CPOM Module 9, Section 4: Conflict Resolution Frameworks for Pharmacy Teams
MODULE 9: CHANGE MANAGEMENT & CONFLICT RESOLUTION

Section 9.4: Conflict Resolution Frameworks for Pharmacy Teams

A masterclass in managing the inevitable disagreements that arise in a high-stakes environment. Learn to facilitate constructive conflict and mediate disputes to find win-win solutions that strengthen team relationships.

SECTION 9.4

Conflict Resolution Frameworks for Pharmacy Teams

From Clinical Disagreement to Interpersonal Friction: Your Role as Mediator and Peacemaker.

9.4.1 The “Why”: The Inevitability and Necessity of Conflict

In the complex, high-stakes ecosystem of a pharmacy, conflict is not a possibility; it is a mathematical certainty. When you bring together highly intelligent, passionate, and often stressed individuals, give them interdependent tasks, and place them in an environment where the consequences of error are severe, the conditions are ripe for disagreement. Conflict will arise over clinical opinions, workflow priorities, communication styles, perceived fairness in scheduling, and a thousand other points of friction. The measure of a great leader is not their ability to create a conflict-free environment—such a place does not exist. The true measure is their ability to transform the kinetic energy of conflict from a destructive force into a constructive one.

The amateur leader views conflict as a failure—a sign that the team is dysfunctional or that they have lost control. They either avoid it at all costs, hoping it will resolve itself (it won’t), or they intervene with blunt force, declaring a winner and a loser and leaving a trail of resentment. This approach is profoundly damaging. Unresolved or poorly managed conflict is a toxin that metastasizes within a team, leading to a catastrophic breakdown in psychological safety, communication, and collaboration. It is a leading cause of medication errors, staff burnout, and employee turnover.

The “Why” of this section is to arm you with the frameworks to re-conceptualize conflict. Healthy, well-managed conflict is not only necessary but beneficial. It is the process through which bad ideas are challenged, better solutions are forged, and deeper understanding is built. When your clinical pharmacists can rigorously debate the merits of two different antibiotic regimens, they arrive at the best possible choice for the patient. When your technicians can openly disagree about the most efficient way to stage medications for checking, they invent a superior workflow. The goal is not to eliminate conflict but to build a culture where “constructive conflict” can thrive, while providing you, the leader, with the tools to mediate “destructive conflict” when it inevitably arises. This section provides the clinical frameworks to diagnose the nature of a disagreement and the step-by-step mediation process to guide your team toward resolution, transforming moments of friction into opportunities for growth.

Retail Pharmacist Analogy: Managing a Complex Drug-Drug Interaction

A patient’s profile flags a major interaction: they have been prescribed warfarin by their cardiologist and have just been started on sulfamethoxazole/trimethoprim by their primary care physician for a UTI. This is a conflict. Both drugs are clinically appropriate for their respective indications, but their combination is dangerous, significantly increasing the risk of a catastrophic bleed.

The Amateur’s Approach (“Avoiding or Forcing”):

  • Avoidance: You dispense both prescriptions, add a warning label, and hope the patient figures it out. This is managerial avoidance of team conflict. The potential for harm is enormous.
  • Forcing: You call the PCP’s office and state, “You can’t prescribe this, it’s a major interaction.” You have declared one prescriber “right” and the other “wrong,” creating resentment and damaging a professional relationship.

The Clinician’s Approach (“Mediating the Conflict”): You recognize your role as a mediator whose goal is to ensure the best overall outcome for the patient. You don’t pick a side; you manage the interaction.

  1. Acknowledge the Validity of Both “Positions”: You understand the cardiologist’s need for anticoagulation and the PCP’s need to treat the UTI. Both are legitimate goals.
  2. Identify the Underlying “Interest”: The shared, underlying interest of everyone involved—including you and both prescribers—is the patient’s overall well-being and safety.
  3. Gather Information & Analyze the Situation: You review the patient’s INR history, their renal function, and the local antibiogram to see what other options might be effective for the UTI.
  4. Brainstorm & Propose Collaborative Solutions: You call the PCP. You start by establishing shared interest: “Dr. Smith, this is the pharmacist calling about our mutual patient, Jane Doe. I see your prescription for Bactrim and wanted to collaborate on the best plan given that she’s on warfarin from her cardiologist.” You then propose solutions:
    • “Would you consider an alternative antibiotic with a lower interaction risk, like nitrofurantoin or fosfomycin, based on her culture results?” (A win-win solution)
    • “If Bactrim is the only option, I recommend we reduce her warfarin dose by 50% and have her come in for an INR check in 3 days. I can coordinate this with her and the cardiologist.” (A compromise solution)
  5. Confirm Agreement & Follow Up: You document the agreed-upon plan and communicate it to all parties, including the patient. You have successfully mediated the clinical conflict, preserving relationships and ensuring patient safety.

