Managing Disagreements and Conflict

Disagreements are inevitable in busy clinical environments. How teams handle them affects safety, morale, and patient confidence.^[1][3] Visible conflict in front of patients undermines trust and can lead

Principles for constructive conflict management

Focus on the clinical question and patient interest rather than status or blame.^[1][3] Use brief “time-outs” to remove debate from the patient’s presence.^[1] Adopt shared tools such as PACE (Probe, Alert, Challenge, Emergency) so junior staff can raise concerns respectfully.^[2] Leaders model openness to challenge and thank colleagues who identify risks.^[7]

• In the moment: If disagreement arises in front of a patient, acknowledge the need to confer (“We’ll compare notes and come straight back to you”) and step aside.^[3][1]
• After the event: Debrief using facts and effects; capture agreed standards in SOPs to prevent recurrence.^[1][4]
• When stuck: Use a third-party opinion (another clinician or pathway lead) and document reasoning transparently.^[6][3]

Preventing recurrence

Teams benefit from “red rules” for common flashpoints—who clears to drive after dilation, when to escalate flashes/floaters, and which staff may adjust paediatric frames. Audit incidents for communication failures rather than individual blame.^[4][1]

Provide joint training (optometrist–DO–assistant) so each understands the other’s constraints and metrics.^[5] Conflict managed well strengthens teams; unmanaged conflict fragments responsibility and invites harm.^[1]

References (numbered in text) Why we include references

1. Patient Safety Incident Response Framework — NHS England Find (opens in a new tab)
2. Probe, alert, challenge and escalate (PACE) — Royal College of Obstetricians and Gynaecologists / Patient Safety Learning Find (opens in a new tab)
3. Good medical practice — General Medical Council Find (opens in a new tab)
4. Being fair tool: Supporting staff following a patient safety incident — NHS England Find (opens in a new tab)
5. Framework for action on interprofessional education & collaborative practice — World Health Organization Find (opens in a new tab)
6. Martha’s Rule — NHS England Find (opens in a new tab)
7. Freedom to speak up — Care Quality Commission Find (opens in a new tab)