I worked as a Neurosurgical Step-Down nurse for many years. We typically received our patients from the ED, OR, or Neuro ICU. When our patients were stable, we transferred them to the Neuro MedSurg Department. All one big happy family – the Neuro ICU, Neuro Step-Down, and Neuro MedSurg – right? Wrong! Interdepartmental conflicts occurred every day. Conflicts such as, transferring patients (the rooms not ready; the nurse can’t take report now), dumping (orders not being implemented and left for the next department to do; issues with family members not addressed, etc.), and condescension, intimidation, and incivility (ICU nurses acting like they’re smarter than the Step-Down nurses; Step-Down nurses acting like they’re smarter than the MedSurg nurses, and enough eye-rolls and ‘tick-sighs’ to last a century!).
Why? Aren’t we all on the same team caring for the same patients? Yet we treat our colleagues (yes, they are professional colleagues) with disdain. It’s an age-old problem that we talk about within our own departments, but rarely do we openly talk about it as colleagues with an intention to resolve it.
Why is this a problem?
Healthcare can be a stress filled environment for patients, families, and healthcare professionals. Conflicts typically arise due to interpersonal relationships, limited resources, change, organizational structures, roles not clearly defined, professional values, and beliefs. Although there is not much data on “interdepartmental conflict”, studies have shown the effects of conflict on employees, patients, and companies:
- Conflict costs U.S. companies approximately $359 billion per year which equates to 2.8 hours per week on conflict.
- Ineffective interdepartmental communication results in 11% of preventable adverse patient safety outcomes.
- Conflict impedes organizational performance impacting the quality of patient care, nurse satisfaction, individual well-being, and turnover.
One of the leaders in our Department Culture Change consulting program, successfully transformed the culture in her department. They went from constant turnover, daily complaints, and negativity to improved camaraderie, teamwork, and the highest retention rate in the hospital. Time to celebrate – right?
Well, while they established a healthy, professional, and respectful culture within their department, they did not extend that respect and professionalism outside of their department. Interdepartmental conflicts were common, and they started getting a reputation for being fake. After all, they talked-the-talk but didn’t walk-the-walk outside of their department.
If they got “testy” with a nurse from a different department, they were mocked and criticized, “Oh. Not so respectful now! So much for being a role model for a healthy workforce.”
The leader was upset and reached out to me asking what she should do. We discussed how to implement a few short-term strategies to immediately shut down the complaints. Then we discussed long term strategies that would hardwire and spread healthy workforce best practices beyond her department, especially to her “sister” departments.
Strategies to reduce interdepartmental conflict and build camaraderie among healthcare teams:
Establish common ground
When disagreements happen, and they do, even among friends, always start the conversation by identifying your common ground.
Think about that for a moment.
Two employees who don’t get along and argue all the time. Find their common ground – “What can you both agree to first?” (We both care about the patient… we both take pride in our work. we both…)
Do the same between departments.
All three departments cared deeply for our neuro patients… we all wanted them to have the very best recovery…we all wanted them to keep regaining function…The Neuro ICU, Step-Down, and MedSurg departments all had the same goals.
I suggested to this leader that she establish common ground with the other departments. Meet with the leaders from her “sister” departments and start the conversation by saying, “I know we all want to same thing….” Encourage their teams to adopt the same mindset, especially when conflicts arise. To take a step back and say, “I know this is frustrating/difficult, etc. We both want the same thing…”. Doing so can help reset and rebuild the relationships.
START by identifying common ground. It shows that even when there are issues, they are more alike than they realize.
Go first
Before you can expect others to treat your team in a more civil way and be open to receiving feedback about their team members, you must be willing to go first.
I suggested to this leader that she reach out to the department manager she wanted to resolve the interdepartmental conflicts with and have this conversation:
“I’d like to resolve the interdepartmental conflicts we’ve had and improve the relationship my team has with your team. If your team members ever experience negative interactions with anyone from my team, please tell me. I promise 2 things: I promise I’ll be open to your feedback, and I promise to do the same for you.”
First, you must give others permission to give you negative feedback before you share your comments.
Make it safe for others to give you feedback – good, bad, or ugly.
Clean your house first
Be willing to address your team’s behaviors before you expect anyone else to address theirs. Like they say, “clean your house first.”
Set the expectation of professionalism, respect, consideration, and generosity within your department – and the same behaviors must be extended to colleagues in other departments too. Communicate that any incidents of rudeness, incivility, or meanness will immediately be addressed. You expect each team member to be the role models for civility within your department AND with other departments too.
Build a relationship with them
Find opportunities to build relationships with team members from other departments by getting to know each of them. Find reasons to recognize and celebrate everyone. It’s far more difficult to be mean to someone if you know a little something about them. You can do this by:
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- Hosting a tea or breakfast and inviting the other department’s team members to join your team.
- Getting to know the other team members first names and learning something about them you have in common (pets, favorite foods, family, etc.).
- Sending random treats like a basket of “Be Kind” bars or Peppermint Patties with a note “You’re worth a Mint!”.
The key is to be proactive in building interdepartmental camaraderie. As a result, you will find a decrease in daily conflict complaints.
Interdepartmental conflicts are common and are typically lumped into the mantra, “Well, that’s just the way it is here.” But it doesn’t have to be that way. By adopting just a few simple strategies, you can create a healthy work environment within your department and extend that same “health” to others.
That’s how we make healthcare a better place to work!
