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Episode 07 - Hospital Conflict Resolution with Dr. Mandy Brisebois

podcast Nov 14, 2022

Episode Notes

Dr. Kevin Mailo welcomes Dr. Mandy Brisebois, physician and Certified Health and Wellness Coach, to the show to address the reality of interpersonal conflict and how to resolve it. Dr. Brisebois specializes in helping practitioners work through conflict and shares her experience with listeners. 


Dr. Brisebois clarifies that conflict is the end result of missing the boat on necessary steps that come beforehand. She identifies that communication, collaboration, aligned expectations, and knowing each other’s goals are all conversations that should be happening amongst colleagues in order to avoid clashes. However, knowing how to resolve conflict when it does arise is vital, especially in pandemic times of stress and overwork.  


In this episode, Dr. Kevin Mailo and guest Dr. Mandy Brisebois discuss how to address conflict or tense exchanges in the moment, with Dr. Brisebois offering ways to change how we think about the exchange and how to open conversation before walking away. Dr. Brisebois shares what process she has learned to identify conflict, how she takes people through conflict resolution, and the necessity of psychological safety in the workplace in order to foster the communication required.  


About Dr. Mandy Brisebois:

Dr. Mandy Brisebois uses her influence in high level leadership positions to advocate for physician integration into our health systems. Ultimately a deeper understanding of our complex systems will enable physicians to maximize their impact and promote patient care in the most effective capacity. Ultimately this strategy contributes to less conflict in the work environment, and fewer practitioners modifying their practice due to burnout.

Dr. Brisebois is a certified Wellness and Executive Coach (with specialization in healthcare in process), a General Internal Medicine and Palliative Medicine Specialist, as well as having extensive training in conflict, negotiation, mediation, equity, diversity and inclusion. She has served as the Medical Director for a large 290 bed hospital, the Medical Director of the Covenant Palliative Care Institute, as well as an Associate Chief Medical Officer of Covenant Health. She is completing her Masters of International Health Leadership through McGill University and has trained at multiple world renowned organizations including the Mayo Clinic, Berkeley, Oxford, UBC, and the Justice Institute of British Columbia. Her leadership specialty is helping practitioners and teams find success through conflict, and learn from these successes to create happier, more efficient and more effective healthcare teams. She has spoken at many international events, and she is a published author in her fields of expertise.


Resources discussed in this episode:

Physician Empowerment: website | facebook | linkedin

Dr. Mandy Brisebois, MSc, MD, FRCPC, AoDI, CEC: website | linkedin





Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at Phys, that's P H Y S, to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.


Dr. Kevin Mailo: [00:00:35] As I've mentioned before, for those of you that have joined us on our webinars or podcasts, you know who I am. I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast and one of the co-founders of Physician Empowerment, and who I have with me today is a colleague and a friend whom I really admire, not only for her clinical work, but for her incredible leadership. So joining me today is Dr. Mandy Brisebois, and Mandy is a general internist with a hospital based practice. She specializes primarily in palliative care and chronic disease management, but she's also held numerous leadership roles, including Associate Chief Medical Officer and Medical Director at a major community hospital. And Mandy, over the course of her career, has really taken leadership to another level. And one of her areas of focus as a medical leader is conflict resolution. And so that's what we're going to be talking about. And it's going to be interesting because we get a lot of training in medical school and residency on how to navigate a difficult patient encounter. But what we're going to focus down on today is interpersonal conflict between physicians. And I don't need to go to any great length about how common this is, but we certainly know what occurs. And with that being said, Mandy, why don't I let you take it from here as far as introductions and where you want to want to go with our talk today.


Dr. Mandy Brisebois: [00:01:58] Sounds great. Thank you so much, Kevin, for having me here. And it's just been such a pleasure to talk to you. I wanted to be on this show and also really specialize in this conflict work because I think we're in a really bad spot and physicians have been through a really tough time through the pandemic. We've been bogged down and a lot of us don't have much capacity to really be on our best behavior all the time. And I don't think in medical school we get taught how to manage conflict. In fact, I know we don't because in my role as medical director and the ACMO role, I had to manage so much conflict with colleagues and I had no idea what I was doing. And it wasn't my fault. And I thought for a long time that it was my fault. And so I went and got training and this is why I've got so interested in it, because I've got extensive training now in conflict negotiation and mediation. And I realized that there's a process and that we actually can learn how to take care of conflict.


