Conflict Management in the Emergency Department: The Chain of Encounters

January 26, 2022

One of the first things we did in designing Conflict Management and Patient Experience training for the ED was we wanted to allow the staff to see that there are common patterns in confrontations, which reliably repeat themselves and can therefore be reliably prepared for. 

It’s so important for staff to know about what we call the “chain of encounters”. 

For example, a person coming into the emergency department at first will encounter random hospital staff walking around, going here and there, (or smoking outside the building!) but not connected with or related to the emergency department at all.  They’ll have to walk past them in order to find their way to the emergency department. 

In some cases there’ll be gatekeeper staff, such as security officers or reception staff who they will encounter who will direct them to the emergency department and meet the administrators there who will direct them to sit and wait before they’re called for triaging. Once triaged, they’ll be shown inside to the emergency bays and meet a series of nurses and then eventually meet a doctor, and then another series of interactions between nurses and doctors.

We visualize this as a chain of positive encounters that the person should have through their journey in the ED. What we don’t want want to happen is for any positive link to be broken in this chain of encounters – what my friend and colleague, Gary Klugiwicz refers to as ‘starting the negative dance’ of escalating negative encounters. 

Our friend and veteran hospital adviser Joe Ashley talks about upholding the social contract in that we have to treat each person that we meet with dignity by showing them respect. It becomes really important for us to consistently do that across the staff team, so as not to inadvertently begin a process which ends in a complaint or a poor patient satisfaction score

It was so interesting to explore triggers with the staff – things that upset, frustrate and grind their gears at work. 

Sometimes it felt like the staff were blaming patients and visitors for many of the things that the staff don’t enjoy at work. And I’m sure that if we got a group of patients and visitors in a room, they would be blaming the nurses and doctors for all the things that are wrong in the emergency department, somewhere between these two islands of belief, we needed to create a bridge.

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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