With your permission I wish to take you on a journey to a realm where many dentists fear to tread: dental office disputes. And I wish for us to establish a mindset in which we believe that disputes can be beneficial and can be a powerful motivator for change when managed well.
Let’s face it, though. Disputes are not something we typically look forward to. Thousands of years ago Aristotle pondered disputes and offered that anyone can become angry—that is easy; but to be angry with the right person, and to the right degree, and at the right time, and for the right purpose, and in the right way—that is not within everybody’s power and it is not easy. Several years after Aristotle the Christian tradition painted a somewhat more positive picture of disputes when suggesting that blessed are the peacemakers. However we choose to look at disputes I believe that we need not fear disputes. We have dispute resolution tools at our disposal that empower us to collaboratively transform disputes from something to fear into something to embrace.
(For simplicity the terms “conflict” and “dispute” will be used interchangeably throughout this posting. However, please be aware that the literature suggests differences which will not be discussed.)
Most dentists work in private practice, the military, and/or accept university appointments and, as such, are likely responsible for hiring, training, critiquing/reviewing, and disciplining staff. And many dentists report that their number one office concern is staff and staff issues: staff disputes and turnover can be detrimental to the profitability and emotional chemistry of a dental office; hiring staff and training staff is expensive and time consuming; and staff conflicts detract from the chemistry of an office which may ultimately affect the bottom line. Plus, it’s mentally challenging for the office team, dentist included, to work in a toxic environment. But staff are not the only disputants in a dental office. Other potential disputants can be patients (and their families), associates, business partners, spouses of business partners, labs, dental suppliers, repair techs, landlords, lawyers, elected officials, insurance companies, the government, etc.
Anytime, anywhere, and in any job there are going to be disputes. Christianity says that where two or three gather in My name, there I am with them. At the same time when two or more gather disputes are likely also with them. A dental office is no exception. And dentists, like many Americans, tend to avoid conflict as much as possible. In fact, studies show that 50% of Americans are conflict avoidant meaning that one half of all Americans in a conflict or dispute will choose to ignore it, choose to not deal with it directly, never address the issues that led to the dispute, and hope it will blow over all on its own. In a dental office (or any office/relationship) conflict avoidance can have serious repercussions. Untreated conflicts and disputes will fester, bubble over, and eventually become worse (think of an untreated abscess…).
Dentists are the leaders of their respective offices or departments. As such dentists are expected to lead their offices/departments through disputes. In other words, the dentist is responsible for resolving disputes in her/his office or department and this creates a potentially bad scenario: as discussed previously many dentists want to avoid and/or ignore disputes. And how disputes are ultimately handled is of the utmost importance: disputants need to be treated well and in the right way (as difficult as this may be at times).
As stated previously, we have dispute resolution tools at our disposal that can transform disputes from something to fear into something to embrace. What exactly do we mean when saying “dispute resolution”? Dispute resolution refers to the process of moving disputants toward the settlement of a dispute. And there exist many different processes that we use for the resolution of disputes. Some may be familiar, some not so. And all employ varying degrees of win-win (collaborative, joint problem-solving, interest-based bargaining) or win-lose (adversarial) interactions/techniques. The most recognizable dispute resolution processes in the U.S. are litigation, arbitration, mediation, and negotiation. (In the recent past all non-litigation dispute resolution processes were referred to as “alternative” dispute resolution. With “alternative” dispute resolution gaining more traction and becoming mainstream the literature is trending toward dropping the “alternative” designation. Now most non-litigation processes are being designated as simply “dispute resolution”. This is effectively excluding litigation as a labeled dispute resolution process and establishing “dispute resolution” as something separate/distinct from litigation. This posting supports the concept of a stand alone dispute resolution designation separate from litigation and all further mention of dispute resolution in this posting will refer to non-litigation processes.)
Dispute resolution executed well does not mean there will be an absence of disputes: there will always be disputes. Typically, what is dispute resolution expected to accomplish? Aside from the obvious settling of disputes, dispute resolution may establish and/or strengthen the relationship of trust and respect between people or terminate relationships in a manner that minimizes emotional costs and psychological harm. Further, disputes can have a positive side because good can arise from disputes. Usually disputes exist because something is not right and most likely needs fixing. Good can arise if the not-so-good issue that’s causing a dispute is discovered and effectively remedied.
