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Conflict management in healthcare

Creating a culture of co-operation.

Prasad, Alpana ,*

Department of Paediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India

*Address for correspondence: Dr. Alpana Prasad, Department of Paediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India. E-mail: [email protected]

Available Online: 21-Aug-2021

Received May 28, 2021

Received in revised form June 12, 2021

Accepted July 24, 2021

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Author: Garry McDaniel

Publisher: Koehler Books (January 29, 2021)

Language: English

ISBN: 978-1646632169

Editor: Garry McDaniel, EdD

Edition: 1 st Edition, 2021

Price: 1479.00 INR

In the present era of increasing demands for delivery of high-quality affordable healthcare services, along with rising levels of expectations of patients and their families from healthcare providers, there is an unprecedented surge in the reported incidence of conflicts, litigations and violence faced by healthcare organisations worldwide. In this book titled ‘ Conflict Management in Healthcare: Creating a culture of co-operation ’, Garry McDaniel et al ., with their collective wisdom and experience in fields of management and healthcare, have systematically dealt with reasons of conflicts and its effective management so as to create a culture of cooperation which will help to maximise the productivity and performance of any organisation. The quality of services provided by any healthcare organisation is directly influenced by the conflicts which may occur between physicians, between physician and staff, between administration and management, or between healthcare providers and patients or their families. The authors state that not all conflicts are bad as some may be ‘productive conflicts’ which eventually help in the progress of the institution by creating a positive change in its image by improving the quality of services and relationships in the organisation. However, when there is disrespectful behaviour, incivility, harassment or bullying, frequent arguments and lingering frustration amongst the employees, then the conflict is ‘unproductive’ and may lead to wasted resources, litigation or violence which ultimately destroys the reputation of the institution.

Well-managed everyday conflicts provide an opportunity for enhancing interpersonal, team and organisational relationships. The authors have eloquently described the entire process involved in conflict mediation into four crucial steps giving an acronym CCGA – identify the conflict, understand the concerns and needs, clarify the goals and finally develop a plan of action. Conflicts can be minimised by implementing standards for guiding conduct and behaviour, improving communication skills and promoting a work culture that helps sustain a positive work environment. The authors have elaborated on the importance of enhancing communication skills by confronting the conflict honestly, listening and acknowledging the conflict before responding to it and finally committing to a solution which is a ‘win-win’ situation for all those involved. The implementation of conflict mediation system within any healthcare organisation has to be customised to that particular institution as the cultural and behavioural practices vary. At the end of each chapter, the authors have provided tools and activities to manage everyday conflicts and turn them into opportunity for enhanced cooperation.

This publication is strongly recommended as a beneficial resource not only for administrators and managers but for all healthcare staff including medical students and residents. In the midst of the COVID pandemic when every healthcare organisation is facing unprecedented challenges, the authors have provided a comprehensive roadmap for resolving conflicts, building trust and enhancing patient care.

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by Katherine J. Igoe

It’s a stereotype with a grain of truth: leaders are often promoted for past performance , not future potential. That notion certainly rings true in health care, considering how many clinicians are regularly promoted to positions of leadership because of their clinical skills. When things don’t work out, though, it’s less often about their clinical performance and more often about shortcomings in their ability to connect, navigate conflict and instill confidence and loyalty in others. They’re hired for their skills and fired for their humanity, in other words.

To quote leadership expert Marshall Goldsmith, “What got you here won’t get you there.” Clinicians usually operate from a highly detailed, scientific mindset—it’s what led them to success in the first place, argues Ted Witherell , faculty member in the Department of Health Policy and Management, program director for Conflict Feedback and Negotiation in Health Care at the Harvard T.H. Chan School of Public Health, and former Senior Director of Talent Management for the Mass General Brigham health care system.

He explains their cognitive dissonance in a leadership role thusly: “‘As a clinician, I’ve grown up in this hierarchical, structured environment. The letters after my name mean something in terms of what I can and can’t do. In a new leadership role, though, I have to influence.’ That’s a journey, and it trips up some folks.”

So why is influence such a different but critically important skill set for health care leaders and—more importantly—how do they develop it?

Understanding the Unique Challenges of Moving From Clinician to Leader

Health systems are usually organized hierarchically; clinicians are trained to make definitive diagnoses and give clear direction to other medical professionals. In a position of leadership, however, a person may not be able to make decisions unilaterally. Working in a nuanced way with other administrators, experts, colleagues, and subordinates, particularly in negotiation and conflict management, is a completely different skill set.

“It’s a skill that’s as valuable—and, if clinicians want to move their agenda forward, more valuable—than the clinical skills. Those ‘hard’ skills got them to the table but won’t get them to the next place,” says Witherell.

In research on how physicians learn, the concept of “confidently held misinformation” is also common, in which physicians may be incorrect about a particular fact, but have total confidence that they’re right. This is a common mindset that they must unlearn in order to be effective leaders. The shift from answers with no room for indecision to inquiry, reflection and collaborative problem solving is key to medical leaders’ success.

