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Lilith is a 53-year old registered nurse working in a health center. She also works in the ICU, making her a very capable and valuable nurse. She has been working at the center for 15 years and always done everything that needs to be done.

Unfortunately colleagues and patients tend to constantly stumble into conflict with her over nonsense reasons. Every minor slip up with words might bring weeks and months of conflict. The team is tired of trying to communicate with her, managers have given up and patients avoid calling when health issues arise due to the fear of catching her on the phone. The health center and the whole country are in dire need of nurses so firing her is not an option.

Team development

Coaching

Problem solving

Self-management

The core of this session was a role-play of the leader's meeting with Lilith.Pavel's (who played the leader) initial plan to connect on the topic of joking did not work and he very elegantly changed the focus, asking: "When you interact with our clients, what is your favorite moment? " (see at 3:33 of the role-play clip). Although it is important what is being said during such conversations, it is even more important HOW it is being said. When watching the video, pay attention to Pavel's attitude and positive, supportive energy throughout the conversation with Lilith. The most significant impact of the session was a total change in Patrick's belief. When hearing the participants' recommendations, he said: "I sincerely believe that she cannot be approached individually," (see at 6:17 of the clip "Participants' recommendations"). However, after the role-play, he concluded: "From this role-play, I learned that she could be approached individually, but differently," (see at 3:05 of the "Conclusion and learning points" clip). Although, at the session, Patrick said that he is in conflict with Lilith and cannot talk to her, two weeks later he shared that he had done it! He had asked for her views and feedback. Initially, it seemed that the conversation was not very effective. Yet, afterward, changes in her behavior happened. And the next time she met with Patrick, she shared a great joke! Beliefs are robust shapers of our behaviors! Pavel used empathetic conversation during the role-play. A useful tool for such conversations is <a href="https://casehub.pro/toolbox/440aa2535c2155bd4b6636f8d54d15e4?tool=1c90461b4dfb48d86115559970a2315b" target="_blank">7 powerful questions</a> by Michael Bungay Stanier.&nbsp;There are a few other tools that could be used in similar situations:&nbsp;<ul><li>It was mentioned during the session that Lilith does not feel safe in her team and does not trust the people. To find out how team members are feeling, you can use the <a href="https://casehub.pro/toolbox/3631501628d51e27963e3a8468e19f1b?tool=ee548001ca932f036e52d8b0c4b40724" target="_blank">Psychological Safety Questionnaire</a>. This is a handy tool for finding out what to improve.</li><li>Patrick also said that Lilith feels like a victim and that clients are going after her! A shift in thinking is needed in such cases, and a helpful tool is the <a href="/toolbox/22ab1795b7a961dcf469da5dc9a4b357?tool=d4a1547167eb64727eb2bc0668adb80c" target="_blank">Drama Triangle</a>, a framework that helps bring the victim mindset into the awareness of the suffering person and helps them find a way out. The process takes some time, several iterations, and a strong commitment! But if done well can be life-changing.</li></ul>

Working with a conflict-prone colleague

Patrick shares details of the case and answers questions.

Case intro + Q&A

Session participants offer ideas on how Patrick could approach the problem person. Pavel proposes 4 steps to be taken and Patrick likes them.

Participants' recommendations

A leader (played by Pavel) has a conversation with Lilith (played by Patrick) to reduce her conflict-prone behavior.

1:1 meeting role-play

Session participants share their learning points from different perspectives. Partick defines his next steps.

Conclusion and learning points

I feel like she likes animals more than people and showing affection towards people is hard for her. Maybe in this case communicating with her about the fact that how would your cat feel when you show the same attitude towards the pet than you show to the patients. Maybe the cat is the key to get through to her.

Maybe to discuss with her about the past, maybe there is some issue still hanging from the past which is unresolved. To map out if there are any issues. And then address them and set some goals/rules, and also introduce the firing outcome when agreeing to those rules. If they are not met then it will be part ways.

I would suggest holding the case with gentle honesty. There is a history of conflict. Ask 'why'?  Seek first to understand the 'why' (there will be an underlying cause) before seeking to employ your own bias/viewpoints. Make the discussion one of gentle curiosity and enquiry rather than accusation. Cleanse your own 'filters' in attitude to the nurse. Appreciate the subtle difference between healthy 'opposition' and personal conflict. Look beyond her 'reputation' to identify the nurses huge contribution to the team; identify how her strengths could be further utilised. Involve her in things rather than avoid her,  treat her as an individual etc etc

Well, I know the question was how to solve this without letting her go but Patricks reaction to the question what if she left, said everything. They could move on without her, yes it will be hard some point but I thing this poison in the workspace if worse. Dont make rabbits swim but them running. So maybe full time im ICU is the best solution when most of the people are knocked out.

