In the Health Service Journal (22nd August), Rob Behrens, the new head of the Parliamentary and Health Service Ombudsman (PHSO), warned that the NHS was still too defensive about mistakes and that it failed to invest in proper complaint handling. He goes on to say that neither the NHS nor the PHSO used mediation and early resolution actions to deal with complaints, which he wanted to see introduced.

While the PHSO is dealing with a different range and level of complaints, his comments nevertheless echo aspects of our experience in working with doctors and clinical teams who are in conflict. Early resolution of concerns, disagreements, tensions etc. seem either not to happen or to be ineffective. All too often we hear from managers that they have done very little, hoping ‘the issue’ would sort itself out; alternatively we hear of informal mediation by an untrained person and whom one party perceived to be biased; we hear too of lack of follow through if a resolution has been agreed, or of no action being taken when a party infringes an agreed way of behaving. Other actions include team building – often attempted a number of times without sustained change or success. This latter intervention is sometimes taken in order for the team to take responsibility for the behaviour of one or two individuals – thus making an individual difficulty a team problem. As a result ‘the issue’ has become entrenched and spilled over to others affecting the whole team. Individuals are extremely frustrated that ‘nothing has been done’ and often resort to taking matters in to their own hands by going for what the Royal College of Surgeons (see Avoiding unconscious bias) calls the nuclear option – writing a formal grievance. This can escalate in to tit for tat behaviour with grievance and counter grievance and is destructive.

While it might be necessary to put a concern in writing, and there are undoubtedly bullies and difficult people whose behaviour should be dealt with through disciplinary action, it is always best to attempt mediation and conflict resolution first and early on rather than hope the situation will resolve itself. Once you are into tit for tat behaviour there is little, if any, good will remaining to give conflict resolution a chance of succeeding. Hurt, fear of future threat and doubt that the system will support you, make it difficult to re-establish trust. Early resolution therefore has the greatest chance of establishing productive working relationships.

by Dr. Megan Joffe