Influence: What It Is and What It Means for Medical Leaders

Witherell begins class discussion about conflict management with a simple premise: that conflict is inevitable, and that there is nothing we do not negotiate over. It’s not conflict “resolution,” because the problem may not have a solution. Instead, influence involves bringing together disparate viewpoints and advocating without dictating.

“Influence in this context is a way of thinking about power with more nuance—ways it can show up that are more dynamic than the way you’ve known it in the past,” he says. Put more bluntly, it’s “getting people over whom you have no authority to do stuff.”

The three elements to cultivate effective influence, as Witherell defines it, are as follows:

• Conflict: working through disagreement in a way that solves the problem at hand and maintains or enhances the relationship with the other person.
• Feedback: having difficult conversations around thorny issues like performance and change—which can be significantly harder than just avoiding the conversation or giving commands.
• Negotiation: approaching conversations with a win-win mindset, i.e., instead of advocating for your slice of the pie, engaging with the other person to make a bigger, better pie together

That last bullet point is relevant to leadership in all its forms. Known as interest-based bargaining, it is a mindset that involves getting away from a “mine” mentality and towards an “ours” mentality, even in scenarios where money, responsibility or other critical issues may be at stake.

What Medical Leaders Can Do to Cultivate Influence

All of this can, obviously, be challenging for a medical leader. Understanding that there is something to learn, and stepping back to learn it, can be a process in itself. Witherell describes the initial process like this: “In learning we move from a state of unconscious incompetence—ignorance is bliss—to conscious incompetence, which is very uncomfortable.” Witherell says that when students begin to process this in class and internalize new ways of thinking, it leads to a sort of rebalancing and renewed confidence.

Fortunately, most clinicians have seen effective leadership even if they themselves have not yet lived it. And the work to improve begins simply: by having difficult conversations, over and over again. A few important points to remember during that learning process:

• Influence requires empathy for the other person or people—and, as an associated skill, the willingness to not be right 100% of the time.
• Solving from the top level of conflict instead of the basement (i.e., using one’s prefrontal cortex instead of the emotion-driven limbic system), as noted by Harvard faculty Leonard Marcus , is a skill in and of itself. Another aspect of conflict management is helping the other person stay at the top level, too.
• An interest-based mindset is all about “getting to yes,” or as Witherell says, “getting all those viewpoints on the table and seeing where we have moments of agreement.” It’s important to remember that, especially in moments of tension.
• Developing better leadership skills can pose unique challenges for each person. Thus, the learning process will also be unique. “Watch for the triggers: the kinds of things that push your buttons, that you’re willing to go to battle over,” says Witherell.

Throughout the process, Witherell underscores that conflict is borne of passion—generally, we disagree over things we care deeply about—and clinicians care about patients already.

“It’s a fallacy to assume that conflict is a battle to see who cares more. It’s really just different viewpoints about ways to care,” he says. “And there’s no wrong way to care.”

Harvard T.H. Chan School of Public Health offers Conflict, Feedback, and Negotiation in Health Care , an online program designed to help you Develop strategies for overcoming the barriers and challenges to conflict management.

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Recognising, understanding and managing high conflict behaviours in healthcare

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James Kelly, Yasir Al-Rawi, Recognising, understanding and managing high conflict behaviours in healthcare, Postgraduate Medical Journal , Volume 97, Issue 1144, February 2021, Pages 123–124, https://doi.org/10.1136/postgradmedj-2020-139173

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Conflict in healthcare is commonplace, may be increasing, and is hardly surprising given the combination of a high stress environment and multiple stakeholder involvement. 1

The national health service (NHS) identifies three major forms of conflict: task conflict relates to differences in opinions and viewpoints. Typically associated with change and short-lived, it may be functional, involving a healthy challenge of the status quo and driving improvement. Process conflict involves disagreement over the logistics of achieving an outcome or change, which can also be functional. Finally, relationship conflict, where there is a perceived interpersonal incompatibility, either between staff or between staff and a patient or relative. 2 Such conflict is dysfunctional, often relates more to personalities than problems and accounts for the majority of negative and destructive conflict. When severe, multiple adverse outcomes may occur, including decreased job satisfaction and productivity, absenteeism and medical errors 1 2 and occasionally it may be extreme enough to garner media attention. 3 Where unusually difficult or protracted, especially where there is consensus that the conflict is unjustified or disproportionate, a high conflict personality may be the primary issue. 4 5

High conflict persons are characterised by four cardinal criteria 4 5 : preoccupation with blaming, extreme behaviours, unregulated emotions and all or nothing thinking (often ‘splitting’ people into all good or all bad). Cognitive distortions, adversarial thinking dominated by negative emotions, lack of reflection and identifying targets of blame are common. Some become ‘persuasive blamers’ and successfully recruit ‘negative advocates’—influential non-high conflict individuals who may come to support their cause. Insight is generally absent so few ever seek help or are diagnosed 6 and unsurprisingly, formal studies have not been done. However, over the last two decades, there is increasing consensus that many such persons have a type B cluster personality disorder (PD). 4 5 7