Disputants (people in a dispute) typically argue because they want something and, dentistry notwithstanding, many feel that disputants share in a general lack of communication or perhaps even fail to communicate. This may not necessarily be true as we find that many disputants know and communicate all too well with their opponent/s. What is usually lacking between disputants is effective communication that discovers and explores the issues driving their particular dispute (disputes are all too often motivated by unfulfilled needs and/or a clash of values). How do we effectively communicate with our opponent/s? How do we jointly problem-solve with someone who may be irate? How do we collaborate with our opponent/s and keep our sights on win-win? Enter “[t]he method of principled negotiation developed at the Harvard Negotiation Project” (Fisher and Ury 1981, p. xviii) which, by many accounts, has become the well-spring of today’s dispute resolution movement. The method is comprised of four distinct parts and they are as follows:
“Separate the People from the Problem” (Fisher & Ury 1981, p. 10)
Great care must be taken to ensure that ingrained human frailties do not turn negotiations away from the original problem that precipitated the dispute. Further, we need to ensure that we create and maintain an environment that supports effective negotiations and joint problem-solving. All too often disputant’s inner dialogues, outward verbalizations (including word choices), body language, and emotions turn negotiations away from objective problem solving and create entirely new problems (and subsequent disputes). Often disputants become so engrossed in new problems created by out-of-control emotions and language that the entire precipitating problem is supplanted and may become nearly impossible to re-discover (all too often disputants give up and hire attorneys to continue the battle until someone wins and someone loses and all at great financial and emotional cost). Essentially, barriers to effective negotiations become ensconced.
William Ury (1991) suggests that negotiations can not and should not proceed until negotiation barriers are breached (as stated previously, we need to create and maintain an environment that supports negotiation and joint problem-solving). How do we get around negotiation barriers? Ury’s (1991) answer is the five strategies of “breakthrough negotiation” (p. 9). Strategy number one is first and foremost we must manage our personal emotions and reactions. Ury (1991) calls this “go to the balcony” (p. 11) with the balcony representing a calm mental promontory from which to step back from a situation, calm down, ascertain the situation, and regain perspective and composure before re-entering the situation or negotiation. Strategy number two is management of the other disputant’s emotions and reactions. Ury (1991) calls this “step to their side” (p. 53) which requires doing the opposite of what the other party expects. Ury (1991) suggests that opposites, such as listening and acknowledging (rather than attacking), can catch the other party off-guard. This creates a psychological condition called “cognitive dissonance” (p. 67) which is “an inconsistency between perception and reality…inducing [the other disputants] to change their perceptions of you in order to reduce the cognitive dissonance” (p. 67). Strategy number three is reframing the other party’s tactics as means to tackle the problem. For example, the opposite of rejecting the other party’s tactics is to acknowledge their proposals and then reframe the proposals as potential options (thereby turning the proposals toward identifying interests). Ury (1991) calls strategy number four “build them a golden bridge” (p. 4) in which we help give our opponent/s a voice in developing their own answers and solutions (this effectively supports appreciation and autonomy). Strategy number five is to use our power not to attack or escalate the conflict but to educate the other party. Ury (1991) suggests “(u)se your power to educate the other side that the only way for them to win is for both of you to win together…Don’t try to impose your terms on them. Seek instead to shape their choice so that they make a decision that is in their interest and yours” (p. 133).
“Focus on Interests, Not Positions” (Fisher & Ury 1981, p.10)
According to the famed psychologist Abraham Maslow, every human has innate needs and values. Maslow (1943) labeled them “physiological” (p. 372), “safety” (p. 376), “love” (p. 380), “esteem” (p. 381), and “self- actualization” (p. 382). Fisher and Shapiro expanded upon Maslow’s (1943) “hierarchy” (p. 386) and introduced the “five core concerns” (Fisher and Shapiro 2005, p. 15). “Core concerns are human [needs] that are important to almost everyone in virtually every negotiation. They are often unspoken but are no less real than our tangible interests. Even experienced negotiators are often unaware of the many ways in which these concerns motivate their decisions…These core concerns are appreciation, affiliation, autonomy, status, and role” (Fisher and Shapiro 2005, p. 14).
In dispute resolution we collectively refer to each person’s unique needs, values, and core concerns as their interests and understanding interests is key to the effective resolution of disputes. Interests speak to each one of us subconsciously and are the powerful yet silent motivators that drive people toward particular wants. We collectively refer to people’s unique wants as their positions. For example: “I want a million dollars” = a position; or “I want a Rolls Royce” = a position. So what are the interests (why’s/needs) that are driving the positions in our examples? “I want a million dollars” (why?…here comes the interest) “because I need to start my charitable foundation”. “I want a Rolls Royce” (why?…once again, here comes the interest) “because I need to start my luxury chauffeur business”. In sum, needs and values equal interests…interests generate positions…positions represent wants.
