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A common theme in the recent patient safety reports To Err is Human and Crossing the Quality Chasm (IOM 2000 and 2001) and the Canadian Adverse Events Study (Baker and Norton 2004) is the need for healthcare organizations to create a culture of safety. However, as Lucian Leape (2004) has noted, it is an axiom still much in need of being adopted because the predominating culture of most healthcare organizations is not one of safety but of fear. Healthcare professionals fear litigation, professional discipline and coroner’s inquests. Patients fear becoming one of the statistics of the unsafe system that they hear about in the media. Administrators fear bad publicity, lawsuits and increased insurance premiums. What this really means is that people fear being blamed and punished for making a mistake, and most of all they fear being seen as incompetent. Unlike the popular television show, this “Fear Factor” has no winner at the end, but only losers; losers in the form of healthcare professionals, administrators and most of all patients. Fear creates anxiety and mistrust, which leads to failures in communication and a lack of collaboration and teamwork (Baggs 1992; Spears 2005). The inevitable result is high levels of conflict among and between healthcare professionals. And while conflict is a daily, often hourly experience for most healthcare professionals, it is rarely acknowledged, and even more rarely dealt with. As a result, mistrust persists, anxiety grows and conflict increases, creating and perpetuating an unsafe culture. While the experts in the field of patient safety identify the need for culture change in order to improve patient safety (Baker and Norton 2001, 2004; Reason 2000; Leape 1994), little has been written about the fact that a significant contributor to unsafe cultures is the presence of unacknowledged and unresolved conflict. In this article, we will discuss how the prevalence of conflict in healthcare organizations is a leading cause of unsafe cultures and a serious threat to patient safety. We will illustrate how training and education in conflict resolution can provide healthcare professionals with skills to help them deal with the workplace conflicts that they face and in turn allow them to provide a safer environment for patients.

Preventing and Managing Conflict: Vital Pieces in the Patient Safety Puzzle