Why does conflict between hospital staff keep landing on the director’s desk?

Recurring disputes as a diagnostic clue

When the same dispute lands on the hospital director’s desk again, it helps to compare the last few incidents. Who was involved, at what point in the shift did their accounts diverge, and which decision remained unresolved? It also matters whether something similar happened after one of the people involved changed. Recurrence does not prove that staff behavior is irrelevant. It does, however, give the director reason to examine how work is organized alongside that behavior. If an argument recurs at every shift handover, before arranging another mediation, check whether it is clear who is responsible for the decision, what information must be passed on, and whether the parties are receiving conflicting instructions. This account helps distinguish an isolated incident from a pattern that persists despite conversations.

Role ambiguity and role conflict are different problems

Role ambiguity and role conflict call for different questions. In the first case, an employee does not know enough about expectations and responsibilities: they may not know who approves a decision or where their task ends. In the second, they know what is expected but cannot reconcile the demands because two people require incompatible actions from the same role. A meta-analysis of the links between these issues and job performance found stronger evidence of an association for role ambiguity; the association between role conflict and performance was small. These are correlational findings, so they do not prove that simply clarifying responsibilities will improve performance. They do, however, help keep the two problems separate and guide which questions to ask about what happens on shift.

How the way a dispute is handled can make it worse

What the parties disagree about, and how they argue, also matters. Task conflict differs from relationship conflict, where the discussion shifts toward judgments about the other person. In a meta-analysis, both types of conflict were associated, on average, with poorer team outcomes and satisfaction. That does not mean every substantive disagreement is harmful, or that the dispute itself caused the poorer outcome. Still, the director should separate analysis of the decision from accusations carried over from earlier meetings. If the parties disagree about handing over an order, reconstruct what was agreed and what was documented. Without records, it is easier to return to claims about someone’s character than to determine where information was missing.

Why agreements can be short-lived

An agreement may be enough to end a meeting, but not necessarily the dispute. After an earlier conversation, it is therefore worth checking whether a working rule changed or whether the parties merely promised to cooperate better. If, on the next shift, both can still reasonably expect different actions, the source of the disagreement remains. Reconstruct an actual case and identify the missing arrangement: when information passes to the other party, who confirms receipt, and how an exception is reported. That is easier to test than a declaration of goodwill. It also helps show whether the conflict returns because the arrangement was not followed or because it never covered the disputed situation.

How to conduct a diagnostic conversation

A diagnostic conversation is best grounded in one recent case described by both parties. Ask each to set out the task, the limits of their responsibility, their authority to make the decision, and the expected outcome. Then compare their answers: when does each believe the case was handed over, and what would tell them it was complete? Differences in these accounts may reveal a missing condition that a general discussion about the relationship would overlook. Finally, choose one decision to clarify rather than trying to repair the entire working relationship at once. This gives the meeting an outcome that can later be tested on shift, while leaving room to address the participants’ behavior separately.

A rule needs an owner

Even a clearly written rule needs someone with the authority to put it into practice. A qualitative study based on interviews with healthcare managers in Sweden described difficulties when people tasked with coordinating different areas of work lacked a sufficient mandate. This does not measure how often such situations occur in Polish hospitals, but it offers a useful prompt for discussing authority. If the dispute resurfaces, the director can record who assigns the task, who can change a decision, who must be consulted, and where an unresolved disagreement goes. They should also check whether each person’s authority matches their responsibility. The owner of the rule should be able to change the procedure, arrange cover, and receive reports of departures from the rule during a shift.

Test it against the next case

A new arrangement should not end with a signed note. It is worth rehearsing it against a situation that previously caused a dispute, then revisiting it when the next real case arises. Did both parties know who would make the decision, when to pass on information, and where to report an exception? Check not only whether the argument has stopped, but also whether the disagreement has shifted to the next stage of work. If the dispute returns at the same point, the rule may still be unclear or unworkable. If the roles are now clear but people continue to treat others inappropriately, that calls for a separate response. This test helps distinguish a poorly designed workflow from behavior that clarifying responsibilities alone will not resolve.

When the same dispute returns after successive shifts, another conversation about working together is not enough. The hospital director needs to establish who makes the decision, when information is passed on, and what happens when an exception arises.

Empatyzer in conversations about hospital conflict

When the director hears another dispute between the heads of two departments, they can begin by describing the last three situations to Em: the decisions that stalled and the areas of authority that may have overlapped. They can then ask for questions that help identify a common flashpoint rather than assigning blame to one side from the outset. With the selected people as context, Em can help tailor difficult questions to each person and separate questions about the relationship from those about roles. The team view can help the director examine differences in preferences that may be fueling the conversation, but it cannot replace establishing who has the authority to decide. Before the meeting, the director can use Em to prepare two examples described in the same way to both parties and compare their responses. Once a rule has been agreed, micro-lessons can help build the habit of returning to it after a set period. Whether the rule works, however, will be determined by the next case on shift.