By Bev Thomas
Tavistock Consulting has a long history of working with staff in conflict, but in the last five years we have seen increasing referrals for more senior clinical staff and, in particular, for consultants whose working relationships have broken down.
Our approach to understanding conflict between staff is to use a systems psychodynamic approach. By understanding both the underlying dynamics between the individuals involved, as well as the wider situation or context, we are able to come to a greater understanding of the development and maintenance of the difficulties between particular staff members. Given the increasing pressures on the NHS, the financial cuts and service reconfiguration, it may be unsurprising that the consequences of these pressures get played out in tensions between staff and teams.
However, there is a tendency to individualise these problems, with many of the requests being for conflict resolution. While there is often a case for these individuals to enter into a mediation process, the detail of the issues between the two individuals concerned is rarely the whole picture. Very often we find that the root cause of the conflict can be traced way back, and is less about the individuals, and more about the wider system.
Frequently, the problems can be traced back to a change in the organisation, either at a service, departmental or team level.
One example of this was the referral for a team dealing with drug and alcohol abuse, who were in conflict. The problems were located with the two lead consultants, and the Clinical Director suggested mediation for them both. It transpired that the current service was an amalgamation of two separate drug and alcohol teams that had been merged two years before. Each consultant held a very different theoretical model of addiction and this was causing problems for the staff who were becoming increasingly divided over client service provision. At the point of referral, there had been open hostility and fall out between staff members. On further questioning, it emerged that the merger of the two services had been imposed, as part of a Trust saving. The different theoretical approaches of the consultants also reflected the opposing political views regarding treatment of drug problems at the time, with one (abstinence) currently favoured over the other (maintenance) in terms of national funding.
So the ‘war’ between two consultants over treatment of their patients, reflected a bigger national ‘war’ over funding for treatment options.
When the services were merged, there had been no consideration of how such polarised views could be incorporated, or indeed embraced or celebrated. Without attention to this difference of approach, it became a source of rivalry and competition, a ‘right or wrong’ approach, rather than offering a richness and diversity of options for patients.
Service restructures and mergers are a feature of today’s NHS, however, these service changes need to be handled with sensitivity and care.
Different models of service provision, treatment approaches, and changing roles for staff are key areas to be addressed in order to ensure the smooth running of what will be a new and changed service.
Without attention to these important details, staff will be left to bear the brunt of the changes with confusion and chaos, resulting in conflict and resentment between staff, and with the inevitable impact on the quality of patient care.