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The Complexities of Care and Conflict

Paradis, Elise, MA, PhD; Whitehead, Cynthia R., MD, PhD

doi: 10.1097/ACM.0000000000002526
Letters to the Editor
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Assistant professor, Leslie Dan Faculty of Pharmacy, Department of Anesthesia, and Department of Sociology, University of Toronto, and scientist, Wilson Centre, Toronto, Ontario, Canada; elise.paradis@utoronto.ca.

Associate professor, Department of Community and Family Medicine, University of Toronto, director and scientist, Wilson Centre, and vice president for education, Women’s College Hospital, Toronto, Ontario, Canada.

Disclosures: None reported.

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To the Editor:

We gladly read Eichbaum’s article,1 which we see as an invitation to integrate conflict into our understandings of interprofessional collaboration or teamwork in health care. We agree with the author that conflict is a fundamental aspect of care delivery, and that its creative potential needs to be better recognized; indeed, after noting the striking absence of power, conflict, and hierarchies in the interprofessional education literature, we made a similar call in 2015.2 We are thus grateful for Eichbaum’s identification of three ways forward for collaboration and teamwork, but would like to stress how the proposed solutions often clash with the context and complexities of care.

First, while Eichbaum notes that not all collaborative work is done within teams, he does not tell us how psychological safety, innovation, or the health humanities might help individual workers collaborate safely or innovate when there is no “team” to speak of. In the context of teaching hospitals, where trainees and academic faculty regularly move on and off clinical services, this is a core problem. Finding a way to conceptualize these shape-shifting “teams” as collaborative entities will be essential if we are to develop effective and appropriate education for collaboration. Turning to frameworks such as Hollenbeck and colleagues’3—who define teams by their skill differentiation, authority differentiation, and temporal stability—might be a starting point.

Moreover, the use of Steve Jobs to illustrate the importance of collaborative intelligence and the associated trade-offs between agreeableness (of which Jobs had none) and creative nonconformism raises fascinating yet unanswered questions: Where is the line between acceptable and unacceptable behavior? Where does potentially creative conflict stop and destructive rudeness begin?

Furthermore, while Eichbaum emphasizes how evaluative systems hinder interpersonal risk taking—including behavior that might seem “unprofessional,” such as speaking up and pushing back—he offers no insight into how we might change these systems to encourage productive conflict and innovation. While solutions to this thorny issue may seem elusive, it is imperative that as an academic community we tackle such concerns head-on, examining both theoretically and empirically how to support innovation and risk taking in these settings.

Finally, while we absolutely support the goal of flattening care hierarchies, we doubt that educational interventions alone will suffice here, as we have argued elsewhere.2,4

In sum, we applaud Eichbaum’s piece, and invite our community to tackle the very hard problems of teamwork and collaboration he has raised by confronting, directly, their complexities.

Elise Paradis, MA, PhD

Assistant professor, Leslie Dan Faculty of Pharmacy, Department of Anesthesia, and Department of Sociology, University of Toronto, and scientist, Wilson Centre, Toronto, Ontario, Canada; elise.paradis@utoronto.ca.

Cynthia R. Whitehead, MD, PhD

Associate professor, Department of Community and Family Medicine, University of Toronto, director and scientist, Wilson Centre, and vice president for education, Women’s College Hospital, Toronto, Ontario, Canada.

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References

1. Eichbaum Q. Collaboration and teamwork in the health professions: Rethinking the role of conflict. Acad Med. 2018;93:574–580.
2. Paradis E, Whitehead CR. Louder than words: Power and conflict in interprofessional education articles, 1954–2013. Med Educ. 2015;49:399–407.
3. Hollenbeck JR, Beersma B, Schouten ME. Beyond team types and taxonomies: A dimensional scaling conceptualization for team descriptions. Acad Manag Rev. 2012;37:82–106.
4. Paradis E, Whitehead CR. Beyond the lamppost: A proposal for a fourth wave of education for collaboration. Acad Med. 2018;93:1457–1463.
© 2019 by the Association of American Medical Colleges