The purpose of this activity is to enable the learner to recognize conflict, understand the different types of conflict and learn how to resolve conflict.
This course is designed so that the healthcare professional will be able to:
In a field like nursing, where passions and tensions run high, learning to handle conflict effectively is a critical safety skill.1 Conflict occurs when two or more values, perspectives and opinions are contradictory in nature and have not been aligned or agreed upon. Conflict will always be present in the workplace and is an inevitable condition that is essential for change. Stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources or needs of the worker.2 Conflict may be:
There are other types of conflict such as competitive, destructive or disruptive conflict. In these instances, the desired outcome is to “win” by overcoming one’s opponent.
Conflict exists in all work environments and has positive aspects, as it usually precedes change. Conflict occurs when individuals or groups have disagreements on goals, ideas, values, beliefs, attitudes, feelings, perceptions, opinions, or actions for issues of importance. The challenge is identifying the cause of conflict and working through the modes of conflict resolution in a constructive and healthy way.
Conflict and stress can be a healthy aspect of change. Healthcare professions must change their attitudes toward conflict and learn how to move toward resolution in a healthy and constructive manner. Conflict can be damaging, and many individuals actively avoid dealing with situations arising from conflict. Conflict can also be a natural, unavoidable prerequisite to positive changes.5
Stress is the natural and normal reaction to events that are unfamiliar and infrequent. When a person fails to control stress or cope with it, the individual may experience distress. Healthcare professionals must learn to cope with stress by understanding how to manage stress and to utilize time management techniques. To enhance workplace productivity and resolve the conflicts that occur, managers have to find ways to handle conflict in a constructive manner. We are able to appreciate that disagreeing with others is not always a negative or destructive process.4
Managers spend 25-40% of their time dealing with conflict according to various surveys and estimates. Since conflict resolution takes so much constructive work time from managers, the nurse must learn to become comfortable with the resolution process. There are several styles for dealing with conflict6:
Kathy is an excellent nurse, but is quick tempered and argumentative, especially with the unit manager. Even though they have worked together for two years, things have not improved. The unit manager, Denise, is frustrated and realizes Kathy’s moods have affected the entire team. During a discussion with Kathy, Denise learns some of the reasons why Kathy is unhappy. Scheduling and the lack of teamwork are the biggest concerns. Denise decides to bring the entire team together, including physicians, unit clerks, and the nursing staff. Using the shared governance approach, Denise hopes to make the team more comfortable. Shared governance fosters ownership of the work to be done by formally involving the team in exploring different of avenues of resolution. Organizations that embrace this philosophy experience profound growth because the staff understands as well as implement progressive changes. Bringing the issues brought to the table by Kathy, without implying Kathy, enabled the team to start the resolution process.
Encouraging collaboration, with the goal of a cohesive team, Denise guides the staff to examine all the issues one at a time, ensuring that each member of the team has the opportunity to discuss their feelings. The staffing issue was resolved by the staff working on the schedule together, with the unit needs in mind, to allow a smooth-running unit. They decided, as a team, to be cross-trained in all aspects of the unit to cover any holes in the schedule. Weekly meetings were set up to update the schedule as needed. Denise told the team that as long as the unit was covered, and patient care was not affected, she would not intervene.
The issue of cohesive teamwork was addressed by inviting the hospital nursing education department monthly classes until everyone felt comfortable with the changes needed.
Conflict may be either functional or dysfunctional. Dysfunctional conflict is destructive and leads to decreased productivity; functional conflict may encourage greater work effort and promote improved performance.
The types of conflict that managers might have to deal with are intrapersonal, interpersonal, intragroup and intergroup conflicts
Intrapersonal conflict occurs within an individual and is not always easy to identify, but it can become apparent when mood swings are present, or depression is evident. Intrapersonal conflict is also apparent when a person has trouble choosing between two or more goals.7
An example of intrapersonal conflict is when an employee needs a degree to advance his/her career yet has neither resources or the time to go school. A frequently occurring intrapersonal conflict for healthcare workers is deciding how to allocate time with patients. This type of conflict requires prioritization skills. This employee has an internal fight between what the heart wants to do and what the brain says to do.
