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Conflict is a major factor underlying interpersonal interactions and situations involving group decisions (Boss & McConkie, 2000).  In the surgical room where teamwork is necessary for delivery of sufficient and efficient care, it is not surprising for conflict to occur. Here, professionals with diverse educational backgrounds and work experience are brought together by a common goal of providing optimal care to the patient. Given their diverse backgrounds, these professionals may bring their different perspectives regarding optimal care to their clinical duties.   In the operating room, a broad range of professionals (nurses, technicians, physicians) often have overlapping roles and sometimes poorly delineated responsibilities which may lead to the occurrence of conflict (Booij, 2007).  Contributing to conflict in the operating room is the work related pressure to achieve positive results (Howard et al., 2002) and sleep deprivation which may lead to stress and the development of a volatile work environment.  Conflict takes place on a continuum which ranges from minor differences of opinion and disagreements to open hostility including physical confrontations.  In light of the high risk of conflict in the operating room, this paper is going to use Wehr’s conflict mapping model to demonstrate how conflict can be understood in terms of “origins, nature, dynamics, and possibilities for resolution of conflict” (Wehr 1979, p.19).  Wehr’s conflict mapping model consists of a number of stages which include; summary description of conflict, conflict history, conflict context, conflict parties, dynamics, alternative routes to conflict resolution, and conflict regulation potential.

Summary description of conflict

The conflict involves a general surgeon and an anaesthesiologist who differ about the appropriate time to carry out a surgical procedure on a patient whom the surgeon had diagnosed with acute cholecystitis. Whereas the general surgeon wants the surgical procedure to be treated as a matter of urgency, the anaesthesiologist wants it to be delayed by 5 more hours. The general surgeon ignores the anaesthesiologist’s misgivings and insists that the surgery should take place.

Conflict history

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A 37 year old woman with a height of 157 cm and weight of 101kg has been experiencing intermittent abdominal pain for the last 4 days. For the last 24 hours, the pain has become more persistent and intense; localizing to the right upper quadrant and accompanied by vomiting and nausea.  The last time she ate was three hours before being brought in the emergency department.   A preliminary diagnosis by the general surgeon has shown that the patient suffers from acute cholecystitis.  The surgeon thus feels that surgery should be performed as an emergency intervention. The anaesthesiologist has however expressed his preference for delay of the surgery for 5 more hours. The surgeon responds that despite the misgivings from the anaesthesiologist, surgery should proceed. He insists that he is the one who is ‘ultimately responsible.’

Conflict context

The conflict between the general surgeon and the anaesthesiologist takes place in the operating room where the patient has been moved. The nature of the conflict seems to revolve around whose recommendation should be followed through.

Conflict partis

The primary parties involved in the conflict include the general surgeon and the anaesthesiologist. Secondary parties include other surgeons and anaesthesiologists in the care setting. Third parties include nurses and physicians.

Issues and Dynamics

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The issues involved in the conflict include a disagreement between the general surgeon and the anaesthesiologist about the appropriate time for carrying out the surgery and about who is in charge of the theatre operations i.e. the ‘captain of the ship.’  The general surgeon and the anaesthesiologists are two care professionals from different disciplines and it is likely that their different perspectives regarding the best care for the patient have come into play. As is evident in the surgeon’s suggestion, surgery should commence immediately after diagnosing the woman with acute cholecystitis. However, according to the anaesthesiologist, the surgery should be delayed for 5 more hours.  The different positions held by the two professionals can be explained in terms of their different professional background, training, and experience. Differences in education, perspective, and experience have been described as a potential source of conflict between not only surgeon s and anaesthesiologists but also among other operating room professionals (Booij, 2007).

