Three Keys to Making Disagreements Constructive

On the surface, the job of the Private Diagnostic Clinic Outcomes Research Team is fairly straightforward.

Caregivers from Duke Health System enlist the help of the team, known as PORT, when they have an idea for a quality improvement project or a way to improve patient care but need to see if data supports their hypothesis.

PORT, a diverse group of computer, clinical and data experts housed within Duke Health Technology Solutions’ Analytics Center of Excellence, then sifts through Duke Health System’s wealth of data to produce products that ultimately give clinicians tools, technologies and data they need.

Of course, the path from initial idea to final report can be tricky.

Jennifer Gagnon, senior information technology manager at Duke Health Technology Solutions who oversees PORT, understands the challenges inherent in getting people from different backgrounds to work together on a project.

“The biggest challenge we have is bridging the technical with the clinical,” Gagnon said. “We have world-renowned experts asking profound questions about patient care, but sometimes the data we have doesn’t seem to provide the answer.”

But as Gagnon points out, these hurdles are rarely insurmountable. And in some situations, they can create opportunities to figure out a better way to reach the project’s goals.

“When the project team hits a barrier, team members put different ideas on the table,” Gagnon said. “Sometimes many of those ideas look attractive and the team can’t agree on which ones to pursue.”

Being able to disagree in a constructive way is a hallmark of successful teams.

“Different people bring varying perspectives, said Don Shortslef, senior practitioner with Duke Learning and Organizational Development. “They can challenge us or bring in information that we had not considered. So it’s important to create a work environment where people feel empowered to speak up.”

With PORT as a guide, here are some key ingredients for moving forward when people have different views.

Shared Purpose

Each PORT project starts off with several meetings between clinicians who’ve commissioned the study and the tech-minded PORT team members who comb through data to create the final report.

These meetings are where most of the hard conversations happen.

Doctors may want data that can’t be obtained within a reasonable amount of time, or the quality of the data available may not allow reliable conclusions to be drawn. So, there are often instances when compromises between what’s ideal and what’s possible must be hammered out.

But Gagnon, who was honored with the Managerial Meritorious Service Award by Duke President, Vincent E. Price, at last year’s Presidential Awards for Duke University and Duke University Health System, said that these discussions are largely pleasant and constructive since everyone at the table has a common cause.

“We’re here for patients,” Gagnon said. “We’re all passionate about what we do.”

According to Shortslef, if all of the stakeholders are working toward the same goal, disagreements are much more likely to reach positive resolutions.

“Having a mutual purpose is important,” Shortslef said. “Without a common objective, there’s no real reason to have these conversations.”

Transparency

Gagnon said that the most common question asked during meetings between PORT members and clinicians is “why?”

While doctors may enter the conversation with a set list of data points they’d like analyzed, PORT members often press them on the reason they want to explore those particular ones.

“It’s critical for us to keep asking why they want this or that,” Gagnon said. “Sometimes, they think they want to know something, but they actually might not need to know that, or they might be better served by looking at something else.”

In order to for conversations to be fruitful, there needs to be a free flow of information. Neither side can have their guard up.

If the clinicians aren’t forthcoming with the thoughts behind what they’re asking for, and the members of PORT don’t explain why they’re asking so many questions, the process won’t yield its best results.

“You want to have an environment where people are comfortable sharing what they’re really thinking,” Shortslef said.

Trust

Shortslef, who teaches courses on, among other topics, communication and leadership, said that the most important element to navigating potentially tense conversations is trust. If everyone involved has positive motivations, most disagreements can be overcome.

“What really affects trust the most is how you perceive people’s intention,” Shortslef said. “If you feel that my intention is good, then you’re more likely to trust and talk to me and open up to me. But if you feel that my intention is to blame, criticize, be negative or bring you down to make myself look good, you’re not going to trust me.”

For PORT and the people the group works with, that trust is most evident during the “retrospective meetings” that occur periodically during the project.

It’s in these meetings that clinicians and team members take a frank and honest look at how the project has unfolded thus far and point out and discuss what helped propel it forward and the complications that may have slowed it down.

At the root of the meeting is an understanding that people on all sides have done the best they could with the resources and information available.

“Those are the best meetings,” Gagnon said. “You leave your emotions at the door. The intention is to make us a better team. We learn a lot.”

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