Conflict Causes and Solutions

The shift starts as one of those days where what can go wrong does go wrong: medics sick, ambulance maintenance problems, medical supply shortages, hospital diversions and rainy weather. Staffing shortages require you, the EMS shift supervisor, to pair two medics whom you would generally never assign together no matter what—except today you have no choice.

There is a little uneasiness as you announce the assignment, because you realize neither of them is going to be pleased working with the other, even for just one shift. The medics accept the assignment without comment, but conflict begins before they have even left the station.

The medics’ initial dispute is over who rides and who drives. As dispatch is asking for the unit’s response status, the medics are arguing while competing for the driver’s door handle. This is an example of overlapping authority that occurs when partners claim responsibility for the same task or assignment, and it is a common source of conflict between EMS providers. All EMS managers have had to address such conflicts between partners.

A common solution is that partners rotate every call, split a shift or rotate shifts providing patient care. One prerequisite of such agreements is that the partners must possess equivalent medical certifications. Providing an appropriate level of medical care consistent with the patient’s health status takes precedence over the partners’ ride rotation schedule.

Eventually, the medics reach a compromise and notify dispatch that they are available to respond. The first emergency call results in another conflict between the medics, because they utilize vastly different approaches for helping a patient make a transportation decision. Does the patient want the ambulance to take them to the hospital, have family or friends drive them to the hospital or private doctor, or does the patient just want to stay at home? Some medics have a strong preference for advocating that patients accept EMS transportation, while others have a passion for advocating “on-scene” education, reviewing with patients their range of transportation options and then obtaining refusals. When medics with these different approaches are assigned together, their preferences can be a source of intense conflict as a result of incompatible goals.

Sometimes, within the close confines of providing patient care in a small bathroom or bedroom, patients and bystanders can sense the subtle conflict among the EMS providers. The situation becomes even more intense when the differing transportation views of responding firefighters and law enforcement officers are introduced.

One recommendation is that EMS partners should reach a consensus before the first alarm on when to stop the transportation negotiations and simply fetch the stretcher.

You return from breakfast to retrieve a voice mail message from a fire department captain wanting to file a formal complaint against both medics for their public disagreement on the call. Conflict between two people often results in meetings with many more people in attendance.

When the medics arrive at the hospital, they encounter another source of conflict—task interdependencies. This type of conflict occurs with activities where a medic is dependent upon his/her partner for completing a task. Within EMS crews, interdependency is quite high and begins as soon as the shift begins: The driver is dependent upon the other crew member to read the map correctly, one partner completes the patient paperwork while the other restores the unit to in-service status, and so on. The primary author of this article experienced this conflict whereby his partner failed to put the stretcher back into the ambulance after a call. On the next alarm, the tension was quite high when the stretcher omission was discovered. Unfortunately, this kind of thing really does happen and conflict can be an outcome.

Halfway through the shift, you meet with the crew to address the fire captain’s complaint, and direct the paramedic (with less seniority) to be responsible for the crew and possess authority over the emergency medical technician (with more seniority). You are pleased, assuming there will be no more conflict, since someone is officially in charge. However, you fail to factor in the conflict source of incompatible rewards.

Within EMS, the level of certification is often the primary criteria for who gives orders and who takes them. When paramedics with less tenure possess responsibility and authority over more-tenured emergency medical technicians, there can be conflict and tension over the reward system. It’s important to acknowledge that rewards are more than money, and authority is viewed by many as being a reward in itself.

Fire department medics providing EMS transport generally have enormous freedom over their shift activities. For instance, while EMS call volume is remarkably higher than for those personnel assigned to fire-suppression equipment, medics generally manage their own units with only limited oversight from their shift fire supervisors. This can be another source of incompatible-reward conflict if the medics are perceived as taking advantage of the situation by avoiding non-emergency assignments or training details.

As the medics spend more time and handle more calls, eventually they work out issues and become more comfortable with their partnership. Upon returning to quarters for dinner, you inform them, “Due to three medics quitting, you can’t attend EMS EXPO next month—sorry.” The medics had anticipated attending the conference and are angry at being denied access to more comprehensive training opportunities due to circumstances beyond their control.

Regrettably, many EMS agencies find it difficult to fund or provide staffing coverage when medics desire to expand their EMS skills. Consequently, conflicts can develop as medics are expected to develop their skill sets, but the organization’s scarce resources limit access to training. Many medics understand and accept training restrictions during vacation periods, but are frustrated when adequate staffing still results in a denial of a request for training.

Conflict Mitigation Approaches

Inevitably, even the most tolerant and respectful medics will find themselves in a conflict crisis. In a perfect world, as employees mature in the job, there are fewer conflict triggers, and people accept more incidents of disagreement without taking them personally. However, in those conflict situations that require a response, medics have a variety of approaches they can take.

Avoidance is an approach that medics should perhaps consider employing more frequently. For instance, when family members are upset, let law enforcement resolve the conflict so the medics can focus on providing patient care. Another illustration of the avoidance approach is to simply load the patient into the ambulance and leave the scene, rather than engage in conflict with highly emotional individuals. However, employing the avoidance approach between partners is probably not a good strategy, since it’s a “for better or worse” relationship.

The solution approach involves identifying the root causes of the conflict and finding solutions. The primary objective should be to focus on the issues and not the parties’ personalities. Also, if the issues are complex, consider taking some incremental solution steps to make some progress. These small achievements can create good will for the parties to build upon to conquer the more challenging aspects of the conflict.

Subordinating goals involves acknowledging that the organization’s achievement objectives are more important than our own conflict expectations. Essentially, we choose to ignore our conflict frustrations for the greater good. However, subordinating conflict goals has the capacity to increase frustration levels until there is a conflict crisis.

Compromise has value as a conflict resolution tool, but has limitations in that oftentimes one or all parties feel they compromised too much. These feelings may be suppressed, allowing the conflict to fester and be a source of continual tension. It’s critical when employing compromise to ensure the parties acknowledge the solution really had a beneficial outcome.

Forcing is a method frequently employed when one party possesses more power or authority than the other party. “How about we do it this way, since I’m the boss” is a solution all of us have experienced. However, the conflict is really not resolved, just conquered by force. While the forcing approach may be necessary when there are severe time limitations, it’s best to be selective when forcing resolutions from less powerful parties who may vote with their feet and simply quit the organization.

Finally, smoothing is a possible resolution approach. At times, parties have other interests that require them to calm the tensions until a better moment. Most of us have told a coworker that “this is just not a good time to argue, since I’m going on vacation next week. We’ll do it your way and then get it resolved when I return.” In addition, the parties need to ask themselves, is it really necessary to get folks upset over an issue that will eventually resolve itself without any intervention?

Conclusion

Medics should consider developing an approach whereby conflict is addressed outside the presence of patients and the public. When conflict tension emerges, resolve it while it is manageable. Do not allow personalities and personal attacks to complicate an otherwise solvable issue.

This article is dedicated to Captain Bill Bolton, EMT-P, who is retiring after 32 years as a firefighter/paramedic with the Clayton County (GA) Fire Department. Bill is one of the finest public servants, best partners and closest friends with which any medic could spend a shift. Good luck, Bill!