracted.

Balance of Power
Any meetings attempting to resolve a dispute should be structured in a way that both parties perceive they are, for the purpose of the meeting, equal and that both will be heard and respected. If either party perceives they have lost control of the situation, it will be infinitely more difficult to reach an agreement. And even if an agreement is eventually reached, it is less likely to last.

Impartiality/Neutrality
When you become aware of a conflict between two members of your team, it is vital that you appear neutral with respect to the issues. Unfortunately, this is often easier said than done. One thing that may help is to remember that while on the surface an individual's position may seem unreasonable or incomprehensible, there are often underlying causes that are responsible for that person’s behavior. Only in an environment of trust and through active listening can you hope to truly get at the heart of the matter.

In the case that you are a party to the conflict, your impartiality will naturally be in question. Even if you believe that you can remain impartial, remember that it is the perception of the person with whom you have a dispute that must be considered. If it is not feasible to have (or you are not comfortable having) another party preside over the mediation, it is still possible to assume a somewhat neutral stance. To do so, you should not attempt to have a discussion about a situation when you are emotionally involved. Take a breather first, then invite the team member to meet with you, preferably outside of the office. I suggest the following tone to be used when approaching your unhappy team member:

"Mary, I want to let you know I'm concerned because something seems to be bothering you. If you're comfortable sharing it with me, I'll be happy to listen and see what we can do about it."

Depending on her history with the practice, Mary will be more or less open to expressing herself. Most people will respond well to a request phrased in such an open-ended manner. Once the concern is expressed, options can be explored as to how best to address anxieties.

Following are skills that, once mastered, can greatly assist you in managing and resolving conflict in your office:
1. Active Listening: Show a sincere desire to know what the person is saying through your body language.
2. Mirroring: Restate what is said to you to confirm your understanding. Care should be taken to "neutralize" statements by eliminating or changing words that are emotionally charged or are accusatory. Mirroring also refers to assuming the physical posture of the person with whom you are speaking. This is a basic example of what has been termed Neuro-Linguistic Programming (NLP).
3. Pacing: Another example of NLP, pacing means getting into the rhythm of a person's speech pattern, then slowing it down. The goal is to calm the person down so that a more productive conversation may take place.
4. BATNA: Best Alternative to a Negotiated Agreement. This involves asking the person to consider what the best possible outcome will be if a mutually agreeable settlement cannot be reached. An example is, "Joseph, I know you don't like making reactivation calls in the evening but you’re the only one on our staff who is capable of doing so. And you remember the mess we were in before we brought you on. What do you think will happen if we just stop doing this?" (This sentence also shows another technique called stroking - see #8.)
5. Reality Test: Similar to BATNA, the reality test attempts to get the person to see that his or her proposed solution is unrealistic, or at least not optimum.
6. Blame Yourself: A great way to neutralize tension during the mediation session is for the mediator to take responsibility for any misunderstandings or uncomfortable situations that may arise. For example, if one person grows impatient while the other is speaking, you might say, "I'm sorry for not giving you an opportunity to speak, Sam. Just as soon as Bill finishes, you'll have your chance."
7. Ask "Harmless" Questions: Ask "leading" questions when the parties seem to have reached an impasse. Ask "safe" questions to get the parties talking again. For instance, say, "By the way, did I remember to thank you both for helping me juggle those four patients this morning? I owe you for that one!"
8. Stroking: During the mediation, let both parties know they're doing a great job and that you really appreciate their willingness to sit down and talk things over.

The main goal of the above techniques is to help people see for themselves why conflict resolution is in everyone’s interest, including their own. If people feel they are being manipulated, or that a solution is being forced upon them, the parties involved will be less likely to adhere to the proposed agreement. Remember that agreement is not the sole criterion of a successful resolution.

Another way to prevent conflict is to create an environment where it is less likely to arise and then implement systems and training to prevent these situations from ever occurring. Several examples include:
1. Personality conflicts between staff members: Implement a compatibility assessment into your employee screening procedure, as well as for current employees. This can help you understand who may work better with whom.
2. Patients’ complaints about having to wait: Implement a policy of having a staff member notify patients in advance if you are running late. Promote a "no waiting policy" as part of your mission statement or declaration of principles. When the occasional complaint does occur, your office staff should be prepared to use disarming statements such as, "The doctor asked me to apologize to you for not being able to see you. He is busy with a procedure that has proven more involved than we anticipated. He assures me he will do everything he can to see you as soon as possible. Is that acceptable to you Mr. Jones?" Doing this before a complaint arises is a great way to show sincere concern for your patients and respect for their time.
3. Staff member refusing to implement changes or grow with the practice: Implement active listening, BATNA and reality testing to get at the true source of this member's unwillingness to work with the team. In many cases, you may discover something more fundamental going on that has far reaching implications for the practice.

One final way of preventing conflict is to continually educate and motivate staff members to recognize the value of the work they do, as well as the value of the practice to its patients and the community.

Remember, an agreement needs to last, especially if it is between people who must continue to work together. Listening and respecting other's viewpoints is the beginning of resolving conflicts and achieving a positive outcome amongst all parties.