Type B cluster PDs are strongly associated with conflict 6 7 and are characterised by emotional dysregulation, impulsivity and lack of empathy. They comprise borderline, narcissistic, histrionic and antisocial variants, 8 and at a combined population prevalence of around 3%, 9 are commoner than chronic obstructive pulmonary disease. Of these, borderline (characterised by intense mood dysregulation, anger, volatile relationships and absence of a cohesive sense of self) and narcissistic PD (strongly linked with interpersonal exploitativeness, grandiosity, entitlement and a need for admiration) are probably the most common in disputes. 4 5 7 Histrionic PD is characterised by attention seeking, excessive but shallow displays of emotion and suggestibility, while antisocial PD is associated with deceitfulness, disregard for other’s rights, impulsivity and lack of remorse. 8 Interestingly, narcissistic traits appear to be increasingly prevalent in younger persons, 10 likely incubated by the emphasis on expressive individualism over collective values in contemporary culture. While potentially less impairing than the other cluster B PDs, narcissistic PD is strongly associated with adverse effects on well-being in close associates, more so than borderline PD.

Successful strategies exist for dealing with high conflict persons. 4 5 Management emphasises controlling one’s own emotional responses which, unmanaged, may cause escalation, and a feed-forward approach focusing on the future relationship rather than the current issue or past behaviours and events. 4 5 For example, the ‘CARS’ method is designed to reinforce the best potential behaviours of the high conflict personality and redirect their energy constructively as follows 4 5 : C onnect—showing attentiveness and empathy for how the person is feeling, without necessarily assenting to their perspective; A nalyse—after connecting, trying to move them from emotional to logical thinking, jointly reviewing possible solutions to the problem; R espond—not letting misinformation go unchallenged, especially when directed to potential negative advocates; and S et limits—outlining acceptable limits to behaviour but keeping this impersonal, referring instead to external reasons such as trust policies and logical consequences if violated, keeping the focus on future not past behaviour. Bear in mind that individuals with PDs experience internal distress which they see as having external rather than internal causes, 5 7 8 suffer a range of adverse outcomes 6 and that there are significant genetic and neuroimaging associations, suggesting reduced freedom in the expression of some behaviours, hence compassion may be the most appropriate attitude, while taking care not to reinforce negative behaviours.

It is important to stress two things. First, only a minority of inter-personal healthcare disputes involve persons with a high conflict tendency though when present, it is seldom recognised or appropriately managed. Second, if there is a suspicion a high conflict personality underlies a dispute this should remain a private working theory and it is recognition of the pattern that is the primary issue, the underlying cause being of secondary importance.

The combination of increasing competition for scarce resources 1 and a rising prevalence of conflict-prone traits in the population 10 suggests high conflict behaviours within healthcare are here to stay and likely to increase. Learning to recognise, understand and manage high conflict behaviour will likely reduce distress and lead to better outcomes for all parties when cases arise and pay high yields in the future.

JAK conceived this article which was then researched and written in collaboration between JAK & YA-R who contributed equally.

There was no funding source and the authors have no competing interests.

None declared.

Not required.

Not commissioned; internally peer reviewed.

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Conflict Management in Healthcare, Essay Example

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In my practice, I believe that I tend to avoid conflicts. Conflict avoidance can be both beneficial and harmful, according to Raines (2013, p. 9). The author also explains that people who have had negative experiences when dealing with conflict tend to avoid them. While I do not always avoid conflict, when the problem seems to be insignificant, I tend to sit down and think how can things get managed without having to intervene directly. I also understand that conflict is necessary for negotiation and innovation, therefore, when necessary, I sit down with others and try to find a solution together. I do sometimes refuse to take notice of the problem, and hope that it will solve itself, and this is definitely one of the leadership development areas I need work on.

My secondary conflict management style is collaboration. When I realize there is a problem, I attempt to get all the people in the team together to find a solution together. While I do not always make sacrifices, I often do, but expect the same in return. When I appoint a team member to become responsible for liaising with patient representatives, I offer training and coaching, but also expect them to provide support and report back to me on a regular basis on the issue. I believe that having a positive and encouraging work environment is important for all team members, and that is why I try to work on collaboration. However, I do also understand that collaboration cannot solve all workplace problems (Raines, 2013, p. 14), and in some cases I do need to make decisions and claim my authority. As an example, I recently realized that I could not possibly ask all of the team members which shift they prefer, as it is dictated by the needs of patients, the department’s standards and targets.

Overall, when there is a conflict of interest in the team regarding tasks, and both of them would like to do the same, I use collaboration. However, I am also avoiding the conflict until it is evident that the two nurses cannot solve it themselves. In some cases, too much collaboration makes it hard for me to make important decisions, such as selecting employee training programs, as I listen to team members, instead of trusting myself to make the right decision.

Raines, S. (2013) Conflict management for managers. Resolving workplace, client, and policy disputes . Jossey-Bass.

