Conflict Reduction Strategies According to Emtala (Emergency

Conflict Reduction Strategies According to EMTALA (Emergency Medical Treatment and Active Labor Act), hospitals are responsible to ensure on-call physicians respond in a reasonable time frame and medical staff bylaws, or policies and procedures, must define the responsibilities of on-call physicians to respond, examine, and treat patients with emergency medical conditions (On-Call Responsibilities for Hospitals and Physicians, 2013). And, "when feasible, requests for consultative services should be made in accordance with patient's preferences and/or health plan" (EMTALA and On-Call Responsibility for Emergency Department Patients, 2013).

The conflict in Betty's case involved the orthopedic resident's response time of two hours, indication of surgery by Thursday when the physician was not in office before Wednesday, the physician did not treat hands, therefore another referral was made a week later, and after returning to ER, the physician's assistant did not respond to questions concerning the availability of the physician.

The first thing that is suggested for Linda, the nurse manager, is to meet with all parties to define the conflict and gather information (Complying with the New Leadership Standard LD 2.40, November 2007). Conflict can be a symptom of a bigger problem. The root to the problem could be a lack of communication between the physician and the orthopedic resident and/or a lack of training with the orthopedic resident. The physician assistant may not be aware of the reporting policies to confront issues.

Forcing is using formal authority or other power to satisfy concerns without regard to the other party's concerns (William, no date). After gathering the facts of the situation, Linda, the nurse manager, should first consult with the hospital's risk manager for advice on how to handle the situation. By doing so, she would be better prepared to confront the situation with the physician.

It would also help in understanding the legality and liability issues that can stem from the situation and gain help if the physician does not comply with the policies. Accommodating is allowing the other party to satisfy their concerns while neglecting your own (William, no date). Betty needs some accommodation for the poor quality of care she received.

Linda should consult with the director of nursing to gain some insight about how to accommodate for the quality of care and how rectification can be given to Betty, even if it only consists of explanation the situation is being handled, explanation of her rights, and other measures she can use to resolve treatment issues. At the same time, the physician's assistant needs instruction on how to report and confront disruptive behaviors from others that can bring poor quality of care for a patient.

Conflict reporting polices need to be explained to the PA to prevent any further occurrences. The PA also needs to know policies and procedures on the referral processes to keep from violating physician/hospital contracts and causing more liability and conflict. The PA needs to be made aware of how conflict can be handled with issues of referrals. Forcing and accommodation are two strategies that can be used to resolve the conflict in Betty's case.

The physician may need to be forced to comply with policies regardless of how the physician chooses to handle the conflict with the orthopedic surgeon.