Interpersonal conflict is seen when two or more people do not agree on issues or the best way to manage a specific problem. Examples of interpersonal conflicts that might occur are:
Intragroup conflict occurs between individuals within a specific group. Departmental harmony is essential to help maintain productivity and workplace morale. When two or more people do not get along together, that personal battle can affect everyone.7 These conflicts may arise from objective differences of interest and are aggravated by antagonistic or controlling behaviors and attitudes. Individuals may strive for power, position, economic incentives, value differences or differences in gratification of personal needs. Often there is a mixture of all of these, and these incompatibilities may develop into intragroup conflict. Cliques develop and there can be overt or covert attempts to instigate hate, start verbal disagreements, disrupt productivity or prevent upward mobility of an individual or a group of individuals. Intragroup conflict can cause inappropriate behavior, lower morale and it can result in the fracturing of the group into diametrically opposing parts. Groups experiencing intragroup conflict may solicit the input of managers or show delayed progress in achieving a goal. Signs of intragroup conflict may include:
Each behavior, by itself, does not necessarily indicate conflict. People do not always complete work on time or answer all phone calls; sometimes they miss meetings. These individual behaviors might be acceptable. A conflict is present when a behavior is taken to an extreme and causes severe or irreparable damage.
Intergroup conflict is defined as an incompatibility of goals, beliefs, attitudes or behaviors between groups. This conflict occurs between two or more competing or distinct groups. Perceived differences in status and different group goals can fuel intergroup conflict. Often, this leads to miscommunication or even no communication, affecting the team’s ability to function.7
Each group has its own identity, and this identity will influence how it interacts with other, coining the term “group dynamics” in the early 1940’s.
Intergroup relations between two or more groups and their respective members are often necessary to complete the work required to maintain a smooth-running unit. In a group with poor group dynamics, people’s behavior disrupt work, resulting in poor decisions or no decisions at all.8
Communication is the key between groups that depend on one another. Lack of communication will prevent or delay effective resolutions. Positive outcomes are achieved when there are group trust and open communication.
Managing conflict is a team effort with nurse leaders, department heads and charge nurses working together to develop managerial actions and structures to minimize conflicts. They have an obligation to handle conflict in a constructive manner and with a positive attitude, using effective communication and listening skills. There are three strategies used to manage conflict: win-lose, lose-lose, and win-win.
Win-lose scenarios often involve groups and intragroup conflicts. When the group votes on an issue and majority rules, there is a winner and a loser. This scenario can erode the cohesiveness of a group and may diminish the group leader's authority. Another scenario could involve a nurse who has 30 years of seniority and wants a specific holiday off and another new employee also requested the same holiday off. The senior nurse refuses to give in and wants to win this argument.
Lose-lose scenarios involve losses to both parties. This scenario is often the case when a union arbitrator in union contract negotiations gives something to both parties and yet neither party gets what it wants.
Win-win scenarios involve collaboration: all groups or parties work together to meet the goals and objectives of all involved. Group consensus is reached after a careful investigation of the situation, specified needs of the group are understood by all, and a workable solution is reached. In this type of win-win scenario, there is no voting or other traditional dispute measurements: only the true group. Some of the advantages of collaborating include solving the actual problem, it reinforces mutual trust and respect, builds a foundation for effective collaboration in the future and shared responsibility of the outcome.10
Modes of conflict resolutioncome from the TKI or Thomas-Kilmann Conflict Mode Instrument. The TKI is a questionnaire designed to measure how an individual tends to handle inter-personal conflict. "Conflict Situations" are situations in which the concerns of two people appear to be incompatible. In such situations, a person's behavior is described along two basis dimensions11:
The TKI was developed in the early 70's by Kenneth W. Thomas and Ralph H. Kilmann. It was originally developed as a research tool and has grown into a wonderful training tool. The five conflict resolution modes are:
Avoiding - This is unassertive and uncooperative which involves avoiding or withdrawing and not dealing with the conflict. The individual does not pursue his/her concerns, or those of the other person, and the conflict is not addressed. This mode may be done for diplomatic reasons, to wait until a better time, or to withdraw from a threatening situation.