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Conflict Resolution Strategies for Nurse Leaders

3 min read • September, 18 2023

Conflicts are inevitable when you work in a stressful environment like health care. Tension and stress can result from miscommunication and differing opinions and priorities. You can't ignore a volatile situation between staff members as a nurse leader. Conflicts within your nursing team can create an uncomfortable work environment for everyone. It's often not the conflict that's your biggest challenge — it's how you work to resolve it.

Conflict Management in Nursing

Discord can stem from opposing personalities, biases, or perceptions, and internal or external stressors. To be an effective nurse leader, you may need to provide guidance and coaching to help your team resolve conflicts.

Examples of Nursing Conflicts

Consider these nursing conflict scenarios:

• Staff conflicts regarding workload distribution, staffing ratios, and shift preferences
• Interdisciplinary disagreements about treatment plans, responsibilities, or decision-making processes
• Ethical disputes on topics such as end-of-life care, patient autonomy, and resource allocation
• Communication breakdowns resulting in misunderstandings or lack of information
• Discrepancies in management styles, decision-making authority, or organizational policies
• Role conflicts resulting from overlapping roles or ambiguity in responsibilities
• Resource conflicts due to limited supplies, equipment, or budget allocations

Potential Responses to Conflicts in Nursing

The health care environment requires teamwork to provide safe, quality care. It's in everyone's best interest to work collaboratively to resolve the conflict. How you and your staff respond to a conflict will vary based on the situation and individual personalities. Try these five approaches to resolve interpersonal conflicts among your team:

• Accommodation . Use this strategy to maintain peace and harmony by smoothing over differences. This method of conflict management in nursing may be appropriate when escalating the issue could create a severe disruption.
• Collaboration . This approach, committed to solving the problem by objectively evaluating differing views, can lead to creativity and new ideas.
• Compromise . This bargaining strategy recognizes the importance of resolving the relationship and can provide a temporary solution.
• Avoidance . In situations fueled by intense anger, avoiding conflict also provides a short-term resolution.
• Competition . Another short-term solution involves assertively resolving a conflict when one person has more decision-making power.

Additional Conflict Resolution Strategies in Nursing

Nursing conflict resolution requires patience, active listening skills, and a commitment to finding a beneficial solution. The goal is to address conflicts among your nursing staff and promote a safe and harmonious work environment that provides quality patient care.

Ignoring the problem may result in your staff developing resentment toward the person who made the work environment uncomfortable. Rushing to fix the conflict without determining the source of the issue could lead to other problems. Treat the situation like a conflicting diagnosis and identify the source of discord before proceeding.

Tips for Conflict Resolution in Nursing

Conflict resolution in nursing requires communication, collaboration, and listening. Here are practical tips for navigating conflicts:

• Create a supportive environment that encourages active listening and honest conversation.
• Make sure you fully understand the situation.
• Approach the problem objectively and, if necessary, seek additional perspectives from your human resources department or another nurse leader.
• Facilitate constructive dialogue to work toward a mutually agreeable solution.
• Seek the conflict's root cause.
• Find solutions that aren't quick fixes but address the core problem.
• Ask questions to prompt different perspectives and creative solutions.
• Identify and discuss underlying interests to soften rigid views.
• Find common ground and work toward a mutual agreement.
• Emphasize the importance of collaboration.
• Develop effective communication and conflict-resolution skills.
• Support suggestions for productive and innovative solutions.
• Rule out and quickly address bullying and incivility .
• Admit and apologize if you've played a role in the conflict.
• Be consistent with standards and potential consequences.
• Handle conflicts fairly and transparently.
• Document the situation, steps taken, and the resolution.
• Monitor to ensure the problem gets resolved and doesn't reoccur.

Conflicts in health care vary in nature and complexity. Other strategies, such as arbitration or involving an ethics committee, may be appropriate depending on the circumstances. Be alert for signs of a conflict before a situation becomes volatile or uncomfortable. Sometimes, despite your best efforts, disciplinary action may become necessary.

Dealing with conflict fairly and effectively can help you gain the respect of your nursing staff and grow as a leader. Conflict resolution in nursing leadership identifies underlying issues and creates better solutions. By listening and collaborating, you can resolve conflicts constructively to maintain a positive work environment.

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Leadership Guide to Conflict and Conflict Management

Fadi Smiley

“A part of effective leadership is caring for and supporting one another, even when there is conflict or a difference of opinion.” -Ty Howard

Introduction Conflict may occur between people or within groups in all kinds of situations. Due to the wide range of differences among people, the lack of conflict may signal the absence of effective interaction. Conflict should not be considered good or bad, rather it may be viewed as a necessity to help build meaningful relationships between people and groups. The means and how the conflict is handled will determine whether it is productive or devastating. Conflict has a potential to create positive opportunities and advancement towards a common goal, however, conflict can also devastate relationships and lead to negative outcomes ((Kazimoto, 2013; Fisher, 2000; Evans, 2013).