Dr. Kevin Mailo: [00:02:58] Awesome. So what are some of the contributing factors then to conflict? Like talk about the ingredients for interpersonal conflict. I mean, one of the big ones coming out to me is like limited resources, right? For physicians as we try to deliver the standard of care to our patients. But tell me a little bit more about what do you think contributes to a conflict prone environment for health care providers?


Dr. Mandy Brisebois: [00:03:23] That's an excellent question, and I love that you bring up the resources because it's typically what we go to is what's limiting me. And the conflict, usually I say if we have conflict, we've kind of missed the boat. Conflict is the end result. The beginning is the communication, the collaboration, the expectations that are aligned, actually knowing what each other's goals are and having those conversations. And because we haven't really been taught how to do that, we end up just going, I don't have enough resource or I can't take care of my patient. And we shrug our shoulders and then we say to somebody, Give me more resources. And we don't actually know how to talk to them about what is the problem. And we don't know in the moment to say to someone, let's say a physician colleague talks to you in a very terse way, how do you manage that rather than walking away kind of thinking, Well, my day is really bad. I'm just going to, it's going to get worse now. Instead of talking to them in the moment and solving it and then it's over and you know your colleague better and your day is actually better when you learn how to solve those in the moments and you learn how to actually go through the problems and see what they are. It's not just about a resource thing. You have to actually nail it down to a solvable, neutral problem that you can solve. And it takes a lot of work and skill to figure out how to do that. And so I think we need to practice on it and learn how to do it.


Dr. Kevin Mailo: [00:04:47] So finding shared interests then is a key part of this.


Dr. Mandy Brisebois: [00:04:51] Yeah, and especially with big organizations, I keep saying that we are part of these massive organizations now. They have multiple strategic plans. Most of the time we're not really aware of what the strategic plans are, and so we want a resource. We don't know where it fits in our organization's strategic plan because we haven't, well, maybe we haven't looked at the Internet. The expectation that we're supposed to look on the Internet hasn't really been connected to us either. And even our leaders aren't really sure, like, what am I supposed to give to my colleagues? What do they care about? How do I connect the organizational goals with our goals as physicians? And when we don't connect, then we don't communicate. We don't know how to move forward and to really action on our knowledge, which is clinical care. And so I'm really trying to promote if we get these conflict situations under control and learn how to talk to each other about hard things that we actually learn about each other, we learn more about our jobs and we want to come to work instead of just sort of putting our heads down and walking in the door and going home.


Dr. Kevin Mailo: [00:05:55] Yeah, I think that's it. You know, as far as like when morale falls, I think a lot of people do just honestly just want to get in, get out and get through it. But that means people aren't invested in health care systems in which they work in, right. Because people sort of, I think, throw up their hands and feel disempowered. So how do you go about that process of learning to say those initial, start that conversation? I think that's probably one of the hardest steps is to say, I'm identifying a conflict here. How do we, how do we get to that point ourselves personally as individuals working within the health care system? And then what practically do we say when you talk about sharing in the moment or notifying a medical leader? How does that look? How should that look?


Dr. Mandy Brisebois: [00:06:42] It's so hard because we're not really used to it. We're not really used to responding to behavior that we're not comfortable with. And it is important to remember there's so many cultural differences between people that sometimes someone maybe seems very terse or no expression, and that just might be the way they are. So one of the things they say that if you notice something at work and somebody says something to you, let's say it seems quite aggressive because this happens a lot, someone's like, they were really aggressive and demeaning. And I'll ask them, Well, what did they say? And only 7% of what we understand are the words. So the rest of it is the tone of voice, the mannerisms. And often when they tell me the words, what they remember the words being, it didn't seem like it should be something that you would be so upset about because I wasn't there. And often when these people get feedback after the fact, they don't know what they did either. So what I tend to do is if someone, and you have to develop your own little things, but if someone says something to me in quite an aggressive tone, often I'll just do a little tear. I'm like, Oh no. Or I'll say, Ouch. Or I'll say to them, Are you okay?


