The challenges that face healthcare professionals are numerous and constant. Time and available resources are far too often extremely limited, adding further pressure to an already high-pressure profession.

This type of environment, where all workers are under considerable stress, can easily lead to a rise in tension and anxiety.

If these issues are not resolved swiftly and amicably then they can become a source of conflict. While the potential for conflict between colleagues is high so is it between patients are healthcare workers.

Patients all come from different backgrounds and have varied expectations, providing plenty of potential flashpoints.

The consequences of unresolved conflict can be very serious indeed. Contentious situations between colleagues can lead to a breakdown of communication.

When this happens vital information does not always reach the people it needs to.

Breakdowns in communication can also lead to resources not being allocated properly or to work being duplicated.

Conflict in the workplace can contribute to creating a toxic environment that may cause patients to become uncomfortable.

In the most serious cases of unresolved conflict, the result can be patient harm.

The good news is that healthcare professionals already possess most of the skills required for conflict management and resolution.

The key process of patient care involves; carrying out an assessment, making a diagnosis, crafting a treatment plan, followed by ongoing evaluation and modification to the treatment plan if necessary.

This exact same process can be applied to situations where conflict arises.

However, to apply these techniques, situations that can lead to conflict need to be spotted early. Two things that can allow conflict to escalate are a failure to address issues head-on and failure to notice the warning signs.


The aggression continuum

Awareness of how situations develop into conflict is a key component of managing the risk factor.

To help identify this Steven Wilder, an expert in healthcare safety and security, developed the ‘aggression continuum’.

Hardly ever do people go straight from being at peace to being physically aggressive and violent.

Rather, Wilder has identified six emotional stages that people progress through and worked out the key ways to respond to each one.


The six stages of the aggression continuum

The first stage is being calm.

This is most people’s default setting. In this emotional state, they are able to refrain from any aggressive behaviour and state any concerns they might have in a polite and courteous manner.

In this situation, the best response is to focus on their needs, listen to them, and show compassion.

The second stage is verbally agitated.

This is when a usually calm person is having a bad day and they are feeling frustrated or agitated.

They can be verbally aggressive but they are frustrated with something else, not anything you are responsible for.

Wilder calls this “non-directed anger”.

The key to responding to this emotional state is to not take it personally or to become defensive. Instead, you should listen to them allowing them to vent and express their feelings.

The third stage is known as verbally hostile.

This is very similar to the previous stage ‘verbally agitated’, except with an added element of emotion.

The person in question will be more resistant to attempts to calm them down and will use hostile but general statements.

When responding to this emotional state it is important to be keenly aware of the person’s emotions, be vigilant for clues such as, voice cracking or eyes tearing up.

Use non-confrontational body language and respect their personal space. Avoid issuing instructions or telling them what to do.

Instead, ask them how you can help.

The fourth stage is called verbally threatening.

This manifests as ‘direct anger’ and threats are directed at a specific person. They will single you out, be demanding, and threatening if they don’t get what they want.

Maintain eye contact with them but avoid making them feel trapped or cornered, this can lead to them lashing out.

Be braced for the fact that they may become violent and call for help.

Try and limit the number of people interacting with them to three.

This is called the triangle approach, whoever is closest to the person being aggressive is in charge and should be the only one who speaks.

The fifth stage is when they become physically threatening.

Once someone has entered this stage it will become evident from his or her body language.

They will adopt an aggressive stance, ball up their fists, or start looking around for weapons, which may include everyday objects.

If you are dealing with someone in this state you should subtly go into a defensive stance and try to position yourself on their weak side.

The final stage is physical violence.

This is when they physically attack you or others nearby. Your response to this should be to defend yourself.

Bear in mind that the aim is to take control of the situation and not to fight them if at all possible.

When they start raising their voice you should lower yours to try and take the heat out of the moment.


Avoiding conflict escalation

Facing any of these later stages can be disconcerting and worrying. However, by learning to spot the signs and knowing how to react to each stage we can prevent things from escalating and reduce conflict altogether.

Sometimes a person can progress through all six stages during the course of a single conversation.

In cases such as these, we need to be highly alert and well trained so as to be able to respond in the correct manner on instinct. Other times people’s emotional state can develop over days, weeks, or even longer.

There are several things we can do in our day-to-day interactions with people to prevent this from happening. Being present in the moment, engaging in active listening, and using problem resolution techniques, can help us to avoid situations that can give rise to conflict. When we see anger or frustration building it is optimal to tackle the situation head-on.

Talk face-to-face if at all possible, apologise if appropriate, and use a mediator where necessary.