Today’s healthcare leaders are taught to lead change, development, and transformation in organizations. Leadership may be described as the ability to emphasize the pursuit of goals and motivate others to pursue them as well. Northouse states that leadership is a process whereby an individual influences a group of individuals to achieve a common goal (Northouse, 2016). Others characterize leadership as the ability to inspire trust, build relationships, encourage followers .

An under-reported aspect that is not commonly discussed among leadership qualities is the ability to handle conflict (Guttman, 2004). Guttman explains that there might be two reasons as to why there is little recognition of conflict management in leaders. One is called rationalistic fallacy, and Guttman explains that most of the literature available focuses on arming leaders with all necessary leadership concepts and success will just follow, almost as if it is assumed that leaders will automatically know how to manage conflict. Secondly, Guttman explains that leaders may have a fatalistic attitude towards conflict. Leaders may look at conflict as situation that will never be resolved, so why bother addressing it? We should focus on what can be addressed and changed (Guttman, 2004).

Conflict management is a skill that leaders must be able to employ when needed to help foster a productive working environment (Guttman, 2004). There is a realization that conflict management should be a skill that leaders need to give priority to learning and mastering (Kazimoto, 2013). The inability of a leader to deal with conflict will not only lead to negative outcomes but may also undermine the credibility of the leader (Kazimoto, 2013). Whereas if a leader is able to establish an atmosphere of cooperation and foster teamwork, making it clear that this is his/her value system, there is a likelihood that this value system will be adopted by the entire organization (Guttman, 2004). Therefore, it is very important that we discuss and address conflict management as a leadership skill.

This chapter will discuss the definition of conflict and its sources, describe conflict management and resolution, and discuss a guide for leaders to use to help them effectively manage and resolve conflict. We discuss the different types of conflict that can exist and describe the different conflict management modes that can be used to address them. Lastly, we will analyze the relationship between leadership and conflict management through a literature review. By reading this chapter, I hope that readers will understand conflict, the role it plays within teams and organizations, and the importance of developing conflict management skills for leaders.

Defining Conflict What is conflict? The answer to this question varies, depending on the source. The Webster Dictionary defines conflict as “the competitive or opposing action of incompatibles: an antagonistic state or action.” For some, the definition of conflict may involve war, military fight, or political dispute. For others, conflict involves a disagreement that arises when two or more people or parties pursue a common goal. Conflict means different things to different people, making it very difficult to come up with a universal or true definition. To complicate this even further, when one party may feel that they are in a conflict situation, the other party may think that they are just in a simple discussion about differing opinions (Fisher, 2000; Evans, 2013; Conflict, 2011).

To fully understand conflict and how to manage it, we first need to establish a definition that will allow us to effectively discuss conflict management and its use by today’s leaders. Conflict can be described as a disagreement among two entities that may be portrayed by antagonism or hostility. This is usually fueled by the opposition of one party to another to reach an objective that is different from the other, even though both parties are working towards a common goal (Fisher, 2000; Evans, 2013). To help us better understand what conflict is, we need to analyze its possible sources. According to American psychologist Daniel Katz, conflict may arise from 3 different sources: economic, value, and power. (Evans, 2013)

• Economic Conflict involves competing motives to attain scarce resources. This type of conflict typically occurs when behavior and emotions of each party are aimed at increasing their own gain. Each party involved may come into conflict as a result of them trying to attain the most of these resources. An example of this is when union and management conflict on how to divide and distribute company funds (Fisher, 2000; Evans, 2013).
• Value Conflict involves incompatibility in the ways of life. This type of conflict includes the different preferences and ideologies that people may have as their principles. This type of conflict is very difficult to resolve because the differences are belief-based and not fact-based. An example of this is demonstrated in international war in which each side asserts its own set of beliefs (Fisher, 2000; Evans, 2013).
• Power Conflict occurs when each party tries to exert and maintain its maximum influence in the relationship and social setting. For one party to have influence over the other, one party must be stronger (in terms of influence) than the other. This will result in a power struggle that may end in winning, losing, or a deadlock with continuous tension between both parties. This type of conflict may occur between individuals, groups, or nations. This conflict will come into play when one party chooses to take a power approach to the relationship. The key word here is “chooses.” The power conflict is a choice that is made by one party to exert its influence on the other. It is also important to note that power may enter all types of conflict since the parties are trying to control each other (Fisher, 2000; Evans, 2013).

According to Ana Shetach, an organizational consultant in team process and development, conflict can be a result from every aspect such as attitude, race, gender, looks, education, opinions, feelings, religion and cultures. Conflict may also arise from differences in values, affiliations, roles, positions, and status. Even though it seems that there is a vast array of sources for conflict, most conflict is not of a pure type and typically is a mixture of several sources (Shetach, 2012).

Conflict is an inevitable part of life and occurs naturally during our daily activities. There will always be differences of opinions or disagreements between individuals and/or groups. Conflict is a basic part of the human experience and can influence our actions or decisions in one way or another. It should not be viewed as an action that always results in negative outcomes but instead as an opportunity for learning and growth which may lead to positive outcomes. We can reach positive outcomes through effective conflict management and resolution, which will be discussed in more detail later in the chapter (Evans, 2013).

