Conflict Resolution

Four Stages of Ending a Conflict

Don’t make me swear to it, but I believe it was Karl Slaikeu who first presented to me the four stages — or, better, “declensions” — of ending a conflict.  If it was somebody else, my apology.

Which, by the way, is the first stage.

Taking Responsibility.  The first stage is to admit the wrongdoing, acknowledge the full consequences of your action, and express regret.  In this stage the party ceases argument or denial and adopts the posture of the complainant: 

Yes, Ms. Smith, our radiologists misread the mammary screen and failed to detect your breast cancer.  As a result of this error the cancer has metastacized and your prognosis is poor.  If we had detected it in the first instance your life expectency would probably not have been  effected.  Now, however, you have been seriously compromised and there is a real chance of serious cancer.  This is a very bad outcome and we are very, very sorry.  I wish we could be perfect and never make mistakes.  However we’re not, and we do.

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Offer to Repair the Damage.  Assume not only the responsibility for the harm, but also the moral obligation to acknowledge the consequences and address them to the extent possible.  Assure the person harmed that you are prepared to make her whole without hesitation and without concern for yourself.

Ms. Smith, we suggest that you select an attorney who is well-versed in medical malpractice in this region.  Take as much time as you want to make your selection.  Have that attorney contact the hospital’s attorney and arrange a meeting with me, you, and both lawyers.  Your attorney will know the approximate amount of money that is appropriate in cases such as this; our attorney does too, of course.  We will agree to the right amount and there will be no need for a lawsuit or a costly trial.  We will make sure that your family is fully taken care of and that the costs of your continued care is fully covered.

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Assure No Repetition of the Harm.  Take steps to prevent a recurrence of the conduct.  Assure the person harmed that you are not in the business of hurting people like this, that you do not regard it s a mere “cost of doing business,” and that you will do your best to prevent it happening to anyone else.

Ms. Smith, this is a teaching hospital and we would like to make every effort to ensure that this mistake never happen again.  Or at least that our doctors know what happens when they make mistakes.  Would you agree to take part in a video of how to identify these tumors, and to explain the effect that this has had on your life and your family?  It would help impress on our young doctors the vital importance of being as nearly perfect as possible.

Ask Forgiveness.  This is an odd stage, because its completion is not in the control of the wrongdoer, as the other three are.  It contemplates that the person hurt will recognize and accept all of the indicia of resolution set forth above, and will choose a life without remorse and vindictiveless, putting the whole matter in the past. 

Of the four, this might be the most difficult, and the least common.  It is, however, the most important for health.

For those so inclined, let me note that hospitals who have adopted this approach to doctor/patient errors spend less on lawyers, less on insurance, and less on patients, and better control their risk and their cash flow, compared to those that do not.  So it has benefits to both parties that can be measured if that’s the kind of assurance what one needs before doing the right thing in the first instance. 

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1 Comment
  1. I like this reminder that ending a conflict often requires more than merely exchanging offers and counter-offers.

    I’ve seen the acts of voicing responsibility and emphasizing wanting to do right by repairing damage go a long way toward putting some conflicts to rest. Too often, finalizing deal points is focused upon as the ultimate step in dispute resolution.

    The four declensions can help in reaching an agreement, and in cementing an agreement. In such disputes, I sometimes hesitate to broach apologizing or requesting forgiveness for fear of jinxing a tentative deal, and so the earlier in the process these often difficult sentiments can be surfaced the better.

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