Spend enough time in a doctor's office—either as an employee or a patient—and you're going to encounter conflict and tension.

For patients, already anxious about their health, even during well visits, it can be particularly unsettling to hear voices raised or accusations flying. It may be a receptionist dealing with a patient who has just been informed that his copay was raised. It could be an office manager confronting a billing clerk over a documentation error. It could be a physician assistant's personal troubles spilling into the work place.

Whatever the reason, conflict is a cancer in the healing environment. It has to be contained.

For years, Terri Levine, president of North Wales, PA—based Comprehensive Coaching U, has parachuted into stressed out physicians' offices to negotiate an end to hostilities.

"I've never seen a business, a corporation, a physician office, that doesn't have conflict," Levine says. "People are people. There is conflict in our experience. It's part of humanity." By far, she says, the most prevalent form of conflict is among coworkers.

Because of the serious nature of the work in physician offices, even on the best of workdays, stress—the seed corn for conflict—will always be present.

"There is more stress that we find particularly in medical doctor practices than in any others," Levine says. "In a retail store, you mess up, you don't ring up the right order. In a physician's office, you can be dealing with serious life-and-death issues. And the other thing is that most physicians are Type A personalities. Just by the nature of who they are, they can create stress even if they don't open their mouths."

Conflict isn't always about screaming matches at the front desk.

"Sometimes one employee could be angry with another and could be withholding information, being quiet, not giving them everything they need, forgetting to give important data and messages," Levine says. "Anger. Talking behind the other employee's back. Sarcasm. Those are the warning signs that something needs to be handled. Usually it is underneath the surface and you have to look for it because it can become a shouting match."

Paula M. Comm, a practice administrator at PRA Behavioral LLC, serving the northwestern suburbs of Chicago, says the head psychiatrist at the practice has a zero tolerance policy toward workplace conflict. "He hates conflict, and he really practices what he preaches," Comm says. "Especially in a psychiatric practice, you don't want someone coming to the window and feeling the tensions that are going on within the office because it's so apparent."

Comm says she is aggressive in sniffing out workplace tension. And one of the best ways to do it, she says, is to get out of your office and stand in the hall and listen.

"I go up there and just stand. I can get a feel for what is going on immediately. I can tell by the tone, by the attitude. I have an office manager beneath me who isn't attuned," Comm says. "So, I will go in and stand up there and go to her office and say, 'Do you know that it's tense up there?' And she will say 'what do you mean?' "

Levine says one major reason for conflict is personality differences. "We have different beliefs and different philosophies. We have different stories and programs based on our past experience," she says. "Even though I understand my job is to do X, I am still a human being bringing my own personal stuff into the workplace. I'm not going to like everybody else's personality and I may not understand exactly what I need to be doing or there might not be the same communication style between a couple of employees."

Levine says personality profiling plays a prominent role when she coaches employees at physician offices.

"Let's say I find out somebody is a director type. They give quick information; they don't like to converse. If I understand that person's style, I can use behavioral flexibility and talk to them in that way," she says. "If someone is more of a relater, they like to socialize, chit-chat. Then again, we teach how to be more behaviorally flexible in that area."

Levine says many of the employees she coaches are surprised to learn of their personality type, but their coworkers aren't.

"I was with a group last month and one person came out to be a director. The rest of the group was all saying 'Yup!' and the person said 'I didn't think I was like that.' Then as we went through specific examples of how a director behaves, she said 'Yes, that is me.' "

Levine says the way to reduce physician office conflict is not to hire the same types of people, but to make sure each employee understands one another's personality traits.

"We need a combination of personalities in the office. It's better to have all different personalities. If you've got a patient who needs TLC, get the relater our there, not the director," she says. "If you understand how your coworkers function in the world, you can have some behavioral flexibility toward them and some more understanding of who they are."

Levine says there are "three common denominators" in conflict resolution that facilitate that flexibility.

"First, be more understanding of how other people react. Second, increase group cohesion and mutual 'Let's work together to figure out the conflict.' Third, use your improved self-knowledge to understand what happens to you when you feel conflict," she says.

When employees come to her with a complaint about a coworker, Comm says she encourages them to meet face-to-face to constructively to resolve the problem.

"The worst thing is one employee complaining to me about another employee. When I confront that employee, that employee will say 'Why didn't she just tell me in the first place? Why did she have to go to you?' It's kind of like 'I'm telling Mom!' "

"The first response out of me is 'Have you spoken with her directly?' Because that is how you develop healthy relations. You talk to each other directly, because sometimes instant messaging can be misinterpreted," Comm says.

BayCare Health System this week opened a new $225 million hospital in suburban Lutz, just north of Tampa. St. Joseph's North is the first full-service hospital built in the Tampa Bay area in more than 30 years.

The 350,000-square-foot, three-story hospital features 108 private beds, 32 of which are for outpatient observation, and 76 of which are for inpatient care. The "all-digital" hospital offers emergency care, surgical services, imaging and diagnostic facilities, ICU, and a family-centered environment.

The full-service Emergency Department at St. Joseph's Hospital-North includes 30 private rooms for adult and pediatric patients. A fast-track area expedites treatment for minor emergencies.

Many of the private suites include large HDTVs, full bathrooms, and accommodations for an overnight guest. Room service provides made-to-order meals.

"Our family-centered care philosophy allows relatives and visitors to be collaborators in patient care," said Paula McGuiness, COO for St. Joseph's Hospital-North. "By incorporating the family, everyone is working together to meet the needs of the patient."

Evidence-based design include an identical floor plan to improve efficiency; workflow designs to ensure that medication, supplies, and meals deliveries keep caregivers close to patients; and noise reduction features, such as carpeted hallways, noise-absorbing tiles and glass sound barriers.

