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resilience
Addressing Relationship Ruptures in Healthcare Settings
When internal conflicts, or relationship ruptures, put our culture of wellness and psychological safety to the test, how do we navigate these tough conversations? Resiliency Center’s Jake Van Epps discusses the importance of acknowledging relationship ruptures and value repairing them to reinforce team cohesion and resiliency.
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healthcare, our ability to respond to challenges improves significantly when we have the support of our coworkers. We can’t prioritize the health and safety of our patients if we’re distracted by poor team dynamics.

We may think of relationship ruptures, or conflicts between team members, as an insurmountable obstacle to effective team collaboration. But these disagreements actually give us a unique opportunity to acknowledge our shortcomings, gain new perspectives and ultimately work together to achieve our collective goals.

Moreover, the prevalence of chronic loneliness among healthcare workers highlights the need for stronger social connections. If we let these relationship ruptures fester, we risk isolating team members, undermining our wellness culture and jeopardizing the psychological health of our teams.

By actively addressing and repairing these conflicts, rather than avoiding them, we can create a more cohesive and resilient workforce, leading to exceptional patient care.

Understanding the Context

Our ability and willingness to collaborate with our colleagues affects us in ways we may not even realize. When we feel connected to others, we find strength in their support. It’s often easier to deal with stress and adapt to new challenges when we feel like our team has our back. 

But when we feel as if our psychological safety is at risk, we may become socially isolated from our team. That loneliness may impact your health more than you realize.

According to US Surgeon General Vivek Murphy, strong social relationships are an important health indicator. Chronic loneliness is associated with the same increased mortality rates as smoking 15 or more cigarettes a day. It has worse mortality rates than obesity or excessive alcohol consumption and is far more prevalent.

From regularly coping with life-or-death situations to navigating a pandemic, healthcare workers often face extreme hardships together. When there's more social connection and social cohesion on their units, they tend to weather those storms in healthier ways. During difficult moments, teams are more vulnerable to breakdowns in communication. It’s how we choose to navigate those ruptures that determines the outcome

Recognizing Ruptures and Repair

Sue Johnson, an EFT couple’s therapist, describes a healthy relationship as two parties being accessible, emotionally engaged and responsive to each other. And while that’s the goal we hope to achieve, ruptures occur no matter how much effort we put into maintaining a state of harmony.

These ruptures can come in many forms. Inherent challenges of working in healthcare, such as coping with acute stress, managing changes in operations and navigating differences in values, can all cause ruptures.

As a society, we put a lot of emphasis on avoiding interpersonal conflicts. We’re taught to keep peace because we believe that’s what is best for our team and our patients. But research teaches us something different: ruptures are inevitable. And, more importantly, repairing ruptured relationships is more predictive of positive outcomes than the ruptures themselves.

It's important that when ruptures occur in our relationships, we don't just write someone off and walk away. Instead, we must ask ourselves: “How do I engage with this person to repair it so that we can get back to working towards our collective goals?” Finding the strength and humility to work through our emotional distress and restore balance ultimately helps us grow, as individuals and as a team.

Exiting the Blame-Victim Cycle

Repairing ruptures can be tricky because there's often a lot of emotions involved. People feel hurt. They believe their perspectives aren’t being valued.

When we’re trying to mend a relationship, the first step is getting out of the blame-victim cycle or blaming the other person for causing the conflict. Both parties must recognize that their relationship is co-created. They need to both take ownership for their part of the dynamic between them.

We’re not arguing the facts of what occurred. The repair process begins when we:

  • Listen to each other’s perspective.
  • Understand each other’s emotional experience.
  • Validate each other’s perception of the event, even though our opinions differ.

Then, from a place of mutual acknowledgement, we can refocus on finding collaborative goals that we can use to realign our interests moving forward. It doesn’t mean we will always agree, or be best friends, but we will be better equipped to resolve our conflicts in the future.

Giving Up Being Right

The biggest barrier to overcoming ruptures is the belief that it’s more important to be right than to salvage and repair the relationship. In the heat of the moment, we’re focused on our own hurt feelings.

To move forward, we must focus on an introspective approach. Ask yourself:

  • “What does it mean for me to be wrong?”
  • “What does it mean for me to compromise on some of my goals or values around this?”
  • “What is triggering my emotional reaction in this situation?”
  • “What piece of this is challenging me the most?”

Only once we acknowledge the hurt that we feel, and admit that it’s okay to have those feelings, can we move past the blame-victim cycle and embrace a more collaborative process towards repair.

As you begin to reframe your thoughts, consider these wise words from Brené Brown: “All I know is that my life is better when I assume that people are doing their best.”

If we enter these interactions assuming that the other person is incompetent, lazy, or doesn’t care about their job, then we’re blindly attacking their personal identity instead of having productive conversations. Be generous with your assumptions and accept that you are not the only one trying their best. 

Case Studies and Practical Approaches

Let’s consider the case of two physicians, each steadfast in their differing methodologies. They began offering passive-aggressive feedback to one another, intent on proving their way is better. Their ongoing conflict hindered their collaboration and negatively impacted team morale.

To resolve this, they were asked to sit down and have a structured conversation. Each physician was given the opportunity to share their experience, acknowledge the emotional distress that their disagreement caused and validate their perceptions.

Next, they were encouraged to reframe their conversation around their common goals and asked to identify ways they could contribute to helping their team achieve those objectives. This process highlighted to importance of aligning values, setting collaborative goals and fostering accountability in repairing relationships. Each physician recognized their role in improving their team dynamic through productive communication and compromise.

Leadership's Role in Facilitating Repair

In the midst of a conflict, we urge our leaders to step up and create neutral space to facilitate relationship repair. Here are some key ways you can initiate positive interactions:

  • Validate each employee’s emotional perspective, even if you believe they need additional direction or corrective action. This will help reduce defensiveness and set the tone for a more collaborative, growth-oriented conversation.
  • Encourage conversations to find shared goals and values. The goal is to move past our differences and establish a common ground.
  • Set clear values and expectations to guide team behavior. Establishing clear guidelines not only helps resolve existing disputes, but also fosters a positive team culture by proactively addressing potential conflicts.
  • Seek support. We don’t expect our leaders to navigate these ruptures alone. The Resiliency Center offers consultations for those who need additional assistance.

While we recognize that having these difficult conversations can feel uncomfortable, repairing relationship ruptures helps us uphold a culture of wellness and psychological safety. It’s not simply about resolving disputes – it’s about reinforcing our team’s cohesion and resilience. These opportunities for growth assist us in aligning our goals and deepening our relationships to a place of mutual respect. 

Our leaders play a pivotal role in the repair process by creating a safe space where employees can openly communicate their experiences, validate their emotional distress and work together to identify shared goals and values. We encourage you to adopt proactive approaches to facilitate repair and maintain a healthy team dynamic.

Remember – we are stronger together.

Contributor

Jake Van Epps

Associate Director, Resiliency Center, University of Utah Health

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