It's obvious that Lilith has communication issues and she is destroying every work reletaed relationship. As her work is valued, her personality is not a match for this position, it seems that she is not motivated because her behaviour is destroying all others. As this company is working as one team I would let her go saying that she is not a fit for this position. You should think about the whole team and how she is affecting them. If you are letting go one it might happen that their motivation will boost and they are able to cover some part of her work. It's very difficult to work under negativity and fear to say something wrong etc. I would pay more attention to the whole group and not just for one person. If she does not give her best to be part of the team, you shouldpart ways because every relationship has two sides.

Hey, Lauro! 
My own problem with her ended after a heart-to-heart, but she is still in constant conflict. I don't work at the health center daily anymore, I go there once or twice a month and am always happy to see her.
They still can't let her go, but I know that quite a few other nurses have quit because of her.

So yeah, no big difference for the people surrounding her, but a big help for me.

The session helped me see her side better and bridged the gap so I could actually communicate with her and fix our relationship.

If it seems that the situation is so complicated that there is no solution, in fact there is - one simple thought-out friendly conversation with positive energy

Make Lilith aware about the impact of her behavior for patients and team. Best to do that is by survey.  Assume that health center has mission and values described and would have discussion with her- how she evaluates herself and would support her to recognize the need for improved behavior.

Very interesting case, familiar to many. Maybe we could ask Patrick to find ways of reserving judgement, seek how he could find common ground and assess his own reaction to Lilith. Help him identify his own strengths he could bring to help resolve the conflict and ask himself how best to communicate in an effective style which Lilith is likely to respond positively to. Patrick can look within to resolve this situation.

One on one talk about what she appreciates work there and some other subject to open her up.

What thoughts came to my mind.
All people are different. Some are more positive than others. Some do not like teamwork and are rather lone wolves. But we all want to feel safe and need attention.
If you show interest in a person and their opinion, then this is already a small bridge for a person to open up.
I think it is very important to get feedback from superiors. We all do our best, but we want to know if it's worth anything.

Refer her to work more in the intensive care unit, where there is less communication with the explanation that she is very good there.
Direct her towards positive things, through recognition that she is good at his job but could be more compassionate.
Find her strengths and focus on them. But also to give feedback to her conflicting saying with an explanation so that she tries to understand why this behavior was not appropriate

Seems like a very tough dilemma indeed. I would try to giving Lilith more positive feedback and try focusing on the positive qualities that she has. In doing so that would maybe open her up more. Maybe some bonding activity outside work if that could be possible so that she could gain confidence and trust in her coworkers. If that step is done then try to have a good coaching conversation with her so that she could really see the problem herself and how to solve it. Try to find out if she wants to keep working in that hostile environment and how to fix the negativity in her. Coaching conversation could work but only if she trusts you enough and can open up to you. In the conversation you should find out if she wants to keep working there and then focus on how to fix the problem. If she doesnt want to change I would let her go because the negative work environment is no good for anybody.

I think it is a good idea to sit down with her and find out what she loves about her job. WHY is she working there. If a sincere "thank you" is what makes her happy then why is she prone to conflicts? She must have noticed that when she is rude, she won't get gratitude from patients.. Maybe positive feedback  from her colleagues every once in awhile will also help to improve her behavior.

It’s unfortunately unclear how much and in which form feedback has been provided to Lilith and how she has reacted to it. Is it a matter of just not caring about that feedback (no willingness to improve), or is there something that is holding her back - e.g. maybe she has never had access to mentoring/coaching/training on communication and relationship building with patients (yet she’d be open to it)? I’d be curious to understand more about that and see if sufficient efforts have been made to understand her position, helping her see how her behavior is contributing to a toxic work environment and eroding the trust both in the workplace and from their patients. 

Also, has someone asked what Lilith herself truly enjoys? Why is she doing the work she does? And where do her professional passions lie? Might there be other roles in the health center that play more on her strengths? Or maybe she actually would love to work full-time in the ICU? A nudge toward the direction that aligns more with Lilith’s purpose and passions would be more considerate toward Lilith’s professional growth and satisfaction. 

Patrick’s response to how he’d react if Lilith decided to leave was very eye-opening. We often focus on the near-term pain of resource shortage over the long-term goal of a healthy and thriving work environment. Toxic cultures erode the trust within the team and can create long-term negative impacts. Hence, I’d also encourage the health center to be open to considering hard decisions about Lilith’s future career at their center if the situation warrants it.

