Communication for Patient Safety
Fear and Conflict

Fear and Conflict



Conflict is a normal part of human interaction. There are skills to help navigate conflict.



"The predominating culture of most healthcare organizations is not one of safety but of fear." [3] 

 What do health care providers fear? 

  • making a mistake, doing unintended harm

  • being blamed, shamed, punished - being seen as incompetent,

  • litigation, professional discipline and coroner’s inquests.



"Fear creates shame, which leads to silence and missed opportunities for learning, change and improvement."[3]

How does this affect patient safety?


"Fear creates anxiety and mistrust, which leads to failures in communication and a lack of collaboration and teamwork. The inevitable result is high levels of conflict among and between healthcare professionals.... it is rarely acknowledged, and even more rarely dealt with. As a result, mistrust persists, anxiety grows and conflict increases, creating and perpetuating an unsafe culture." [3]


Conflict is a normal part of human interaction. There are skills to help navigate conflict. If we can be comfortable with conflict we can manage it more effectively, perhaps even prevent it. There are ways to create a culture of safety[7][8] and all of them start with communication.


"Conflict often arises from ineffective communication; effective or assisted communication and positive collaboration promotes successful resolution of differences.  Communication is at the heart of conflict and resolution." [3]


Disputes often involve many people, including patients. Successful resolution requires that all who are affected and involved need to be part of the solution - patients, family members, administration, members of the health care team and staff. [3]


"It is finally becoming evident that the best way to resolve difficulties is for the parties involved to get together and talk through their issues."[3]  "While people fear retaliation and legal action if they are open about errors...many professionals in healthcare are realizing that open and honest dialogue is preferable to secrecy and that positive communication produces favourable results for both patients and caregivers."[3]






3. Marshall P, Robson R. Preventing and Managing Conflict: Vital Pieces in the Patient Safety Puzzle. Healthcare Quarterly. 2005;8:39-44.

7. Fleming M. Patient Safety Culture Measurement and Improvement: A "How To" Guide. Healthcare Quarterly. 2005;8:14-19.

8. Milligan F and Dennis S. Building a Safety Culture. Nursing Standard. 2005;20:48-52.

All references for this section