Dr. Kevin Mailo: [00:07:50] Right.


Dr. Mandy Brisebois: [00:07:51] And they'll be like, What are you talking about? And I'll say, Well, this just wasn't the reaction I was expecting from you. I really thought we were on the same team. I'm worried I said something wrong. Can you tell me where you're at? And when you flip it around like that, people sort of go, Yeah, I'm having a terrible day. I've got 15 people in the Emerge, you know, what did you interpret? And I'm like, I just thought you were really upset with me. And most of the time they say, No, actually I'm not. I'm just really stressed. Thanks for saying something. Now, if they don't say that, I was talking to someone else and someone else said, What if they say screw you? And you start to think, Well, that would really feel bad. But you know what? I say the same thing because if someone says that I don't like it, that you're talking to me about this, I'll just say, But I really want to work with you. And when I got on this team, I was excited to hear what you had to contribute to the team. And for me, I can't be a part of that if I don't really understand what you're saying or I feel you're yelling at me and I want to be part here. And how do you think we can move forward? Or I'll say to them, what kind of tone of voice do you think you're using? And they'll sort of look at me and go, What are you talking about? And I had one person say, Well, I'm in the military, so I don't know. That's just how I talk. And I said, Oh, that's good to know. Like, you start to know each other.


Dr. Kevin Mailo: [00:09:11] Yeah, well.


Dr. Mandy Brisebois: [00:09:12] It's fun.


Dr. Kevin Mailo: [00:09:13] Yeah, well, that's that's what I sort of discovered as I get a little bit older and a little bit wiser. I saw personalizing things that I came across, whether that's a patient that might be irritable or an allied health colleague or a physician colleague, it's just peeling back that layer. Peeling back that layer just a little bit to find out what's going on. Because very often it's that old iceberg theory that comes up, which is we don't know 1/10 of what someone's really dealing with beneath the surface. Right? And I'll never forget watching one of the most egregious outbursts from a physician towards another staff physician when I was a medical student. And it was later in the week that he just sat down and described how his whole life was falling apart on a personal level. And that's when I realized, like hurt people hurt. And I don't think that's an excuse and to say, okay, well, we're just not going to deal with it. That's that's not right either. But it's about saying, okay, now there's another issue here, right? We're not talking about beds or discharges. We're actually talking about something else. So now we are going to deal with it. It's an opening.


Dr. Mandy Brisebois: [00:10:20] Yeah, exactly like you said, it's an opening and that person may go home and kill themselves. And I'm not trying to be depressing.


Dr. Kevin Mailo: [00:10:27] Oh, God, I completely agree. I have looked at the stats - for anyone that's listening to this podcast that I'd encourage you to look at the Canadian Medical Association statistics on physician wellness. There was a great publication that came out in 2017, 2018, and I think there is now post pandemic data that's coming out and it's staggering. And I think we all need to give one another some compassion and some space because the job is incredibly stressful, but so are many of our personal lives.


Dr. Mandy Brisebois: [00:10:54] Yeah, and don't give up on people. And I always say, just take a pause if something seems off, because after the fact, it is so hard to go over who did what and who said what. And especially if you go to a supervisor or something, we really try, it's called the Vanderbilt model, where you really start with this coffee chat and you just sit down with someone. I say, don't wait for coffee, do it right then, but talk to someone, look at them in the eyes and say, I actually care about you. I mean, you may not think I do and we're not, maybe we're not perfect friends.


Dr. Kevin Mailo: [00:11:28] Yeah, Maybe we're never going to get together --


Dr. Mandy Brisebois: [00:11:30] Yeah.


Dr. Kevin Mailo: [00:11:31] -- and go hang out outside of work. But I do care.


Dr. Mandy Brisebois: [00:11:34] Yeah. And I'm invested in health providers, whether it be a nurse, a physiotherapist or a physician. And I really do want to be here. And if you don't want to talk, just recognize. I recognize something. And if you ever have a chance to talk, I want to talk to you about it, but I'm just letting you know how I feel so you know that those things impact me at work too. And they sort of make me wonder whether I want to be here too. And when you say it that way, people start going, Oh, I'm impacting other people's work as well.