Since conflict can result in emotions that can make a situation uncomfortable, it is often avoided. Feelings such as guilt, anger, anxiety, and fear can be a direct result of conflict, which can cause individuals to avoid it all together. Conflict can be a good thing and avoiding it to preserve a false impression of harmony can cause even more damage (Loehr, 2017a). If we analyze the CPP Global Human Capital Report, we see evidence that conflict can lead to positive outcomes within the workplace environment. This research project asked 5000 individuals about their experiences with conflict in the workplace environment. They reported, that as a result of conflict:

• 41% of respondents had better understanding of others
• 33% of respondents had improved working relationships
• 29% of respondents found a better solution to a problem
• 21% of respondents saw higher performance in the team
• 18% of respondents felt increased motivation (CPP Global Human Capital Report, 2008)

Based on this report, we can conclude that conflict can lead to positive outcomes and increased productivity, depending on the conflict itself (Loehr, 2017a). Approximately 76% of the respondents reported that conflict resulted in some type of positive outcome. This speaks volumes to the ideology that conflict within the workplace is something that should be welcomed and not avoided (CPP Global Human Capital Report, 2008).

Conflict can occur in various ways in the human experience, whether it is within one-self between differing ideas or between people. Even though this chapter will focus on the conflict at the social level, it is important that we review all the different levels of conflict that may exist. The levels of conflict that we will discuss include interpersonal, intrapersonal, intergroup, and intragroup conflict (Loehr, 2017a; Fisher, 2000; Evans, 2013).

Levels of Conflict

• Interpersonal Conflict . This level of conflict occurs when two individuals have differing goals or approaches in their relationship. Each individual has their own type of personality, and because of this, there will always be differences in choices and opinions. Compromise is necessary for managing this type of conflict and can eventually help lead to personal growth and developing relationships with others. If interpersonal conflict is not addressed, it can become destructive to the point where a mediator (leader) may be needed (Loehr, 2017a; Fisher, 2000; Evans, 2013).
• Intrapersonal Conflict. This level of conflict occurs within an individual and takes place within the person’s mind. This is a physiological type of conflict that can involve thoughts and emotions, desires, values, and principles. This type of conflict can be difficult to resolve if the individual has trouble interpreting their own inner battles. It may lead to symptoms that can become physically apparent, such as anxiety, restlessness, or even depression. This level of conflict can create other levels of conflict if the individual is unable to come to a resolution on their own. An individual who is unable to come to terms on their own inner conflicts may allow this to affect their relationships with other individuals and therefore create interpersonal conflict. Typically, it is best for an individual dealing with intrapersonal conflict to communicate with others who may help them resolve their conflict and help relieve them of the situation (Loehr, 2017a; Fisher, 2000; Evans, 2013).
• Intergroup Conflict. This level of conflict occurs when two different groups or teams within the same organization have a disagreement. This may be a result of competition for resources, differences in goals or interests, or even threats to group identity. This type of conflict can be very destructive and escalate very quickly if not resolved effectively. This can ultimately lead to high costs for the organization. On the other hand, intergroup conflict can lead to remarkable progress towards a positive outcome for the organization if it is managed appropriately (Loehr, 2017a; Fisher, 2000; Evans, 2013).
• Intragroup Conflict . This level of conflict can occur between two individuals who are within the same group or team. Similar to interpersonal conflict, disagreements between team members typically are a result of different personalities. Within a team, conflict can be very beneficial as it can lead to progress to accomplishing team objectives and goals. However, if intragroup conflict is not managed correctly, it can disrupt the harmony of the entire team and result in slowed productivity (Loehr, 2017a; Fisher, 2000; Evans, 2013).

Regardless of the level of conflict that takes place, there are several methods that can be employed to help manage conflicts. And with the seemingly infinite triggers for conflict, management of conflict is a constant challenge for leaders. To help address this, we will next discuss what conflict management is and then later examine the role of leadership in conflict management and resolution.

Conflict Management Conflict Management may be defined as the process of reducing negative outcomes of conflict while increasing the positive . Effectively managed conflicts can lead to a resolution that will result in positive outcomes and productivity for the team and/or organization (Loehr, 2017b; Evans, 2013). Leaders need to be able to manage conflict when it occurs, and their ability to manage them is critical to the success of the individuals and/or teams involved (Guttman, 2004). There are several models available for leaders to use when determining their conflict management behavior. So where do leaders begin when they want to recognize their own conflict management styles? In this section, we will cover a popular method of conflict management styles, the Thomas-Kilmann Conflict Mode Instrument, that will help us answer this question (Loehr, 2017b; Evans, 2013).

