TOUGH ROOM Disagreements are inevitable when the stakes are so high day in and day out.

Can't we all get along? Not always, especially in the high-stress world of surgery. When spats between staff members threaten to impact the surgical team and jeopardize the communication that's essential to maintaining exceptional patient care, you need to step in.

First, acknowledge the problem. Attempts at conflict resolution should begin by encouraging each of the individuals involved to resolve the issue themselves. However, staff members embroiled in a serious disagreement sometimes don't want to meet one-on-one to reach common ground, or don't have the tools to do it successfully.

If they can't bury the hatchet themselves, it's critical that you inform them that the situation is disruptive to the entire staff and may have an impact on their morale and productivity. Meet one-on-one with each individual involved. Listen to the issues that are causing the conflict. Take each complaint seriously, from serious accusations to petty complaints. If something is bothering a member of your staff, you need to resolve it as quickly as possible so small issues don't evolve into big ones and serious problems don't explode into critical matters.

Next, bring the individuals together for a meeting. Make the purpose of the meeting clear: to resolve the problem and restore a healthy workplace environment. Set behavioral guidelines and your expectations for the meeting:

• Professionalism. Proper language will be used at all times. The employees must face each other and make direct eye contact during the conversation. Facial expressions and body language that portray frustration are not permitted.
• Show respect. Ask the participants to take turns presenting their concerns. When one person is speaking, the other must give them the floor and commit to truly listening to the point of view without interruption.
• No finger-pointing. Ask the participants to discuss the issue by presenting what happened from their perspectives instead of throwing you did this and you did that accusations at the other person. The meeting will be much more civil and productive when the participants focus on how they feel instead of what they think the other person did.

• Stick to the current facts. Frustrated employees have a tendency to bring up issues that happened months or years ago that aren't relevant to the issue at hand. It's your job to keep them focused on the current disagreement.
• Stay calm. This can be tough to do, especially when you're dealing with a hot-button topic and people's careers or reputations are at stake. When emotions run high, people tend to go off on tangents and, as they talk more, get even more worked up. As the mediator, you must make sure both parties remain as calm as possible and stay focused on the topic at hand if they begin to stray. Direct and redirect the conversation if tempers flare so the situation doesn't turn hostile.
• No bullying. Assess the personalities of the combatants before the meeting. Is one stronger or quieter than the other? Some arguments might involve staffers who both have strong personalities and end up bullying each other, refusing to back down from their stances.

Know whom you're dealing with before the meeting starts, so you have an idea of how actions will be shared or explained. A strong personality can be perceived as the bully. She might attempt to steer the conversation her way or intimidate the other person by interjecting to accuse the other person of lying or by denying each point made against her.

Some staff members don't feel comfortable coming to you for help, and will only do so in a last-ditch effort to save the situation. You must act as the go-between in the room, ensuring both parties, regardless of their personalities, have fair opportunities to express their opinions.

The next steps
After you've heard the issues from both individuals, determine what other steps you need to take. Perhaps the opportunity to vent their frustrations in an open and honest dialogue will release some of the tension and convince them to recommit to working together in a more positive way. In certain circumstances, you may need to interview other staff witnesses about the situation. Depending on their relationship with their co-workers, it's important to make sure you're hearing an unbiased account of what they witnessed.

Consider separating the arguers for a period of time so they don't work together until the issue cools. But remember there's rarely a simple resolution to conflict. It might require a series of steps and processes before you reach a final decision. Your ultimate call is not always easy — you might have to let one of the staff members go because of the seriousness of the circumstances — but you must always act in the best interest of the staff and facility.

Work quickly and effectively to quash disagreements, no matter how minor they might seem. I've seen conflicts between 2 individuals affect the whole staff. It's usually not a private matter that you can hope to keep between you and the staff involved. Whoever's in the midst of the conflict will want to tell their work friends, physicians or anyone who will listen. The word spreads, and not always accurately. When the situation escalates to this level, you might need to hold a general staff meeting. At this meeting, don't provide details of the disagreement you're dealing with. Simply relay a clear explanation of the need for professionalism, workplace expectations and respect for privacy.

The goal of any administrator is to promote healthy workplace relationships and job satisfaction for their staff. Dealing with these conflicts can be very difficult, depending on each situation and cause. It's ultimately your responsibility to facilitate, arbitrate, listen, look for compromises, stay neutral, make difficult decisions and act on them.