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January 5, 2022

Conflict Management in the Emergency Department: Managing Expectations

“I sat with a doctor in the emergency department that night. She told me how the records that she’s looking at before she goes to see the patients sometimes show interactions with the patient that happened earlier in the day at the clinic where they first presented themselves. 

The doctor turns to me, she says, “for example, this patient is already upset. She’s had late lab reports. She’s been waiting and waiting.” 

She turned to one of the nurses. “I need a per-minute estimate of lab results, so I can tell her when they are coming exactly”

I suggested that she should add five minutes to that estimate, so that she can be sure to meet expectations, just in case people on the other side of the lab report are delayed. 

“This is a tough crowd”, she says, “impatient and angry!”.  I make sure to explain everything using baby language. I watch my body language. I watch my tone of voice, and I make sure to give them lots of information to increase certainty.”

 Later on, I would see this doctor being spontaneously hugged by the wife of a man that had been brought in with chest pains. I could see that the doctor listening to her and explaining calmly what the processes would be to find out what was wrong with the man and how they would treat him, and that everything was going to be all right. That he was in the best place now to keep him safe and get him well.  It was having a visible effect on the woman’s level of stress, anxiety, and concern

Children in the emergency department. I learned get lollipops when they’re compliant. I randomly thought, wow, we give lollipops to the children for their patience, forbearance and compliance with our requests. What is it that we offer to the adults when they do what we’ve asked them to do the difficult things that we ask them to do in the emergency department?

A curtain moves aside. A woman pops her head out from inside the cubicle and says, “er…nurse….we’ve been waiting for a long time”. This is a request for attention. People  – worried, scared, and anxious in the emergency department – crave attention. 

I ask the doctor about some of the complaints that I’ve been able to see on their system particularly about people not getting their test results and not understanding the processes. 

“I use a closed loop communication”, the doctor says, “I ask the patient to repeat back to me what they understood about my instructions with respect to test results and next steps in their care, et cetera. I make sure that they understand and before they leave. And that way I think they’re prepared for any waiting or any questions they need to ask later on.  Baby language – as simple as I can make it”

The doctor tells me that whenever there’s an aggressive or upset patient in the department, her colleagues call for her, “because I know how to do it”, she says, “I learned how to do it in my training”. 

It turned out that this conflict expert, to whom all her colleagues turn to for interacting with patients who are already escalated, had already had training, and that I was the person who had trained her, some 8 years previously at another hospital in Dubai!  

When we realised this, we laughed at the smallness of the world, and I reflected on the power of training interventions in conflict management.

Dynamis provides a comprehensive conflict management training programme which spans the whole spectrum of encounters in a hospital environment.  In this series of posts, our Director of Training reflects on key ideas in addressing conflict in the hospital.

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Gerard O'Dea is the Director of Training for Dynamis. Training Advisor, Speaker, Author and Expert Witness on Personal Safety, Conflict Management and Physical Interventions, he is the European Advisor for Vistelar Conflict Management, a global programme focussing on the spectrum of human conflict.

Gerard O'Dea

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