When Team Conflicts Threaten Quality of Care: A Study of Health Care Professionals' Experiences and Perceptions

Abstract

Objectives To explore professionals' experiences and perceptions of whether, how, and what types of conflicts affected the quality of patient care. Patients and Methods We conducted 82 semistructured interviews with randomly selected health care professionals in a Swiss teaching hospital (October 2014 and March 2016). Participants related stories of team conflicts (intra-/interprofessional, among protagonists at the same or different hierarchical levels) and the perceived consequences for patient care. We analyzed quality of care using the dimensions of care proposed by the Institute of Medicine Committee on Quality of Health Care in America (safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity). Results Seventy-seven of 130 conflicts had no perceived consequences for patient care. Of the 53 conflicts (41%) with potential perceived consequences, the most common were care not provided in a timely manner to patients (delays, longer hospitalization), care not being patient-centered, and less efficient care. Intraprofessional conflicts were linked with less patient-centered care, whereas interprofessional conflicts were linked with less timely care. Conflicts among protagonists at the same hierarchical level were linked with less timely care and less patient-centered care. In some situations, perceived unsatisfactory quality of care generated team conflicts. Conclusion Based on participants' assessments, 4 of 10 conflict stories had potential consequences for the quality of patient care. The most common consequences were failure to provide timely, patient-centered, and efficient care. Management of hospitals should consider team conflicts as a potential threat to quality of care and support conflict management programs.

Exploring group boundaries and conflicts: a social identity theory perspective

“…Although task conflicts can be productive in clarifying opinions and finding innovative solutions, conflicts are usually perceived negatively. Studies have suggested that conflicts can lead to poor communication, suboptimal patient care and further tensions if left unaddressed . One of the key reasons for communication failure is difficulties members of the team have in raising their concerns with their hierarchy .…”

Nurses and Pharmaceutical Care: Interprofessional, Evidence-Based Working to Improve Patient Care and Outcomes

“…In contrast, fighting over roles and responsibilities with the aim of defending or extending professional identities and territories hinders collaboration. Lack of collaboration between professionals results in unsatisfactory, suboptimal care, delays in provision of care, more clinical errors, demotivation of professionals, negative attitudes towards patients and low patient satisfaction [ 69 , 70 ].…”

Non-technical Skills in Healthcare

“…This effect appears to be more likely among female workers who have children [127], a dominant demographic of healthcare workers, especially in nursing and allied health. It seems intuitive that interpersonal conflict within healthcare teams would be a threat to patient safety; indeed surveys and structured interviews confirm that healthcare workers strongly hold this perception [128,129]. Interpersonal conflict is a key feature of whistle-blower cases of serious and serial patient harm [130]; however the conspicuous conflict in these cases is mostly a consequence of poor individual or team performance (and conflict over reporting this) rather than a cause.…”