Managing interpersonal conflict on your team requires the exact same clinical mediation process. Your job is not to decide who is right, but to guide the involved parties toward a solution that serves the team’s shared interest: providing safe, effective, and efficient patient care.

9.4.2 The Diagnostic Tool: Understanding Conflict Styles (The TKI Model)

Just as you diagnose the root cause of resistance, you must first diagnose the nature of the conflict you are observing. The Thomas-Kilmann Conflict Mode Instrument (TKI) is a foundational model that provides a powerful diagnostic lens. It maps individual conflict styles based on two key dimensions:

  • Assertiveness: The extent to which an individual attempts to satisfy their own concerns.
  • Cooperativeness: The extent to which an individual attempts to satisfy the other person’s concerns.

By plotting these two dimensions, the TKI model identifies five distinct conflict-handling modes. Understanding your own natural tendency and being able to identify these styles in your team members is the first step toward managing conflict effectively. Each style has its place; none are inherently “good” or “bad.” The key is knowing when to use which style, and how to respond when you see a particular style being used inappropriately.

The Thomas-Kilmann Conflict Modes
Assertiveness
Cooperativeness
Competing

“My way or the highway.” (High Assertiveness, Low Cooperativeness)

Collaborating

“Two heads are better than one.” (High Assertiveness, High Cooperativeness)

Avoiding

“I’ll deal with it later.” (Low Assertiveness, Low Cooperativeness)

Accommodating

“Whatever you want is fine.” (Low Assertiveness, High Cooperativeness)

Compromising

“Let’s split the difference.” (Moderate Assertiveness & Cooperativeness)

Masterclass Table: The Five Conflict Styles in a Pharmacy Context
Conflict Style Description & Mindset When It’s an Effective Style to Use When It’s a Destructive Style to Use
Competing Goal-oriented and assertive, not cooperative. Views conflict as a win-lose situation. Focuses on their own position and uses power to win.
  • Emergencies: During a code or a critical patient safety event, a leader must take charge.
  • Unpopular but Necessary Decisions: Implementing a non-negotiable regulatory requirement (e.g., new USP <797> rules).
  • Ethical Boundaries: When a core professional or ethical principle is at stake.
  • For routine interpersonal disagreements.
  • When used by a leader as their default style, it creates a culture of fear, crushes morale, and stifles feedback.
  • When dealing with peers where collaboration is needed for long-term success.
Accommodating Unassertive and highly cooperative. Neglects their own concerns to satisfy the concerns of others. Yields to another’s point of view.
  • When you realize you are wrong and want to show reasonableness.
  • When the issue is far more important to the other person than it is to you.
  • To build social “credits” for future issues.
  • When preserving harmony is more important than the outcome of this specific conflict.
  • If used habitually, it can lead to burnout, resentment, and being taken advantage of.
  • When it involves yielding on an important safety or ethical principle.
  • Can lead to suboptimal solutions because your own valuable perspective is withheld.
Avoiding Unassertive and uncooperative. Sidesteps, postpones, or withdraws from the conflict. Does not address the issue at all.
  • When the issue is trivial and not worth the time or energy.
  • When you need to cool down and gather more information before addressing the conflict.
  • When there is no chance of you satisfying your concerns (i.e., you have no power in the situation).
  • When used for important issues, it allows problems to fester and grow worse.
  • As a manager, avoiding conflict between your team members is a dereliction of duty and destroys team trust.
  • It can create ambiguity about rules and expectations.
Collaborating Both assertive and cooperative. Views conflict as a problem-solving opportunity. Works with the other person to find a “win-win” solution that fully satisfies both parties’ concerns.
  • When the issues are too important for a simple compromise and a creative, integrated solution is needed.
  • When you want to merge insights from people with different perspectives.
  • When building long-term relationships and commitment is crucial.
  • For resolving complex workflow or clinical disagreements.
  • It is very time- and energy-consuming. It’s not practical for all conflicts.
  • Not effective for trivial issues or when a quick, decisive action is needed in an emergency.
Compromising Intermediate in both assertiveness and cooperativeness. Aims to find an expedient, mutually acceptable “lose-lose” or “split the difference” solution that partially satisfies both parties.
  • When goals are important, but not worth the effort or potential disruption of a full collaboration.
  • To achieve a temporary settlement on a complex issue.
  • As a backup when collaboration fails.
  • For issues like scheduling disputes where a perfectly “win-win” outcome is impossible.
  • Can lead to suboptimal outcomes if a better, collaborative solution was possible.
  • Can feel like a loss for both parties, and may not fully resolve the underlying issue.
  • If overused, can discourage creative problem-solving.

9.4.3 The Leader as Mediator: A Step-by-Step Framework for Resolution

When a conflict arises between your team members that they cannot resolve themselves, you must step in as a neutral mediator. Your role is not to be the judge and jury, but a facilitator of a structured conversation. The goal is to guide the parties toward their own solution. This structured process provides psychological safety and moves the conversation from accusation and emotion to problem-solving and agreement.