Positions are usually expressed as singular wants and each position is silently motivated by multiple interests and herein lurks a problem: fixation on positions is the fuel that sustains disputes. It is unfortunately all too easy for disputants to lose sight of the multiple interests that generated their particular position and all too often people believe that the only way to achieve satisfaction is through the fulfillment of their position. And people will go to great lengths to get what they want and often adopt a winner take all attitude which can drive people to extreme and unspeakable lengths such as violence and war. However, by uncovering and discovering people’s interests, and by understanding and recognizing interests, we can generate creative options that may satisfy a person’s position in a multitude of different and alternative ways. To re-cap, interests, which are usually multiple in nature, are the silent motivators that generate singular positions; recognition and understanding of the multiple interests that generated a particular position provides creative options that may satisfy the position and may ultimately lead to resolution of the dispute. To illustrate, think of an iceberg. The tip of the iceberg sticking out of the water is a person’s position (you don’t see a whole lot, only the little bit that a person allows you to see). But the biggest part of the iceberg rests underwater, invisible, and that invisible part is made up of all the interests that support that tiny and precarious position that we see above the water. Until we see and understand a person’s interests (and even help that person to acknowledge their interests) we may never really know how to satisfy a person’s position.
Here’s another way to look at the struggle between positions and interests. Argue for your position and you will most likely be fighting for one thing, and one thing only, which you may or may not get, and it will become a battle that you must win at all cost at the expense of your opponent (win-lose). Argue for your interests and you will be able to negotiate over several different and creative options with the likelihood that you and your adversary will collaborate and walk away from the dispute each with something to show and both of you will have won (win-win).
So, with dental office disputes a big mistake we dentists make is to assume we know what’s wrong with office disputants and well intentioned fixes can end up blowing up in our faces only because we have not uncovered, identified, and understood disputant’s interests. Shuffling staff hours, repositioning staff in the office, discounting procedures for angry patients, etc., usually don’t work unless we’ve first diagnosed the issues by uncovering, identifying, and understanding the underlying interests. An analogy is two children who want an orange and are subsequently fighting for the orange. Mom comes along, splits the orange in two, gives each child a half and now the children become angry and agitated at mom because that’s not what they needed. Mom says “huh?”. One child says that she needs the rind so she can bake and now she has only half of what she really needs and a bunch of pulp she doesn’t want. The other child says that he needs the pulp for juice and now has only half of what he needs and a bunch of peel he doesn’t want. If mom had taken the time to uncover the children’s interests then she could have generated options to satisfy the reasons why the children needed the orange in the first place. Position=I want the orange. Interest=I need the rind. Interest=I need the pulp.
“Invent Options For Mutual Gain” (Fisher & Ury 1981, p. 56)
As just alluded to, discovery of interests allows for brainstorming of multiple creative options for settlement. And a very important part of this step is to not squelch the creative process. Many options, including some that may seem outlandish, should be generated and considered. The amazing part of this stage in the negotiation is when disputants discover that they really needed the very same things all along. After just consideration of each option disputants are empowered to choose the best means for everyone to walk away from the bargaining table with a degree of satisfaction.
“Insist on Using Objective Criteria” (Fisher & Ury 1981, p. 80)
“The more you bring standards of fairness, efficiency, or scientific merit to bear on your particular problem, the more likely you are to produce a final package that is wise and fair. The more you and the other side refer to precedent and community practice, the greater your chance of benefitting from past experience…A constant battle for dominance threatens a relationship; principled negotiation protects it. It is far easier to deal with people when both of you are discussing objective standards for settling a problem instead of trying to force each other to back down” (Fisher & Ury 1981, p. 83).
In Conclusion
Dispute resolution is not a panacea. Understanding someone’s interests does not always mean that changes can be made in a dental office setting to satisfy disputant’s interests. We can generate creative options through understanding a person’s interests but sometimes even those creative options may not satisfy a person’s interests and this is the time to decide if a person is truly compatible with the interests of the office. So, uncovering people’s interests in dental office disputes can help us to decide if, for instance, terminating someone’s employment or dismissing a patient may be the best thing for the office. As previously stated, dispute resolution may establish and/or strengthen the relationship of trust and respect between people or terminate relationships in a manner that minimizes emotional costs and psychological harm. Further, disputes can have a positive side because good can arise from disputes. Broken parts of the office can be mended, broken relationships in the office can be repaired and strengthened, and people who should no longer be together in the office can go their separate ways and find new ways to be happy and prosper.
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