St. Joseph's North is LEED-registered by the U.S. Green Building Council, and the building is designed to achieve green building certification. The building is made of materials that support energy conservation and clean air with low chemical emissions and recycled content.

The Jan. 12 earthquake that flattened much of Port au Prince, Haiti, and killed at least 230,000 people is providing valuable lessons for disaster preparedness and response on an almost unimaginable scale, says Scripps Health CEO/President Chris Van Gorder.

"There were two reasons why we went down there," says Van Gorder, who recently returned from his second trip to the stricken nation since the earthquake. "The first was humanitarian. The second was the learning. I am passionate about disaster planning and I don't believe the time to learn how to function in a disaster is when the disaster occurs."

Van Gorder concedes that it's doubtful that the United States will experience a natural disaster of similar magnitude because of building codes, infrastructure, engineering, and planning. The Haitian earthquake and the 1989 earthquake that struck the San Francisco Bay area both measured around 7.0 on the Richter Scale. The San Francisco quake claimed 63 lives. Even Hurricane Katrina, with more than 1,800 fatalities, pales in comparison to the death toll in Haiti.

Regardless, Van Gorder says providing care in the most challenging of environments is giving U.S. healthcare professionals valuable experience that can't be replicated by disaster training drills.

"We saw the injuries that would occur in an earthquake—major extremity injuries, major crush injuries, amputations, spinal cord injuries, pressure ulcers caused by people being underground and in the same position for extended periods of time," Van Gorder says.

The Scripps response team and a University of Maryland medical team worked in the remains of the Hospital St. Francois de Sales. It was grim, desperate work under bad conditions.

"Half the hospital collapsed, a four-story building which was their pediatric unit. The estimate was somewhere between 50 and 200 bodies were still entombed in the building," Van Gorder says. "We went into some areas of the hospital that hadn't collapsed, but were adjacent to the building and the smell was atrocious. Our CMO said he almost threw up, and he has been dealing with trauma his entire career."

Even in those hellish conditions, Van Gorder says he was inspired by the extraordinary flexibility and creativity of doctors and nurses.

"They created as sterile an environment as possible without the tools we have here. Our scrub sink was a bucket outside. We saw a rip saw that was being sterilized for amputations. Fortunately we didn't have to use it."

"We were doing our anesthesia on the first trip with ketamine. There was no general anesthesia. There was no intubating the patients during surgery," he says. "A nurse anesthetist gave them a shot and disappeared. I was responsible for monitoring the patients' vitals while the surgeon did surgery and I was a scrub nurse. It wasn't Civil War medicine, but it was more like World War I medicine."

When the Scripps team returned to Haiti with more medical supplies, Van Gorder says they could administer pain medications and general anesthesia.

"Instead of going directly to amputations, we were trying to save limbs," he says. "But we had one woman who died of pneumonia and congestive heart failure. There was no technology there to save her. She died outside under a tent. It was the best we could do under the circumstances."

Van Gorder says the road to recovery for Haiti will be long. Non-governmental organizations that are trying to provide care and other assistance must understand that the Haitian government has essentially ceased to exist.

"The Health Ministry completely collapsed with many of the leaders of healthcare in Haiti killed within the building. The Supreme Court was killed in session. The palace has been destroyed," Van Gorder says.

"The question is what happens from here? It's a poor country that imports everything and exports little if anything. They had a hard time feeding and educating their population before this. Look at the destruction, both in the public and private infrastructure, and you wonder where the money is going to come from to rebuild. I often wonder how long countries and hospitals will have the appetite to continue to work in Haiti. It's not month, we are talking years before they can recover."

An early morning fight at a roadhouse on Presidents Day spilled into the emergency department at Scotland Memorial Hospital in Laurinburg, NC, and ended in a shooting that left a patient in critical condition, his alleged assailant in jail, and the hospital in lockdown.

Scotland Memorial officials issued a statement detailing the 3 a.m. shooting on Monday morning, which remains under investigation by Laurinburg police.

"An individual, stating he was a patient's brother, asked to be let into the Emergency Center to visit his brother. The patient was being treated for a facial laceration that he stated he received as an innocent bystander of a fight that broke out between others. He essentially told the police the same story," the hospital statement read.

"The suspected shooter, upon entering into the patient's room shot him several times and then left the room, wandering around the Emergency Center, looking for an exit, finally exiting from the X-ray area."

"The Scotland Memorial Hospital Emergency Center staff initially took cover, then immediately called 911 and the nursing supervisor once the suspect left their area. The supervisor called the hospital units, alerting them—all units secured themselves and their patients. EC staff quickly returned to their patient care duties, including caring for the injured patient and later, the suspect himself. Local law enforcement responded quickly and captured the suspect on the hospital grounds," the statement read.

The hospital was put into lockdown for several hours following the incident. No visitors were allowed in or out of the facility until 7 a.m., but security staff used wands to check Emergency Center visitors, according to Scotland Memorial.

Scotland Memorial CEO/President Greg Wood said that the wounded patient suffered critical injuries, and has been removed from the hospital.

"We have never experienced anything like this in our hospital before," Wood said in a media release. "The safety of our patients, visitors, and staff is of paramount importance to us and we have extensive security measures in place to minimize the likelihood of such a horrific incident as this. Staff is receiving stress debriefing and we will conduct a thorough review of our policies to see how to strengthen our security even more. Our staff responded with the professionalism expected of them, ensuring that their co-workers and the other patients were unharmed."

Calls to the Laurinburg Police Department were not immediately returned. However, The Fayetteville (NC) Observer reported that police identified the shooting victim as Domario Covington, and that he suffered multiple gunshot wounds to the chest. The alleged gunman was identified as Wayne "Wolf" Simmons, 49. Police told the newspaper the shooting stemmed from an incident at a nightclub in nearby McColl, SC.