Dr. Kevin Mailo: [00:12:02] And I think physicians, we're all by and large, very conscientious. So that I think is a very powerful statement when you say you're impacting me because that that is kind of a a cue for us to evaluate our behavior.


Dr. Mandy Brisebois: [00:12:17] Yeah. And I try to make things, it's really important... I was just talking to somebody else and I said, it's so important to not tell people what to do or what they should do differently because we all want to be different, but no one wants to be told to be different, but really putting it on how it's making us feel and that it's their behavior, it's not them. That it just isn't that you think they're a bad person, it's just that moment that made you feel that way and then really focusing on the positives and you're talking about what to do about it. Well, you do that in the moment. And you know, if it doesn't work and something happens again and you do it again and it doesn't work and you have to get an adviser or a supervisor or whoever is above you involved, if you've said something in the moment, that person will not be surprised. Because you'll have twice said something and you'll say, How do we resolve this? And I'm like, Well, we're not resolving this. Well, I'm going to have to then get some help because I don't have the tools I need. And if you say it like that, like I don't have the tools I need to resolve this instead of someone getting called out of the blue with some complaint they didn't know it was coming because then they're coming into the conversation already unhappy.


Dr. Kevin Mailo: [00:13:26] Right. So, Mandy, you alluded earlier to a process. You said there are steps to go through conflict resolution. Can you give us an overview of that? I mean, obviously, we don't have the time to go into this in a whole bunch of depth, but I would absolutely love to hear this because, I mean, it's probably not that much different when it comes to care. There's a history, there's a physical, there's a lot of tests. I mean, we just we go through a process. So take us through an overview of that process of conflict resolution.


Dr. Mandy Brisebois: [00:13:55] I love this because I always say internal medicine is easy and everyone goes what are you talking about? Well, it's just you categorize things and stepwise, stepwise, stepwise. So this is exactly the thing. So I say, look, we have emotion. So we got, I call it the rant, but whatever it is, you've got to package that somehow, like deal with it. Some people have written me 15 page letters. They're like, This is great, let's send it off. Nope, this is just for you to think about. But you have to get that out and you have to be okay with it and recognize that emotions are normal and it's really hard. So give yourself that. That's the first thing. The second thing, though, is knowing where the place for that is and where the place is not for that. You take care of that and then you go through the process of conflict. I call it conciliation because conflict's never resolved. It's still there.


Dr. Kevin Mailo: [00:14:39] Yeah.


Dr. Mandy Brisebois: [00:14:40] So the first thing is what is the issue, as we say in conflict teaching. And the issue is the problem and the problem isn't He yelled at me. The problem has to be solvable and it has to be very clearly neutral. So it has to be something like if someone's yelling at you, I want to know how we communicate in the workplace to effectively get work done. And what's the process, so another problem would be what would the process be if you feel somebody is behaving in an unprofessional way in the workplace? Those both things are solvable. Both of them are very neutral. You're not using this, Crucial Conversations is a great program and it talks about victim, villain, and helplessness. And when you hear people talking about being a victim or you're a villain or I'm helpless, conversations will not occur, So it's very good to recognize that and keep everything neutral. So I spend an hour with people, actually, and outline the problems. It takes a lot of practice to learn how to do that. So you actually look through the problems, map them all out. People always come with to me with one, and there's actually 18 solvable problems. And when they look at them, they go, Wow, that's really an easy one. Like, I easily can come up with a solution to that. It's just like internal medicine. And so we do that. Then I send them home and I say, I want you to think about these problems and you tell me why you care. And this is really digging deep. It's very reflective. The why do you care if you communicate well with your partners? And it's all about I want to enjoy my work. You know, I want to be able to effectively work. I actually want to have a job. I need my job for for my livelihood. I don't want to take shifts. I'm not taking shifts now. So I'm losing money because I don't want to be there. So there's all these different things. Or it comes in it is infiltrating my family. So really, what do they care about? So then they come back. The next step is we talk about the stakeholders. So who's involved? You know, sometimes it's one person, but sometimes you have a whole team and there's multiple different people. And we go through that. And then I have the person think about what those stakeholders, they care about. And we're just guessing. But it's putting you in that position that you really think about them. And as you said before, what are they going through? They may collapse in tears when they turn the corner. You know, they may be getting separated, their child may be sick. They may be taking care of an elderly person. You don't know. So I always say, guess. Just go through it and think. And we create a, I call it a conflict roadmap, and we create this roadmap. And then I let the person decide, What do you want to do with that? And most people want to meet with the person that they had this thing with. And I usually offer to go sit with them while they're doing that, or I'll coach them through how to actually take that meeting in a really, again, really neutral, neutral language, positive way and just collaborating. And we send the person that we want to meet with, this roadmap beforehand. And it's amazing. The meetings are amazing.


