11 13 drapkin ground rules header
Jen Rosio, University of Utah Health
Ground Rules for Successfully Managing Conflict
Conflict is not about who is right or wrong—it is about being understood, respected, and finding a shared way forward. Pediatric emergency medicine physician Zak Drapkin introduces three ground rules for managing conflict within care teams.

healthcare providers, it is our job to care for individuals during some of the most challenging moments of their lives. For patients and caregivers, grappling with the loss of control and the anxiety associated with healthcare encounters can be overwhelmingly fear-inducing. It’s hard to be your best self under those circumstances. Moreover, the challenges extend beyond patient encounters; often, it's our interactions with colleagues that can be one of the biggest sources of friction.

Conflict is an inherent part of our daily lives in healthcare, making it imperative for all of us to acquire the skills needed to navigate it successfully.

The ability to manage conflict is not an innate trait but rather a skill that demands intentional effort and practice.

What I (Zak) have learned—both the hard way and from people much wiser than myself—is that effectively managing conflict is not about who is right or wrong. It is about being respected, cared for and finding a shared way forward. As part of the Transition to Internship course I teach, we begin each session by sharing these three ground rules for managing any conflict. While by no means exhaustive, they’re a great place to start.

Rule #1: Navigating Emotional Terrain—Focus on the problem, not the person/group.

In the intricate landscape of human interactions, Rule #1 emerges as a guiding principle for effective conflict resolution: Separate the problem from the person or group involved. Recognizing that humans are primarily emotional beings, driven by instinctive reactions, provides the foundation for understanding and overcoming conflicts that arise.

When conflict arises, negative emotions often trigger our primal part "lizard brain", alerting us to perceived danger—a survival mechanism deeply ingrained in our evolutionary past. In contemporary settings, however, these emotions seldom indicate life-threatening situations. Instead of succumbing to the fight, flight, or freeze response, our responsibility is to decipher the underlying messages within these emotions, navigate challenges, and foster personal growth.

A key aspect of this rule involves recognizing common behaviors activate the “lizard brain”:

  • Assigning blame
  • Threats to an individual's self-identity
  • Attempts to assert someone is wrong

Assigning blame or dictating actions can provoke defensive reactions, hindering our ability to address the root issues effectively. These behaviors often concentrate on the person or group involved rather than addressing the core problem.

This rule encourages using language that separates individuals from the issues at hand.

Rather than initiating a challenging conversation with an accusatory "you were rude," try fostering a constructive dialogue by focusing on the specific words and their impact: "I was hoping to discuss something that was said and the impact it had on me." This approach completely separates the person (“you were rude”) from the problem at hand (the impact of what was said) and encourages a nuanced understanding of conflicts, paving the way for resolution and personal development.

Rule #2: Navigating Ambiguity—Focus on actions rather than intentions.

In the complex landscape of interpersonal dynamics, Rule #2 stands as a crucial guideline for effective conflict resolution: Focus on actions rather than intentions. While it's common to assume understanding of others' motivations, the reality is that we can never truly know people's intentions. A thought experiment, presented in the book "Difficult Conversations: How to Discuss What Matters Most," sheds light on the disconnect between perception and reality.

Consider a scenario where you find yourself stuck behind a double-parked Maserati blocking traffic in front of a nice restaurant during your morning commute. The inconvenience is evident, but the internal dialogue varies based on assumptions about the person's intentions. What internal story do you tell yourself about this person? What if you discover the Maserati owner was providing first aid to an injured person laying on the street. Despite the inconvenience remaining the same, suddenly our perception of the experience shifts dramatically.

The truth is, we are often unaware of people's intentions and assume the worst. We can experience hurt when no harm was intended, and vice versa. Recognizing that different individuals can have valid experiences and perspectives is crucial. Genuinely seeking to understand your counterparts experience is often the first step towards effectively navigating conflicts—it provides us with critical information about what issues are really at play behind the initial reactions and emotions. Furthermore, showing genuine interest in the experience of others is remarkably effective at deactivating the “lizard brain” and removing the wall of defensiveness that often erupts during these initial interactions.

Equally important is acknowledging our own contributions to conflicts—we all contribute to every conflict in some way. I may have been short with a college in the past and they are afraid to bring up a concern. I may have been intimidating and they felt threatened. The sooner I can understand and acknowledge my contribution to a conflict and move beyond all-or-nothing, “I’m right and you’re wrong” thinking, the sooner I can make progress.

Rule #3: In Pursuit of Understanding—Seek common ground.

In the intricate dance of resolving conflicts, Rule #3 emerges as a guiding principle: Find common ground and strive to achieve understanding, not necessarily agreement. Human nature often propels us toward adopting rigid positions when we hold strong convictions. In healthcare settings, this might manifest as patients or caregivers insisting on specific treatments or tests, such as a resolute "I want a CT scan."

Rather than engaging in direct disagreement, seasoned conflict negotiators advise a more nuanced approach—delving into the underlying interests that propel these positions. These interests encompass the needs, wants, and motivations behind the expressed concerns, exemplified by the patient's underlying worry: "I'm worried I have brain cancer."

This rule redirects our focus toward seeking understanding, rather than fixating on agreement.

In conflicts, using the phrase “help me understand…” can lead to a remarkably productive conversation. The approach recognizes that conflict, when viewed as a collaborative effort towards understanding a shared path forward, can be constructive rather than inherently antagonistic. Shifting our perspective from adversarial to cooperative lays the foundation for constructive dialogue, moving us one step closer to finding mutually beneficial solutions.

When conflicts arise, all people often revert to a flight or fight state where the “lizard brain” takes over, limiting our ability to make progress. Recognizing what will activate the lizard brain—assigning blame, threatening somebody’s self-identity, and trying to prove that somebody is wrong—will more often than not escalate conflicts and prohibit a successful resolution. On the other hand, when we approach a conflict, we can deliberately deactivate the fight or flight response in ourselves and our counterparts. Some simple first steps include:

  • Seeking to understand and validate your counterpart’s experience
  • Completely separating people from the problem at hands
  • Deliberately separating people’s actions from their intentions
  • Understanding and acknowledging your contribution to the conflict

Conflict is not about who is right or wrong—it is about being understood, respected, and finding a shared way forward. When we deactivate the flight or fight response—both in ourselves and in our counterpart— we can focus on finding meaningful solutions rather than getting stuck in the cycle of arguing about what has happened in the past.

Special thanks to those who contributed to this work:

  • Kat Anderson MD (Professor, Internal medicine)
  • Jerry Benson pHD (Instructor, Professional Education)
  • Megan Fix MD (Associate Professor, Emergency Medicine)
  • LeeAnn Glade JD (Adjunct Professor, Law)
  • Jessica Jones MD, MSPH (Associate Professor, Family Medicine)
  • Howard Kadish MD, MBA (Professor, Pediatrics)
  • Toni Laskey MD, MBA (Professor, Pediatrics)
  • Sarah Menacho MD (Assistant Professor, Neurosurgery)
  • Paige Patterson MD (Associate Professor, Internal Medicine)
  • Jacob Robson MD (Associate Professor, Pediatrics)
  • Mary Steinmann MD (Associate Professor, Psychiatry)
  • Karie VanWoerkom RN (Nursing Director of EMS Relationships, HCA Mountain Star)
  • Cheryl Yang MD (Assistant Professor, Pediatrics)

Zachary Drapkin

Associate Professor of Pediatric, University of Utah Health

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