Even more evident in this conflict scenario is the question of “who is in charge?” which raises the issue of the possibility of role overlap and conflict. This begs the question; who should decide if and when a patient should undergo a surgical operation in the operating room? Is it the general surgeon or the anaesthesiologist? According to Boss and McConkie (2000), the root of many surgeon-anaesthesiologist conflicts is inherent in the ancient doctrine of the “captain of the ship.” According to this doctrine, the mere presence of the surgeon in the operating theatre subjects him with legal liability if any negligent acts occur in the room. This and the traditionally accepted leadership role of the surgeon in the operating theatre may help explain the general surgeon’s assertion that he is ‘ultimately responsible.’ His conviction that he is the ‘captain of the ship’ makes him recommend the surgical operation to go on despite misgivings from the anaesthesiologist. The way the general surgeon asserts his position leaves no room for negotiation or dialogue to resolve the conflict. He gives no reason why he thinks the surgical operation should commence immediately. He neither seeks to establish why the anaesthesiologist thinks the surgical operation should commence after 5 hours.  The anaesthesiologist on his part does not seek an explanation from the general surgeon to establish why the surgeon thinks the operation should begin immediately. All these exacerbate the conflict further with the two parties firmly holding opposing positions.

Alternative Routes to conflict resolution

Teamwork is a very important asset in delivering efficient and quality health care not only in the operating room but also other departments of acute health care settings. One of the factors facilitating teamwork is efficient and effective communication between team members. However, this seems to be lacking in the conflict scenario.  The two parties do not seem to agree about the appropriate time to carry out a surgical intervention to the critically ill woman. It is therefore impportant for the two parties to engage in a constructive dialogue with each one of them explaining the basis for his position. Once each of the parties understand each others’ position, it becomes quite easy to reach a compromise (Pape, 1999).  In compromise, both parties make tradeoffs with the intent of inflicting pain and gain in equal measure.  However, collaboration should come before compromise with the latter only being effected in the instance of collaboration being unsuccessful. It should be noted that although collaboration is time consuming, it increases the probability of sustainable change (Boss & McConkie, 2000) which may impact positively on the working relationship between the general surgeon and the anaesthesiologist. In fact, through collaboration, the general surgeon and the anaesthesiologist will learn how to resolve their conflicts amicably and forge productive working relationship which will in the long run lead to improvement of the quality of delivered care in the operating room.

To facilitate teamwork and collaborative working, there is need for the two parties to respective each others’ professional opinions. There is need for them to understand that each one of them is guided by different values, education, and professional experience which they bring into practice. Respect for each others’ opinions and professional judgement means that the two parties will be willing to work collaboratively in resolving their differences and reaching a collaborative decision. Appreciating the value of collaborating working will particularly benefit the general surgeon who seems to push the anaesthesiologist’s opinion aside and impose his own decision.

Anticipation of conflict between the general surgeon and the anaesthesiologist such as the one described here should be done before hand and appropriate measures taken by the institution to prevent its occurrence. According to Booij (2007), it is important for the institution to put in place a well-defined nil per os (NPO) policy. Such a policy will help identify established standards as well as delineate areas of liability and responsibility. Knowledge of such a policy will make the general surgeon likely inclined toward looking for a collaborative solution rather than imposing his position on the anaesthesiologist.

Conflict regulation potential

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The above outlined solutions will only work if there is a concerted effort to put facilitating systems in place. For teamwork and collaborative working relationships to take place, there should be concerted effort by the institution to promote these measures through policy and appropriate procedures. The roles of the general surgeon and the anaesthesiologist should be clearly defined to prevent overlap. In cases where it is not possible to prevent overlap, appropriate mechanisms should be put in place to guide how such situations should be handled. Lack implementation of these measures by the institution will likely to limitation in conflict resolution.

Conclusion

Conflict in operating theatre occurs often and should thus be anticipated by the care professionals involved. How a conflict is handled determines if it will lead to an amicable solution or to a disruption of care delivered. Wehr’s conflict mapping model is a useful tool to help care professionals understand conflict in the operating theatre and put in place effective mechanisms to find solutions to the conflict.

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