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Resolving Conflict - Now More Important Than Ever​​​​​​​​

In an era of looming predictions for a potential crisis in healthcare, healthcare provider leadership—more than ever before—needs to recognize and deal with conflicts, implementing strategies to identify causes of conflict and effectively strive for resolution.

Why all the fuss?

All interactions present a potential for conflict. In healthcare, factors leading to conflict can be related to personnel issues, physical environment, issues of power, differing value systems, personal issues, and leadership and organizational style. 

Personnel issues relate to the problem employee who chooses not to work collaboratively. Problem employees display innate behaviors and personalities that challenge the cohesiveness of a group workforce. Behaviors can lead to total obstinacy by challenging the authority of leadership. Defiant personalities can also create conflict by undermining the cohesiveness of the healthcare team. Refusing to work, using profanity or derogatory remarks, malicious mocking, obstinate obedience, or avoiding commitment and participation can all lead to ineffective group dynamics. Chronic absenteeism, tardiness, not completing assignments, repeatedly making errors, and lack of competency all lead to performance problems. It’s unsettling for leadership to confront problem employees for fear of resignation or further team unrest. Unfortunately, over time, staff and colleagues cease to confront or address those causing conflict in an organization for lack of time, energy, or reprisal. 

The physical environment of healthcare can be challenging. Lack of space, increased technology, and an aging workforce that can no longer meet many of the physical demands of healthcare settings can lead to stress. Differences in perceptions, values, beliefs, and behaviors can lead to strife and contention. How individuals perceive a situation is based on their own unique perspective. When this perspective is in contrast to others or an action is based on a contradictory perception, conflict may arise. Cultural, social, and religious beliefs, along with differences in strategies for patient care, may all lead to disagreements. Many issues can arise when families and patients struggle with end-of-life decisions or when a healthcare provider struggles with how to compassionately care for a patient who may have a lifestyle contrary to his or her own.

Ineffective communication almost always leads to discord. Not having a clear understanding of direction, goals, and outcomes will result in misunderstandings, along with lack of awareness and collaboration. Standards not conveyed, expectations not understood, or frustrations not recognized can all lead to a divergent workforce. Individual personal issues can cause conflict when they lead to tension and disagreement. Intrapersonal issues, such as family obligations, personal health, and the need for more flexible work hours, may cause tension when they impact job performance. Intrapersonal issues can also carry over to affect interpersonal relationships, leading to conflict within the work group.

Lastly, leadership and organizational style can result in discord and controversy. Management practices and attitudes that lead to a negative work environment may initiate or exacerbate already present conflict. These toxic management behaviors are usually due to poor interpersonal skills or lack of knowledge in dealing with conflict.

Behaviors for dealing with conflict are usually those of avoiding, accommodating, compromising, competing, or collaborating. Avoiding the problem isn’t constructive and usually doesn’t result in resolution of conflict. Accommodating behavior, which attempts to preserve harmony while neglecting oneself for the greater good, also doesn’t lead to conflict resolution. Compromising may be helpful when a decision is needed immediately, but it’s dependent on both parties having equal power. Competition may lead to aggression and is power driven.

Collaboration—seeking input from all perspectives for mutually satisfying solutions—is time consuming but results in the greatest potential for resolution. Studies show that those in leadership positions are more likely to use competition, compromise, and collaboration, whereas subordinates use collaboration, avoidance, and dominance. Gender roles can also influence how conflict is addressed. According to one study on the effect of gender in addressing conflict, men are more prone to utilize competition as a method to resolve conflict.

Where do we go from here? 

In healthcare, the causes of conflict are many and diverse. Conflict is a given; however, it doesn’t always need to be seen in a negative light. It can lead to creative outcomes and become an agent for change and growth. Addressing and effectively managing conflict will lead to resolution, greater job satisfaction, and ultimately improved patient outcomes. We can no longer turn our backs and think conflict will go away or resolve on its own. By the very nature of healthcare, with the need to interact with a multitude of disciplines, and increased expectations, it’s the duty of every manager and those in leadership roles to foster conflict resolution skills and serve as a role model, mentor, and coach for collaborative behaviors. 

Healthcare leaders must become active listeners and effective communicators. It’s essential for managers to focus on leadership, communication, motivation, and team building. Healthcare providers must be provided training in conflict resolution, negotiation, facilitation, and mediation skills. No longer should training be reserved for those in leadership positions.

Individual behavior or performance issues must be addressed quickly. Healthcare providers who aren’t working collaboratively or exhibiting behaviors causing undue hardship on others must be clearly informed of the impact of their behavior. If these behaviors aren’t addressed in a timely manner, frustration ensues that may lead to anger and potential workplace violence. Expectations must be clearly defined and a performance plan implemented. Counseling, constructive feedback, and clear documentation is vital to assist the employee in improving his or her performance.

For whatever reason, there will ultimately be those who can’t embrace conflict resolution even after coaching and mentoring. Employee assistance programs and human resources intervention may be beneficial; however, there’s no obligation to support controversial behavior for the benefit of the majority. It may be best to implement procedures leading to dismissal. Healthcare providers must be given the authority and guidance to make decisions. Serving collaboratively with physicians and other disciplines on hospital committees affords them a higher level of professional autonomy and personal accountability.

Initiating strategies to empower healthcare providers, promote involvement, and strengthen their voice is crucial. Team decisions are superior to decisions made vertically from the hierarchy of management in terms of service quality and cost-effectiveness. Communication should be encouraged in all venues, including team meetings, newsletters, intranets, and surveys.

Many healthcare organizations cite the cost of training, staffing issues, and lost productivity as a deterrent; however, the cost of not providing education is too high. The cost benefit of teaching conflict resolution skills may also be evidenced by increases in productivity and decreases in absenteeism, turnover, disability claims, and litigation risk.

Rising to the challenge

By taking on the challenge of resolving conflict, the gains of improved interdisciplinary communication, relationships, and job satisfaction; minimized stress; workgroup cohesiveness; increased staff retention; empowered and autonomous staff; and improved patient outcomes are achievable. Ultimately, the success of a healthcare organization may depend on how well it attends to conflict and its resolution.

SELECTED RESOURCES

Spath PL. Help! I have a problem employee. OR Manager. 2005;21(3):30–31.

Sportsman S. Build a framework for conflict assessment. Nurse Manage. 2005;36(4):32,34–36,30.

Tomey AM. Conflict Management: Guide to Nursing Management and Leadership. 7th ed. St. Louis, MO: Mosby; 2004: 143–166.

Tyler K. Training & development: extending the olive branch.

http://www.shrm.org/Publications/hrmagazine/EditorialContent/Pages/1102agn-training.aspx.

Vivar CG. Putting conflict management into practice: a nursing case study. J Nurs Manag. 2006;14(3):201–206.

By Jodi Padrutt, MSN, RN, CDE

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