Introduction
Navigating through the multifaceted world of healthcare often entails encountering and addressing conflicts. These instances, although challenging, serve as vital opportunities for development and enhancement. A variety of strategies are available to manage these scenarios, from competing and compromising to collaborating. This essay delves into one such situation, offering an exploration of these strategies, with an emphasis on the collaborative approach’s ability to derive mutually beneficial outcomes.
[order_button_a]
Scenario
A physician has ordered a patient’s discharge to a specific, specialized rehabilitation facility. However, the patient’s case manager disagrees, as the facility is not within the patient’s insurance network. As the nurse manager, I am advocating for the case manager during an interdisciplinary meeting.
The Competing Approach
The Competing Approach The competing approach involves emphasizing the perspective of one party while disregarding the concerns of others (Holman et al., 2021). In this case, the case manager’s viewpoint would take precedence, prioritizing the financial burden on the patient and the legal and ethical implications of an out-of-network facility. While this approach might lead to a solution that benefits the case manager’s interests, it risks escalating the conflict and damaging the working relationship with the physician.
The main advantage of the competing approach is that it can quickly produce a resolution, as it focuses on the preferences of a single party. However, the drawbacks are significant. By neglecting the physician’s rationale, patient care might suffer if the out-of-network facility truly offers the best specialized care for the patient’s condition. Furthermore, disregarding the physician’s expertise may lead to mistrust and resentment, hampering effective collaboration in future cases. It is essential for nurse managers to be cautious when considering the competing approach, as the consequences of alienating healthcare professionals can have far-reaching effects on the quality of care provided.
The Compromising Approach
A compromising approach involves finding a middle ground where all parties involved make concessions to reach a resolution. As the nurse manager, you could propose that the patient be discharged to a different facility within the patient’s insurance network, still providing the necessary specialized care recommended by the physician. This solution aims to address both the case manager’s concerns about financial burdens and the physician’s medical expertise.
The compromising approach demonstrates a willingness to cooperate and acknowledges the needs of all parties. However, it might not fully satisfy either the physician or the case manager, potentially leading to decreased satisfaction with the decision. Additionally, compromising on medical recommendations could compromise patient outcomes if the alternative facility lacks the necessary resources or expertise.
To overcome these challenges, nurse managers must strive for effective communication with both the physician and the case manager. Openly discussing the reasons behind the physician’s recommendation and the case manager’s concerns can help find common ground and identify creative solutions that prioritize patient well-being without sacrificing financial considerations.
[order_button_b]
The Collaborative Approach
The collaborative approach fosters a win-win solution by promoting the interests of all parties involved. As the nurse manager, you could facilitate a meeting involving the physician, the case manager, the patient, and the patient’s family to discuss available options. This approach recognizes the physician’s expertise in the patient’s medical needs while also considering the case manager’s concerns for the patient’s financial well-being. Most importantly, it prioritizes the patient’s preferences and aligns with the principle of patient-centered care.
Collaboration fosters a sense of shared responsibility, improving the likelihood of reaching a well-informed and holistic decision. By involving all stakeholders in the decision-making process, a collaborative approach can lead to better patient outcomes and a stronger working relationship among the healthcare team. It also encourages the exchange of perspectives, potentially yielding innovative solutions that were not initially apparent.
In this meeting, we could explore possible ways to arrange for the specialized care within the insurance network, potentially through a transfer agreement with the out-of-network facility or by involving a care coordinator who could arrange for specialized services within an in-network facility. Such a solution considers all viewpoints and could result in the best outcome for the patient, both medically and financially (Yoder-Wise and Sportsman, 2019).
Considering the potential complexities of the situation, it might also be beneficial to involve the hospital administration or utilization review team. They could provide guidance and support in navigating insurance-related challenges and finding viable solutions that align with the hospital’s policies and the patient’s best interest.
Conclusion
Effective leadership in nursing involves the ability to navigate complex situations and foster positive resolutions. Competing, compromising, and collaborating are all useful strategies for managing conflict, yet the ultimate goal should be to find a solution that serves the patient’s best interest. By actively involving all stakeholders, promoting open communication, and considering multiple perspectives, nurse managers can lead teams towards this objective. Additionally, the willingness to seek support from hospital administration or utilization review teams when dealing with challenging cases can enhance the decision-making process and lead to more favorable outcomes for patients. Ultimately, prioritizing patient-centered care and collaboration can ensure that the patient’s medical and financial needs are met while preserving positive relationships among the healthcare team.
[order_button_c]
References
Holman, H. C., Williams, D., Sommer, S., Johnson, J., Ball, B. S., Lemon, T. L., & Assessment Technologies Institute (Contributors). (2021). Nursing Leadership and Management: Review Module (8th ed.). Assessment Technologies Institute
Yoder-Wise, P. S., & Sportsman, S. (2019). Leading and Managing in Nursing (8th ed.). Elsevier