Dr. Kevin Mailo: [00:17:33] Wow.


Dr. Mandy Brisebois: [00:17:34] Because physicians see that you worked so hard. I really want to be better. I really want to be your colleague and look at all the work I put into it. I want to hear your perspective. I guessed but now you tell me and then you can have a conversation about those things. I had one person come back and say, This was so amazing and someone who would never really share, they went back to their team, they shared everything and they're like, We got to get the team to do this. Because it bonds you. It bonds you together. That you both have some common goals. You see common things together. And it seems so easy when you've done it once. But it takes, it takes practice and courage and the ability and being in a safe place. And this, I keep encouraging organizations let people in your organization be in a safe place where if someone comes back at them and doesn't respond well multiple times, that you have a place to go and someone takes you seriously, that you're trying to do this. So this is the whole thing about psychological safety in our workplaces that we have to take it seriously so we can communicate in the moment.


Dr. Kevin Mailo: [00:18:38] So how do we create psychological safety? I hear that term so much, and I think it's amazing because I didn't hear that term 10, 15 years ago. Right. Or it wasn't that common. But how do we create robust organizations where we feel, number one, that we can share, number two, that we're heard, and number three, that it's safe as we do so. Right. We're not worried about retributive behavior or being silenced. Talk to, talk to us about that. I think that's so powerful.


Dr. Mandy Brisebois: [00:19:11] We need some brave people because it takes vulnerability and it takes bravery in the workplace. And I've sat in situations with my team talking about my son when he was suicidal or drug addiction with family members, really vulnerable, having chronic illness. And it's amazing when you start being vulnerable, people are vulnerable back and you start to develop these dialogs. And so if one person sees somebody model this behavior, so if someone talks to me in a really offensive way from my perspective and I say in front of all the residents and the nurses there, you know, oh, ouch. I'm, I'm really trying hard. You're modeling for all those people. And if it turns out well, which usually it does, honestly, it flips the behavior immediately when you say something like that. I've had patients laugh because they say, what is this emotion? Like I'm yelling, I'm angry. But it really gives people that ability to open up. So I think we need brave people that can model this, that can mentor it. And once you're actually on the ground doing it, it's not something you read on the Internet. Like we can write for our organizations all we want, that we have psychologically safe environments. You have to see it in action to feel safe enough to come forward, because many people have had experiences where they do try to come forward and they don't have that experience. And that's where we need to jump in. And that's some of the work I'm doing where people are stuck in those situations and I'm helping them work through it in that regimented way so we can take that road map to the stakeholders and say, we're really trying to help fix this problem and the organizations do care right now. We have to just come in a regimented way and really show them how we can do it better.


Dr. Kevin Mailo: [00:21:00] And what should medical leaders, like high level medical leaders, be looking to do, practically speaking, to begin to implement this? You know, we talk about modeling it in an encounter or a one on one or in meetings, but at an organizational level, what do we need to be doing?


Dr. Mandy Brisebois: [00:21:18] I think people are afraid in a lot of organizations to say anything. They don't want to jeopardize their relationships. They're working with people and just coming to work and going home is good enough. And I think that organizations and high level leaders need to find strategies for people to report things in safety, whether it be a click of the button that they can just click. And hey, if you have eight complaints about someone, it is, you know, in a lot of regions in bylaws that you can actually move forward without having to put your name forward. I think that people need to know that it's not just the concern that will go forward, but something will occur and they may not know what occurred, but they'll know that that behavior is stopping. And if they don't see it stopping, that they can go back. Because if we don't have those methods for people to move forward and really take it seriously, like really trust the people that we're--


Dr. Kevin Mailo: [00:22:18] We're talking credibility. We're talking credibility.


