Addressing interpersonal conflict among healthcare workers during the coronavirus pandemic

The coronavirus outbreak is having a severe and profound socioeconomic impact worldwide. There are daily reports in the news media of healthcare services that are overwhelmed due to a lack of protective equipment and an increasing caseload of patients in need of hospitalization or intensive care. Healthcare personnel are on the front lines of the pandemic, and abundant evidence shows they are at increased risk of both infection and acute/chronic psychological distress. Greenberg et al. recently discussed moral issues that healthcare workers may perceive during the pandemic.¹ Herein, we would like to shed light to another relevant issue that healthcare teams must deal with during these challenging times.

Interpersonal conflict, a widely recognized stress factor in human relationships, can be defined as a dynamic process that arises among individuals who experience negative emotional reactions to perceived disagreement.² Although interpersonal conflict is unavoidable, it strongly impacts the quality of and perceived satisfaction with human relationships. Thus, it is unsurprising that efficient management of interpersonal conflicts in institutions and organizations has been associated with a better organizational environment and better results.³ Of course, interpersonal conflict already existed in healthcare teams to a greater or lesser degree before the pandemic emerged, and previous research has revealed its negative impact on absenteeism rates and self-esteem in nurses.⁴ Unfortunately, both new and pre-established stress factors could exacerbate interpersonal conflict between healthcare workers during the pandemic. Thus, in the current scenario, which involves increased loss of frontline healthcare workers due to contamination or contact with suspected cases, it is imperative that health organizations improve programs to positively impact their staff’s mental health and mitigate potential causes of absenteeism.

Psychological First Aid and similar tools are well-established interventions to reduce or prevent psychological distress during human disasters and crisis situations. Although these methods focus on enhancing social support, they do not adequately address the complex dimension of interpersonal conflict and associated psychological distress. Therefore, to better address this issue, we propose an ultra-brief clinical intervention model based on Interpersonal Psychotherapy (IPT). IPT is a brief structured psychotherapy intervention focused on resolving interpersonal problems.⁵ The method has been used clinically for decades and has proven efficacy in major depressive disorder.⁵ Although it has not been tested for interpersonal conflict in organizational scenarios such as healthcare teams, some specific aspects of IPT might adequately lend themselves to this goal. First, IPT uses simple language and centers primarily on emotions and feelings triggered by relationships. Second, one of the four clinical foci of IPT is very similar to interpersonal conflict, namely “role dispute.” Third and most importantly, effective and learnable techniques, such as identification/expression of emotion and role playing, are used in IPT but are not specific to IPT. In fact, preliminary evidence suggests that role playing may be effective in healthcare team conflict management.⁶

This is not to say that IPT can be performed without adequate certification and training. However, in these challenging times it is essential to develop alternative means of dealing with the problems encountered in real practice, such as interpersonal conflict between health professionals, while taking good care to implement only evidence-based actions that will either help or cause no harm. Furthermore, liaison psychiatrists and hospital mental health teams could perform these interventions for their healthcare colleagues in need during the outbreak. Thus, when the usual coping techniques are insufficient to resolve interpersonal conflicts between members of healthcare teams, a clinical and minimally adapted IPT intervention could be tried as an alternative, since it is based on a psychotherapy model focused on interpersonal conflict.

References

• ¹
  Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020;368:m1211.
• ²
  Barki H, Hartwick J. Conceptualizing the construct of interpersonal conflict. Int J Confl Manag. 2004;15:216-44.
• ³
  Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Safe Health Care. 2004;13Suppl 1:i85-90.
• ⁴
  McKenna BG, Smith NA, Pool SJ, Coverdale JH. Horizontal violence: experiences of registered nurses in their first year of practice. J Adv Nurs. 2003;42:90-6.
• ⁵
  Markowitz JC, Weissman MM. Interpersonal psychotherapy: principles and applications. World Psychiatry. 2004;3:136‐9.
• ⁶
  Haraway DL, Haraway WM 3rd. Analysis of the effect of conflict-management and resolution training on employee stress at a health care organization. Hosp Top. 2005;83:11-7.

Publication Dates

• Publication in this collection
  03 July 2020
• Date of issue
  Sep-Oct 2020

History

• Received
  5 May 2020
• Accepted
  23 May 2020