Improving Physician Relations and Safety and Quality of Care at a Women’s Hospital

Collaboration Specialists was asked to conduct an intervention in response to professional practice issues between a Family Medicine Department, OB-Gyn Department, health system administration, L&D nursing staff, and the Quality Management Dept. The intervention involved more than 200 professionals, and included these conflict resolution and management techniques:

• Mediation sessions in pairs and small groups addressing different issues and impacts
• Conflict coaching for key leaders, managers and physicians
• Communication skills training for nurses and nurse managers
• Periodic informational meetings and written communications
• Facilitated meetings generating the results detailed below

Assessment meetings surfaced the various aspects of the conflicts, their sources, and the differential impact on different constituencies. Individuals and like-minded groups met ahead of mediations to prepare to participate in them most effectively. Mediation sessions helped resolve a series of interpersonal conflicts and identify solutions and structures needed to implement them. In facilitated meetings, clinicians continued to address ongoing concerns and reestablish trust. Recognizing that these occur over time, clinicians set up mechanisms that will continue to deepen their trust while ensuring good clinical decisionmaking. They generated these results:

• Developed interdisciplinary quality improvement committee
• Implemented interdisciplinary rapid review process for practice disputes
• Developed professional consultation guidelines
• Clarified clinical nursing leadership structure and developed clear chain of command procedures
• Reintegrated estranged physician providers into clinical care environment
• Reached agreements about hand-offs, transfers, and back-up response between departments
• Generated agreements across departments about resident training
• Improved clinical information-sharing practices, including routine problem-solving structures and improved access to clinical case database