Takeaway
Healthcare is a team sport. When working through conflict within your care team, integrate perspectives to deliver better care.
Lifelong Learning in Clinical Excellence | January 12, 2026 | 3 min read
By Laurie Weingart, PhD, Carnegie Mellon University
Mr. Jones was a frail older patient, recovering from complex, multi-system illness. The attending physician felt strongly that aggressive weaning from the ventilator was necessary to prevent secondary complications—but the physical therapist believed the patient’s underlying anxiety and lack of mobility readiness meant this was rushing the process.
For weeks, the two perspectives played out not as constructive debate, but through passive resistance and low-grade tension. The attending became dismissive during rounds; the PT would “forget” to submit necessary progress notes on time. The resulting friction slowed down decision-making, eroded trust, and ultimately delayed Mr. Jones’s discharge to rehab by two weeks.
In today’s complex healthcare setting, multidisciplinary teamwork is essential, yet it often breeds conflict. Every time interdependent professionals share goals and resources, opposing interests can arise—it’s natural to disagree on actions, goals, or logistics. The key to exceptional patient care lies in the willingness to face and constructively work through differences, transforming potential negative outcomes (like stress or delayed treatment) into opportunities for learning and growth.
Understanding the root cause: representational gaps (rGaps)
When conflicts arise in teams, it’s often driven by what we call Representational Gaps, or “rGaps.” These are fundamental differences in perception regarding what the problem even is. A surgeon sees a procedural problem, a social worker sees a systemic family constraint, and a nurse sees a resource limitation. These different perceptions exist because team members bring vastly different types of expertise, knowledge, values, priorities, roles, and even reward systems to the table. One person might prioritize aggressive treatment defined by specific metrics, while another prioritizes patient autonomy or minimizing long-term disruption.
If we let these conflicting differences fester, they can result in relationship conflict—personal attacks, status clashes, or disputes—that’s very detrimental to team cohesion and trust. To move forward, we must focus on the task at hand and develop strategies to bridge these rGaps.
Integrating perspectives for better outcomes
We bridge rGaps through two main types of integration: cognitive and affective.
Cognitive integration involves learning to understand one another’s perspective, reasoning, and constraints. Healthcare professionals can proactively engage in activities to build this understanding:
1. Interview.
Ask a colleague about their goals, pressures, and constraints when treating a specific population.
2. Shadow.
Spend time observing a colleague to better understand what they’re doing and why.
3. Decipher jargon.
Ensure that language and specialized ways of reasoning are understood across specialties.
Affective integration focuses on building strong interpersonal relationships based on trust, respect, and mutual liking. Trust is gained through experience and a willingness to be vulnerable, while respect is often earned through demonstrated expertise and role competence.
2. Get to know each other.
Take time to discuss life outside of work—hobbies, families, and interests.
3. Discuss shared vision.
Talk about the team’s overall vision to reinforce the sense of being on the same team.
4. Develop shared responsibility.
Ensure that success or failure is seen as a joint outcome, fostering interdependence.
Practical tips for healthcare professionals
Effective conflict leads to creativity, comprehensive deliberation, and brings to the surface previously hidden problems. Here’s how clinicians can harness the power of constructive disagreement:
1. Prioritize problem-solving.
Aim for collaborative conflict management that seeks a “win-win” solution by working out a creative answer that serves everyone’s interests, rather than avoiding conflict or forcing your viewpoint.
2. Keep it direct and low intensity.
When expressing disagreement, be direct but avoid high-intensity expressions like arguing or personal insults. Healthy conflict involves direct discussion, point-counterpoint, and the exchange of ideas.
3. Use strategic disagreement.
Utilize techniques like playing devil’s advocate or pointing out ways to improve a plan. This type of direct, low-intensity engagement increases trust, information sharing, and team learning.
4. Identify the real issue.
When conflict arises repeatedly, ask diagnostic questions: How distinct are our knowledge bases? How different are our value systems and incentives? Identifying these underlying rGaps is the first step toward resolution.
It’s natural to sometimes disagree on actions, goals, or logistics. The key to exceptional patient care lies in our willingness to face and constructively work through these differences, transforming potential negative outcomes (like stress or delayed work) into opportunities for learning and growth.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.