The Thomas-Kilmann Conflict Mode Instrument (TKI) The Thomas-Kilmann Conflict Mode Instrument is an assessment tool that helps measure an individual’s behavior in conflict situations. The assessment takes less than 15 minutes to complete and provides feedback to an individual about how effectively they can use five different conflict-handling modes. TKI helps leaders understand how individual or team dynamics are affected by each of the modes, as well as helping leaders decide on which mode to employ in different conflict situations (Kilmann & Thomas, n.d.).

The TKI is based on two dimensions of behavior that help characterize the five different conflict-handling modes. The first dimension is assertiveness, and this describes the extent to which a person will try to fulfill their own concerns. The second is cooperativeness, and this describes the extent to which a person will try to fulfil others’ concerns. The five conflict-handling modes fall within a scale of assertiveness and cooperativeness as shown in the figure below. They include: avoiding, accommodating, competing, collaborating, and compromising (Loehr, 2017b; Kilmann & Thomas, n.d.).

(source:killmanndiagnostics.com)

The TKI Five Conflict-Handling Modes (Avoiding, Accomodating, Competing, Collaborating, and Compromising) Avoiding This mode is low assertiveness and low cooperative. The leader withdraws from the conflict, and therefore no one wins. They do not pursue their own concerns nor the concerns of others. The leader may deal with the conflict in a passive attitude in hopes that the situation just “resolves itself.” In many cases, avoiding conflict may be effective and beneficial, but on the other hand, it prevents the matter from being resolved and can lead to larger issues. Situations when this mode is useful include: when emotions are elevated and everyone involved needs time to calm down so that productive discussions can take place, the issue is of low importance, the team is able to resolve the conflict without participation from leadership, there are more important matters that need to be addressed, and the benefit of avoiding the conflict outweighs the benefit of addressing it. This mode should not be used when the conflict needs to be resolved in a timely manner and when the reason for ignoring the conflict is just that (Loehr, 2017a; Mediate.com; Kilmann & Thomas, n.d.).

Accommodating This mode is low assertiveness and high cooperation. The leader ignores their own concerns in order to fulfill the concerns of others. They are willing to sacrifice their own needs to “keep the peace” within the team. Therefore, the leader loses and the other person or party wins. This mode can be effective, as it can yield an immediate solution to the issue but may also reveal the leader as a “doormat” who will accommodate to anyone who causes conflict. Situations when this mode is useful include: when an individual realizes they are wrong and accepts a better solution, when the issue is more important to the other person or party which can be seen as a good gesture and builds social credits for future use, when damage may result if the leader continues to push their own agenda, when a leader wants to allow the team to develop and learn from their own mistakes, and when harmony needs to be maintained to avoid trouble within the team. This mode should not be used when the outcome is critical to the success of the team and when safety is an absolute necessity to the resolution of the conflict (Loehr, 2017b; Mediate.com; Kilmann & Thomas, n.d.).

Competing This mode is high assertiveness and low cooperation. The leader fulfills their own concerns at the expense of others. The leader uses any appropriate power they have to win the conflict. This is a powerful and effective conflict-handling mode and can be appropriate and necessary in certain situations. The misuse of this mode can lead to new conflict; therefore, leaders who use this conflict-handling mode need to be mindful of this possibility so that they are able to reach a productive resolution. Situations when this mode is useful include: an immediate decision is needed, an outcome is critical and cannot be compromised, strong leadership needs to be demonstrated, unpopular actions are needed, when company or organizational welfare is at stake, and when self-interests need to be protected. This mode should be avoided when: relationships are strained and may lead to retaliation, the outcome is not very important to the leader, it may result in weakened support and commitment from followers, and when the leader is not very knowledgeable of the situation (Loehr, 2017b; Mediate.com; Kilmann & Thomas, n.d.).

Collaborating This mode is high assertiveness and high cooperation. In this mode both individuals or teams win the conflict. The leader works with the team to ensure that a resolution is met that fulfills both of their concerns. This mode will require a lot of time, energy and resources to identify the underlying needs of each party. This mode is often described as “putting an idea on top of an idea on top of an idea” to help develop the best resolution to a conflict that will satisfy all parties involved. The best resolution in this mode is typically a solution to the conflict that would not have been produced by a single individual. Many leaders encourage collaboration because not only can it lead to positive outcomes, but more importantly it can result in stronger team structure and creativity. Situations when this mode is useful include: the concerns of parties involved are too important to be compromised, to identify and resolve feelings that have been interfering with team dynamics, improve team structure and commitment, to merge ideas from individuals with different viewpoints on a situation, and when the objective is to learn. This mode should be avoided in situations where time, energy and resources are limited, a quick and vital decision needs to be made, and the conflict itself is not worth the time and effort (Loehr, 2017b; Mediate.com; Kilmann & Thomas, n.d.).

