Why Daring to Disagree is Important - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

“The biggest catastrophes that we’ve witnessed rarely come from information that is secret or hidden. It comes from information that is freely available and out there, but that we are willfully blind to.” Margaret Hefferman

Throughout our lives, we often receive message that conflict is negative, and we should strive for agreement. But is group agreement always a good thing? I was reminded of the need to have the courage to disagree this week in my discussion with a nurse executive about the training of staff to manage Ebola patients. Members of the executive team in her medical center had prepared a press release indicating that the staff were fully trained and prepared to care for Ebola patients. They were seeking quick approval of the group to move forward with the release. The only problem was that it was not completely true – the ER staff had been trained and had most of the equipment needed but this was not true in other areas of the hospital. She told me that what they had was a good plan but to suggest that they were fully prepared was disingenuous. She pointed out that such a claim would be quickly refuted by their own staff – many of whom had not yet received the training. In the end, there was no press release.

Why You Should Dare to Disagree

We know in health care that a failure to speak up when you disagree can result in medical errors, some catastrophic. Dr. Mark Chassen President of the Joint commission that accredits health care organization, has noted that the incidence of wrong-site surgery could be still be as high as 40 per week. In a study conducted by the Joint Commission examining the root causes of wrong site surgery, communication was found to be the number one problem. Some root cause analyses of these events paint the picture of cultures where some staff did know that there was a problem or that a procedural step had been skipped but no one dared to disagree.

In one of the most widely viewed TED talk leadership videos, Margaret Heffernan (a business leader and writer) discusses how good disagreement is central to progress. She illustrates how the best partners aren’t echo chambers — and how great research teams, relationships and businesses allow people to deeply disagree. Great ideas can and do emerge from seeking diverse points of view on a topic. Powerful moments can and do occur when someone in a room takes a risk and disagrees.

Some of our very best leaders in history such as Abraham Lincoln understood this. Doris Kearns Goodwin tells the incredible story in her book Team of Rivals, which has been made into a movie on Lincoln. When he was elected president, Lincoln assembled a cabinet of his former rivals because he wanted his viewpoints to be challenged. Goodwin presents a compelling case that had Lincoln not possessed the wisdom and confidence to select and work with the best people, he could not have led the nation through one of its darkest periods.

The Art of Constructive Conflict

There is a difference between constructive conflict and destructive conflict. In destructive conflict, we seek to prevail with our viewpoints. Destructive conflict often flows from narrowly defined or rigid goals, and most often produces negative results. Individuals involved become less flexible and assume that the opposing party must suffer defeat. Constructive conflict involves a different approach. It is entering the situation with a dose of skepticism and an alternative viewpoint while remaining open to other possibilities. The parties to the conflict feel comfortable with the level of disagreement and acknowledge a need to compromise. Constructive conflict relies on a steady flow of communication and a shared willingness to embrace change. It is really caring about coming to the best decision or reaching the right resolution. As Heffernan notes, “”Because you simply won’t commit that kind of energy and time if you don’t really care. And it also means that we have to be prepared to change our minds”.

Disruptive innovation is badly needed in health care today. It will only come when professionals are willing to come forward and through that act of daring to disagree keep challenging the status quo.

Read to Lead

Harvey, Jerry B. (1988). The Abilene Paradox and Other Meditations on Management. Jossey-Bass Publishers

Hefferman, M. (June 2012). Dare to Disagree. Global Ted Talk.

Goodwin Kearns, D. (2006). Team of Rivals: The Political Genius of Abraham Lincoln. Simon and Schuster.