Dr. Mandy Brisebois: [00:22:20] Yeah. If someone says that this was very hurtful, it doesn't mean that the words were hurtful, but something about the interaction made it hard for them to work. And so instead of just sort of, sometimes they go to the person and say, well, what happened? And they're like, nothing. I didn't do anything. And they're like, okay, they didn't do anything. And that ends. Instead of that, they can say, What could it have been that this person felt so impacted? And you can actually work through it with the person who felt so impacted and say, What do you think it was? And really dig, it's called appreciative inquiry. You just keep asking these questions to find out what it was. And sometimes you get to an issue that actually didn't have anything to do this situation, or maybe it did, and the person who was talking to them had no idea about what they were getting into or what they were saying, or they didn't realize that something at home was impacting them, even. The person who is being a little aggressive or whatever it may be. So I think it takes conversations, it takes time. And so this means that organizations and physicians need to invest the time and say this is important, that we actually get to know each other, because we can have really great workplaces. And this is the message I'm trying to send that please don't give up hope, because if we do stick together, if you have trouble, we reach out to each other and try to work through this process and get some help. But it's solvable.


Dr. Kevin Mailo: [00:23:43] Wow. Wow. Mandy, this was absolutely amazing. And I hate to wrap it up.


Dr. Mandy Brisebois: [00:23:53] I know we have to go.


Dr. Kevin Mailo: [00:23:54] I know. I know. I don't want to. We are absolutely, absolutely going to talk again because I'll tell you why I think this is so relevant for Canadian physicians is to echo past CMA President, Dr. Smart, we are looking at crisis in our health care system. And crisis in our health care system means fewer and fewer resources for a sicker and sicker population that is aging. And this is going to bring more and more physicians in conflict with one another and in conflict with medical leadership and allied health. And we need the tools to navigate this. And obviously, this isn't the solution. The solution is more resources, which we have to advocate for separately. But the big one is that inevitably things are going to get worse before they get better. That is my own opinion. So how can we weather this storm and how can we come out as a profession, not only having gotten through it, but thriving and growing as a profession? Because I think there's a lot to be learned and I think things got, we learned a lot through the pandemic. And I think there's more to be learned and that the profession is an ongoing effort to modernize and improve.


Dr. Mandy Brisebois: [00:25:03] And we need to stick together, as you said.


Dr. Kevin Mailo: [00:25:05] Absolutely, care for one another, care for one another. You know, I try to treat my colleagues like patients, not, you know, not in a paternalistic way here, but in a notion of compassion. Right. Like just have some compassion for your colleague who might be exhausted, working long hours or dealing with a health issue or mental health issue or whatever. A little bit of compassion goes so far. So far.


Dr. Mandy Brisebois: [00:25:31] Absolutely.


Dr. Kevin Mailo: [00:25:32] So with that being said, we'll open it up to the chat if anybody has got any questions. But otherwise, I am so, so grateful to have had you on here, Mandy. It was just amazing and I cannot wait to interview you again on the podcast and have you do another webinar because I think people need this. I think we all need this.


Dr. Mandy Brisebois: [00:25:55] I need it. I coach, I can't coach myself, but I do, I get coaches to coach me through my own thing, so...


Dr. Kevin Mailo: [00:26:00] It's wonderful.


Dr. Mandy Brisebois: [00:26:01] Yeah, you've got to do it and I will put a plug if you're in the Edmonton zone, I am doing this work through the Medical Zone Staff Association, so go to their website if you need any help, like as a leader or someone in your organization and you want some advice or you want to learn how to do this, I'll help you through it.


Dr. Kevin Mailo: [00:26:18] Absolutely. Absolutely. Thank you again, Mandy.


Dr. Kevin Mailo: [00:26:22] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at Phys, P H Y S, to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.