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How do you deal with conflict in practice?

Here is the final instalment of my three-part conflict blog. I have covered the causes of conflicts in primary care, how these can be prevented, and now we are on to the meaty part; what happens when conflict isn’t avoided and we have people ‘winning’ ‘suing’ and ‘proving’ themselves right?

Clare Sieber
Clare Sieber

First, we must remind ourselves that these conflicts do happen, and they are sometimes unavoidable or inevitable, instead of dwelling in the ‘could things have gone differently?’ stage, it’s time to take action.

If this is a conflict at your workplace that doesn’t directly involve you, you could intervene if you feel comfortable to do so. At the heart of all conflicts are people that don’t feel heard nor understood; listening is the best thing anyone can bring to the table.

There’s lots and lots of listening to do. Having the chance to be heard, talk about how something made us feel and how it affected us, can do wonders for simply ‘moving on’. Sometimes, once someone has been truly heard, even by third party, their positions soften, they start talking about moving on and drawing a line in the sand.

In mediation theory there is something called the ‘PIN model’ – standing for positions, interests, and needs. Imagine a person in a conflict is an iceberg. The tip of the iceberg – the bit that we see – is their position: ‘I’m right, they’re wrong’, ‘I’m going to resign and take this is to a tribunal’, ‘They owe me £100,000’. What is driving their position however is how they are feeling, which is related to their interests and needs. That person will want to feel respected, safe, fed, warm and will probably have dependents to think of, a mortgage to pay, and a reputation to protect.

Understanding these interests and needs are the key to resolving a conflict, as they unlock the real ‘whys’ and open opportunities for resolving the issues; I am yet to mediate in a conflict where there isn’t some common ground between the parties once all of their icebergs have been explored.

If you do decide to step in to help, do look after yourselves. There are two things to watch out for in particular:

1) Don’t ‘fix’ it. People in conflict are desperately looking for someone to resolve it for them, or to come in and ‘make a decision’ for example. Avoid this; conflicts rarely go away when someone else tries to resolve them (even a judge); the people in the conflict need to own it and work on it themselves, albeit with the help of others.

2) Don’t become part of it. It is very easy to get dragged into a conflict; don’t give opinions, make notes (for your own benefit), and if anything does get agreed between all parties, get it written down with everyone’s signoff there and then. It is an absolute classic situation to then find the parties arguing about what was agreed, and if you were involved in that process, they’ll be arguing with you now too.

What if someone has got a lawyer and is talking about court and sending legal letters? Understandably, this might be the kind of conflict that you’d rather stay well away from. Sometimes however, getting lawyers involved can be useful. It’s useful for a person to know what they might ‘win’ if something goes to court, how long that might take, how much it would cost, and what the chances of a win could be. Having this information then gives someone an idea of what their best alternative to negotiating a solution themselves will be – what mediators refer to as the BATNA (best alternative to a negotiated agreement). It often brings people down to earth and back to the table.

Other experts can also be helpful: specialist medical accountants; the local medical committee; indemnity providers; make sure colleagues have reached out to these as they are very experienced in disputes and will provide pragmatic advice but remain boundaried.

Of course, there is also mediation, which is where I often get involved. There are some key principles to mediation which set it apart from other forms of dispute resolution such as litigation or arbitration.

Most important of all, mediation is a voluntary process where people can come together to find their own mutually agreeable solution to a conflict or disagreement under the guidance of an impartial mediator. The mediator will not give an opinion on the arguments, takes sides, or make a judgment (unlike a judge or an arbitrator who would make an award).

Confidentiality is a cornerstone of the process, and there are layers to this. Firstly, the parties will have individual conversations with the mediator that are kept completely confidential. Secondly, what is said at the mediation in any joint meetings between everyone is also confidential. The whole process is then also ‘without prejudice’ which means that nothing that has been said can be used against a party in ongoing or future legal proceedings. Essentially therefore, regardless of whether an agreement is reached at the end of the mediation or not, the whole slate of what has been said until that point is wiped clean; the mediation didn’t happen. It does not matter that someone said ‘sorry’, ‘I’ll pay for that’ or that what they did was ‘wrong’, the other person would not be able to use that against someone in any legal action.

There is also absolutely no obligation to reach an agreement at the mediation. Obviously, it is hoped that this does happen – and it’s unusual for it to not happen – but it is acceptable to just walk away from the process. The parties and the mediator all sign an agreement beforehand to bind themselves legally to the above principles.

Essentially what all of that framework gives is a safe space where the parties might as well participate in good faith to see if they can get a resolution, since they can’t make things any worse for themselves legally, they don’t have to reach an agreement, they can get up and leave at any point, and it never happened as it’s all confidential.

Once an agreement is reached, this is drafted into a settlement agreement which is legally binding once signed and it generally completely ends the matter that was in dispute. That whole thing can happen on the same day. Each agreement is completely unique, as it’s been crafted by the parties themselves.

A judge in court can only order certain things, some sort of transaction or adherence to an agreement, but in mediation all sorts of ‘extras’ or payments in kind can be introduced. We can agree wording of references, or of messaging to staff and patients, notice periods and sabbaticals can be used creatively, even financial transactions can be made in creative ways, within the remit of the law of course.

It would be fair to say that mediation is a pragmatic, all encompassing, and a relatively fast and cheap way to resolve a dispute that has gone quite wrong.

I hope you now have a better understanding of the use of mediation in primary care conflicts, but I also hope that I’ve left you with enough tips to give conflicts a good go, and enough warnings to encourage you to not sweep them under the carpet.

Dr Clare Sieber

Clare is a freelance GP, West Sussex Local Medical Committee member, mediator and co-chief executive officer for The Well-Led Practice.

Last Updated on 30 November 2023