Accommodating - The exact opposite of competing, accommodating is unassertive and highly cooperative. The individual might neglect their own concerns to satisfy the concerns of another person. This mode to conflict resolution could be self-sacrificing, but it can also represent selfless generosity or charity or obeying orders when one would prefer otherwise. Individuals tend to use this strategy when they want to maintain a peaceful, workable environment.
Competing - This mode is considered to be very assertive and very uncooperative. Sometimes the term power-oriented is associated with this mode. It can be represented by an individual who pursues his/her beliefs at another person's expense, using whatever power is appropriate to win his or her position. Although there might be some negative connotations to the way this mode is described, there are times when it is the best and most effective way to resolve a conflict. Losing parties often are left angry and frustrated with the outcome. Managers often use this strategy when making quick decisions.
Compromising or Negotiating - This mode to conflict resolution involves a give and take from both parties. It is the middle ground regarding assertiveness and cooperativeness. Parties find a mutual solution that partially satisfies both parties. The individual gives up more than they would when they are in the competitive mode, but less than they would if they were accommodating. Instead of avoiding the conflict, the issue is addressed directly, but the issue is not given as much attention and analysis as is done with the collaborating mode. Compromising or Negotiating could mean splitting the difference, exchanging concessions or seeking a quick middle -ground position whereby both parties offer concessions. This method is often used in contract negotiations to placate both sides.
Collaborating - This is assertive and cooperative, it is the opposite of avoiding. This method is the most creative form of conflict resolution. An individual attempts to work with the other person to find a solution that satisfies both parties' concerns. Together they investigate the issue and identify their underlying concerns. A commitment among group members and higher levels of problem analysis are often seen when using this mode. Both parties work to understand each other's needs and perspectives so that together they can find creative solutions.
The Manager set up the mandatory brainstorming meeting with the Supervisors and Staff, and as a result, they discovered that there were specific managerial actions that were causing workplace conflicts. Some of the conflicts stemmed from:
The Manager shares what was discovered with the department heads and works on a plan to minimize conflict. Key managerial actions were discussed and implemented.
Key Managerial Actions included the following:
Programs were initiated to help individuals at all levels in the organization learn how to manage intrapersonal conflicts. Highlights included:
Nurse Managers and department heads realized that there were interpersonal conflicts among members of the management team. These had to be addressed before building a cohesive team that could meet the challenges of positive changes.
In managing interpersonal conflicts steps to take include completing a self- analysis before taking action. It is important to write down 5 or 6 traits that irritated you, becoming your "hot buttons."
Suggestions included the following:
The Joint Commission on Accreditation of Healthcare Organizations recognizes the dangers of conflicts and the potential for workplace violence. JCAHO issued a Sentinel Event Alert on July 9, 2008, amending its Leadership Standards to include these requirements/recommendations:12
It also recommends that JCAHO-accredited organizations utilize the practice of mediation in their workplaces. Read the 2009 Joint Commission Standards for conflict resolution (on-page PDF), Standard LD.02.04.01.
Organizations developing a dispute resolution process need to be aware of some key factors to success:
Leaders also need to be aware of the barriers to success such as
Training and education in conflict resolution can provide healthcare professionals with the skills and expertise to help them deal with workplace conflicts. Conflict resolution provides a safer and more satisfying environment for everyone.
Conflict is an inevitable aspect of life. In healthcare organizations, if the conflict is not dealt with effectively, the end result affects customers/patient care, employee's satisfaction, and the desire to do the best job possible and provide a safe and progressive environment. If the process of conflict resolution is viewed as an opportunity for growth and change in a work environment, the potential for a positive outcome is great.
On an individual level, the ability to solve problems and manage change plays a vital role in one's success. In the same way, the overall ability of a company - whether it is a healthcare organization or not - in solving problems through collaborative efforts, has a strong impact on the organization's bottom line and overall success.
This course is applicable for the following professions:
Advanced Registered Nurse Practitioner (ARNP), Athletic Trainer (AT/AL), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Occupational Therapist (OT), Occupational Therapist Assistant (OTA), Physical Therapist (PT), Physical Therapist Assistant (PTA), Registered Nurse (RN), Respiratory Therapist (RT)
CPD: Practice Effectively, CPD: Promote Professionalism and Trust