Conflict Prevention, Conflict Mitigation, and Manifestations of Conflict During Emergency Department Consultations

ObjectivesThe objective was to determine the causes of and mitigating factors for conflict between emergency physicians and other colleagues during consultations. MethodsFrom March to September 2010, a total of 61 physicians (31 residents and 30 attendings from emergency medicine [EM], internal medicine, and general surgery) were interviewed about how junior learners should be taught about emergency department (ED) consultations. During these interviews, they were asked if and how conflict manifests during the ED consultation process. Two investigators reviewed the transcripts independently to generate themes related to conflict until saturation was reached. Disagreements were resolved by consensus. The trustworthiness of the analysis was ensured by generating an audit trail, which was subsequently audited by an investigator not involved with the initial analysis. This analysis was compared to previously proposed models of trust and conflict from the sociology and business literature. ResultsAll participants recalled some manifestation of conflict. There were 12 negative conflict-producing themes and 10 protective conflict-mitigating themes. When comparing these themes to a previously developed model of the domains of trust, each theme mapped to domains of the model. ConclusionsConflict affects the ED consultation process. Areas that lead to conflict are identified that map to previous models of trust and conflict. This work extends the current understanding about intradisciplinary conflict in the clinical realm. These new findings may improve the understanding of the nature of conflicts that occur and form the foundation for interventions that may decrease conflict during ED consultations. Resumen ObjetivosDeterminar las causas y los factores atenuantes para los conflictos entre los urgenciologos y otros colegas durante una interconsulta. MetodologiaSe entrevistaron 61 medicos (31 residentes y 30 adjuntos de Medicina de Urgencias y Emergencias, Medicina Interna y Cirugia General) de marzo a septiembre de 2010, y se les pregunto sobre como deberian los estudiantes ser formados sobre las interconsultas del servicio de urgencias (SU). Durante estas entrevistas, se les pregunto si existe y como se manifiesta el conflicto durante el proceso de interconsulta en el SU. Dos investigadores revisaron las transcripciones de forma independiente y generaron temas relacionados con el conflicto hasta que se alcanzo la saturacion. Los desacuerdos se resolvieron mediante un consenso. La confianza del analisis se aseguro mediante la generacion de una auditoria, que se audito posteriormente por un investigador no incluido en el analisis inicial. Este analisis se comparo con modelos de confianza y conflicto propuestos previamente en la literatura de las areas de negocios y de sociologia. ResultadosTodos los participantes recordaron alguna manifestacion de conflicto. Hubo 12 temas negativos que producian conflictos y 10 temas que atenuaban conflictos. Cuando se compararon estos temas con un modelo previamente desarrollado de dominios de confianza, se mapeo cada tema para los dominios del modelo. ConclusionesEl conflicto impacta en el proceso de interconsulta del SU. Las areas que conducen al conflicto se identifican al mapear los modelos previos de confianza y conflictos. Este trabajo amplia el entendimiento actual sobre los conflictos intradisciplinarios en el area clinica. Estos nuevos hallazgos pueden mejorar el entendimiento de la naturaleza de los conflictos que ocurren y la forma de crear intervenciones que pueden disminuir los conflictos durante las interconsultas en el SU.