Using a ‘ladder of inference’ to improve decision-making
Remote working during the pandemic raised new challenges in resolving conflict between the various stakeholders in the clinical trials ecosystem.
“While conflict in the physical workplace is relatively common, addressing these tensions over a Zoom call adds a further layer of complexity,” says Mary Lord, RN, MS, CCRA, CRA Manager, Site Management and Monitoring, at Merck, known as MSD outside of the US and Canada. “Conflict resolution requires planning, open-mindedness, and whole-hearted action.”
Lord highlights a couple of real-world examples where conflicts may arise.
“A clinical research coordinator (CRC) interacts with a clinical research associate (CRA) who isn’t prepared for monitoring visits and doesn’t make the CRC aware of timelines ahead of time. This leads to an unnecessary scramble for the CRC to meet a database lock or a survival sweep. The CRC thinks, ‘doesn’t that CRA know I see patients and work on more than one protocol?’ Trust is lost and frustration builds.”
In another scenario, a CRA may experience radio silence from a site, waiting for days to get a response. “The CRA waits for a monitoring visit to be confirmed – an essential element in complying with the sponsor’s Site Monitoring Plan,” explains Lord. “The CRC is exasperated, thinking ‘ugh, there go my metrics, again.’”
In a third situation, a manager typically gives little feedback during interactions with a particular employee. “Then there’s a ‘zap’ of feedback,” says Lord. “The employee is shocked, and wonders whether their job is at risk.”
Join Mary at ACRP 2023 [April 28 – May 1; Dallas, TX], where she’ll provide a framework to plan a resolution discussion that can help clinical research professionals who are under increasing stress. View complete schedule.
In each situation, it is important to communicate safely and effectively, taking into account everyone’s core needs. “One tool we use is a ladder of inference, which helps explain how decisions are made,” states Lord. “It is important not to make assumptions, to ask clarifying questions, and to make sure that decisions are based on good, clean data. This can form the foundation needed to reach agreement.”
A rational approach to conflict resolution can help reduce stress despite the remote interactions, worker shortages and shortened timelines that are features of today’s clinical research environment.
Author: Jill Dawson