The Golden Rule of Mediation: Be Hard on the Problem, Soft on the People

Throughout this entire process, you must constantly reinforce this principle. Your language should always frame the conflict as a mutual problem to be solved, not a battle between two people. Constantly redirect the conversation away from personal attacks (“He’s always so lazy”) and toward the objective, observable problem (“So the issue we need to solve is how to ensure the out-of-stock list is consistently completed before the end of the shift”). This depersonalizes the conflict and makes a collaborative solution possible.

The CPOM 5-Step Mediation Process

Step 1: Set the Stage (The Pre-Meeting)

Never attempt to mediate a conflict on the fly in the middle of the pharmacy. This is a formal process that requires a neutral, private setting.

  • Meet Individually First: Hold separate, private meetings with each party. This allows you to hear their unfiltered perspective and allows them to vent emotions without an audience. Your goal here is not to solve, but to listen and understand.
  • Set the Joint Meeting: Schedule a joint meeting in a neutral space (like a conference room, not your office). Inform both parties of the meeting’s purpose: “To have a constructive conversation and find a workable solution to the workflow issue.”
  • Establish Ground Rules: At the beginning of the joint meeting, establish clear rules of engagement. For example: “We are here to find a solution. We will treat each other with respect. There will be no personal insults or interruptions. Each person will get a chance to speak, and our focus will be on the problem, not the person. Do we all agree to these rules?”

Step 2: Gather Perspectives (The Opening Statements)

Allow each person to explain their perspective on the situation without interruption.

  • One at a Time: Flip a coin or ask who wants to begin. Enforce the “no interruptions” rule strictly.
  • Use Active Listening: As each person speaks, use active listening techniques. Nod, make eye contact, and summarize what you’ve heard: “So, if I’m understanding you correctly, your primary frustration is that when the inventory is not ordered on time, it creates significant rework for you the next morning. Is that right?”
  • Validate Emotions, Not Behaviors: You can acknowledge someone’s feelings without condoning their actions. “I can understand why you would feel angry if you believe the workload is being distributed unfairly.” This does not mean you agree with them, only that you understand their emotional state.

Step 3: Identify Interests, Not Positions (The “Why”)

This is the most critical pivot in the entire process. A Position is a person’s stated demand (“I refuse to work weekends!”). An Interest is the underlying need, desire, or concern that drives that position (“My childcare is only available on weekdays”). You cannot negotiate on positions, but you can find creative solutions that meet underlying interests.

Masterclass Table: From Positions to Interests
The Conflict Person A’s Position Person A’s Underlying Interest(s) Person B’s Position Person B’s Underlying Interest(s)
A scheduling dispute between two pharmacists. “I must have the early shift (7am-3pm).” To be home in the afternoon for their children’s school activities. (Need: Family time) “I absolutely cannot work the early shift.” Is not a “morning person” and feels they are more clinically sharp in the afternoon. (Need: To feel competent and safe)

Your Role: Use probing, open-ended questions to dig below the surface of the stated positions. “Can you help me understand what makes the early shift so important for you?” “What is it about the late shift that works best for your clinical rhythm?” Once you have identified the shared and individual interests (e.g., they both have an interest in providing safe patient care and having a predictable schedule), you have the raw material for a solution.

Step 4: Brainstorm Potential Solutions (The Creative Phase)

Now that the interests are on the table, you facilitate a brainstorming session.

  • Focus on Quantity, Not Quality: Encourage the parties to generate as many ideas as possible, no matter how outlandish. Do not evaluate or criticize any idea during this phase.
  • Frame it Collaboratively: Ask: “Given that we need to cover all shifts, ensure patient safety, and accommodate family needs, what are some possible ways we could structure the schedule?”
  • Potential Solutions for the Scenario: Maybe they could work mixed shifts. Maybe one could work 10-hour shifts four days a week. Maybe there’s another pharmacist who prefers the early shift and could be brought into a three-way rotation. The goal is to create a list of options.

Step 5: Agree on a Solution & Follow Up (The Agreement)

Evaluate the brainstormed list and guide the parties toward a mutually acceptable solution.

  • Evaluate Options Against Interests: Go through the list of solutions. Ask: “How well does this option meet Person A’s need for afternoon family time? How well does it meet Person B’s need to work during their peak clinical hours?”
  • Seek a Win-Win or Fair Compromise: Guide them toward the option that best satisfies the most important interests of both parties.
  • Document the Agreement: Once a solution is agreed upon, state it clearly to ensure there is no ambiguity: “So, the agreement is that for the next three months, Pharmacist A will work three early shifts and two mid-shifts per week, and Pharmacist B will do the reverse. We will then revisit this to see how it’s working. Is that correct?”
  • Schedule a Follow-Up: Set a date to check in on the agreement. This ensures accountability and allows for adjustments if the solution isn’t working as well as intended.