Okay, wow. This case has brought on a lot of comments and great ideas. I thought it would be a good time to give an update on the situation. I myself pretty much no longer work there, so I have no impact on the situation, but everything is already going really well. 
Lilith was actually promoted to senior nurse. She is now in charge of every other nurse and making sure things are in order. And everyone loves her in this position. It was a surprise for me. Lilith herself seems really happy, content, absolutely glowing. Things really are in order, almost all conflicts have been resolved. 
Such a surprise turnaround :)

In this case the medical centre has a risk of losing  their reputation and clients due to Lilith who clearly does not see that she is behaving badly. Has her manager asked her whether she wants to continue working there?  What is the reason why hasn't she left already?  There is a saying that nobody is irreplaceable. If I were the boss, I would say that I have some good candidates who would like to come and have her job. Maybe she will change her behaviour when she understands that she IS replacable after all. She is 53 years old, it is not easy for her to find a job if the boss gives her a bad recommendation.

My takeaway was associated with thoughts how to manage people at their roles. Lilith was clearly not happy in her role. It was refreshing to read Patrick's comment about Lilith becoming a well performing manager. It was surely no big surprise for me since I have seen this several times in my career. I proposed to go towards an expert role, out of first line but manager is even better. How to realise if this is about power? Some worries still, If the bad behaviour was not her core quality then it would work, but if she is naturally not polite and pro-conflict, she will have troubles as a manager soon too.  I'm rather sceptic here, but let's bet on people's positive side.

I would try to dig deeper into the root cause of her destructive behaviour to better understand what are the reason(s) behind it. How long has this been going on, is it becoming worse or getting better? What are the typical triggers? Also, let her self-reflect on the specific conflict situations - what was going on in her head, did she notice a trigger, an emotional reaction(s). Let her analyse alternative response options and see if she can come up with less descrutive ways. Understand the levels of her personal social and work energies, where is she getting fulfillment and what creates friction. Is it possible to re-design her job to minimize friction? Receiving feedback is a also a skill that can be developed. Find a trustworthy partner who would increase her self-awareness and help her come up with an action plan on how to improve. Depending on the root cause of her behaviour she might need therapy to solve some interenal belief issues, heal from the past unresolved issues, build new values and habits what would help her grow into a collaborative and supportive colleague and a service provider. Find ways to practise humbleness individually and as a team.

I understand that Lilith is good in intensive care. She solves difficult situation well and she has good ideas on solving problems. But she has a big problem in dealing with customers (patients). She is even rude with them and clients don't want to communicate with her. Maybe you can use her best characteristics and change her work tasks? If she is good in intensive care, maybe you can give her only these tasks? I believe that she is not a bad person, but rather that he has a fear and insecurity of communication. I think that if you communicate with her in the same style, the situation will only get worse. You could also try to talk to her kindly (direct manager, colleagues). Maybe she feels lonely and her best friend is her cat?

At first, I thought that it would be best to think of a team and Liliths effect on them but did not consider coaching, reflecting, givinh honest feedback because it seemed that it was tried before, but it didn't work. So why not ask from professionals and try one more time?

Talking to her: Is she doing okay?
Other than that, a "Code of conduct" with very clear, concrete rules about the way they communicate would make it easier to refer to something concrete other than her colleague's feelings (which are valid but can be subjective) when she oversteps or has issues communicating.

I would sincerily recommend to put her in a personality improvement plan. Where you have a way to measure how is she doing in a personal level.

You have series of points where you and her need to agreed and in term of 3 months see how she did. She needs to sign this document in order to improve. 

That way if she does not improve, you could fire her with a reason. If she does not like it, she would leave by her own or if she does everything alright everyone will be happy.

In general mainting this sort of people with toxic behaviour in your work enviorment is not good at all, for your co-workers and patients (They are the ones that your business you need to also worry about what they think).

Liked the discussion around this topic. It would be interesting to know how this all played out also in real life.

She seems stressed. Maybe she's overqualified for the job. She's bored and it's stressful. She does this work out of a sense of duty, because he is a good person and a conscientious person. But she would like other challenges. If there isn't a suitable challenge for her in your department, it seems wiser to transfer her somewhere werw is.

I would solve the case by starting hiring new nurse. Meanwhile have another session with her to reflect the company values and how she is in conflict there. She cloud also be an expert supporting other nurses with difficult cases.

What a nut to break!
We need here to work on on earning her trust to get her to lower her guarding shield. Possibly to focus on praising her on what she does well.
Also we would need to understand what motivates her to see if there is something missing in current job.
Third direction is to find ways how to make her interested in learning about emotional intelligence.
But when communicating with people is not what she likes to do and not something she wants to improve in herself then I would say it is better to plan her replacement. Better in medium term.

Is Lilith even aware of the impact of her behaviour on colleagues and patients?
If not, then sharing feedback to increase awareness might be the first step.
If yes, then she could be invited to complete her own SCOT analysis from behavioral, emotional, and thought perspectives (as a first step)

This is one of the hard cases. People are so different and it's hard to know what's the best possible approach to get the best outcome. It seems that the work she is doing is not for her and she's not the best people person.

Working with a conflict-prone colleague

How would you solve this case?

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