Compromising This mode is moderate assertiveness and moderate cooperative. It is often described as “giving up more than one would want” to allow for each individual to have their concerns partially fulfilled. This can be viewed as a situation where neither person wins or losses, but rather as an acceptable solution that is reached by either splitting the difference between the two positions, trading concerns, or seeking a middle ground. Leaders who use this conflict-handling mode may be able to produce acceptable outcomes but may put themselves in a situation where team members will take advantage of the them. This can be a result of the team knowing that their leader will compromise during negotiations. Compromising can also lead to a less optimal outcome because less effort is needed to use this mode. Situations when this mode is effective include: a temporary and/or quick decision to a complex issue is needed, the welfare of the organization will benefit from the compromise of both parties, both parties are of equal power and rank, when other modes of conflict-handling are not working, and when the goals are moderately important and not worth the time and effort. This mode should be avoided when partial satisfaction of each party’s concerns may lead to propagation of the issue or when a leader recognizes that their team is taking advantage of their compromising style (Loehr, 2017b; Mediate.com; Kilmann & Thomas, n.d.).

Personal Reflections on the Thomas-Kilmann Conflict Mode Instrument I chose the TKC Instrument because I felt it encompassed all aspects of conflict behavior and does a thorough job of explaining those behaviors. When compared to other models, the TKI model is more specific in the description of conflict behaviors as well. The TKI model has been around for well over 30 years, and I feel it does a very good job of breaking down a complex theory of conflict styles into a format that is easily understood and can be used by anyone.

Leaders should be capable of using all five conflict-handling modes and should not limit themselves to using only one mode during times of conflict (Loehr, 2017b). Leaders must be able to adapt to different conflict situations and recognize which type of conflict-handling mode is best to employ given the conflict at hand (Mediate.com). The use of these modes can result in positive or negative resolutions and it is imperative that today’s leaders understand how to effectively employ them (Loehr, 2017b; Mediate.com; Kilmann & Thomas, n.d.).

Leadership and Conflict Management The leader’s role in managing conflict can have a significant impact on how they are resolved within the workplace or organization. Leaders spend about 24% of their time resolving conflicts, however the process to approaching conflict management relates to a great extent to their leadership style (Guttman, 2004). Leaders who use conflict management skills can provide guidance and direction towards conflict resolution. A common trait of leaders is they are able to build teams that work well together and help to set the tone for the organization. They must be able to facilitate the resolution of conflicts through effective conflict management (Guttman, 2004; Doucet, Poitras & Chenevert, 2009).

Leaders exhibit a variety of characteristics and traits that allow them to be great leaders, but does it help them when it comes to conflict management? I believe that it does. These same traits can help leaders dealt with conflict. The ability to recognize one’s own leadership style will ultimately help describe how a leader handles conflict. Peter Northouse states that “it is up to the leader to assess what action, if any, is needed and then intervene with the specific leadership function to meet the demand of the situation.” To be an effective leader, one needs to respond with the action that is required of the situation” (Northouse, 2016). I feel this demonstrates that the job of a leader is to analyze a conflict and facilitate the situation to produce a resolution that can be positive and productive. Northouse reassures us that any leader can draw on his/her leadership skills to employ appropriate conflict management strategies (Northouse, 2016).

A study conducted by Zhang et al. analyzed the relationship between transformational leadership and conflict management. Zhang et al. looked at how transformational leadership affects team coordination and performance through conflict management. What they found was that transformational leaders who used conflict management methods were able influence their teams to establish stronger identities, discuss their disagreements and frustrations outwardly, and work out solutions that benefited the team (Zhang, Cao, Tjosvold, 2011). I feel that this study helps to confirm that leaders must be able to possess conflict management skills to effectively run a productive team and organization. This study also shows us that there may be a possibility that certain leadership styles are more effective at conflict management. This is not definite but hopefully there will be more studies done to determine this.

Earlier in the chapter, we discussed the different types of conflict-handling modes that leaders may possess, but it is also necessary to briefly discuss the leadership skills and behaviors needed to effectively manage conflicts. Leadership skills needed to be effective at conflict management can be categorized to show which skills match up with five of the TKI conflict-handling modes. The avoiding mode requires leadership skills such as: to be able to withdraw from a conflict or sidestep issues, have the ability to leave issues unresolved, and to have a sense of timing . The accommodating mode requires skills such as: being able to obey orders, set your own concerns aside, selflessness, and the ability to yield for the greater good. The competing mode requires skills such as: standing your ground, debating, using influence, stating your position clearly, and stressing your feelings. The collaborating mode requires skills such as: active listening, identifying concerns, analyzing input, and confrontation. The compromising mode requires skills such as: negotiating and finding the middle ground, making concessions, and assessing value (Kilmann & Thomas, n.d.; Understanding Conflict and Conflict Management, n.d.). Behaviors that allow leaders to be effective at conflict management include (Guttman, 2004):

• Be Candid . Leaders cannot hesitate to put issues on the table to be discussed
• Be Receptive . Leaders need to make sure that team members understand that it is ok for conflict to exist and that everyone’s opinion will be discussed
• Depersonalize . Leaders must be able to remove personal feeling from the mix and view conflict as a team issue
• Learn to Listen . Leaders must listen carefully and make sure that they provide feedback as well
• Be clear . Leaders need to make sure that all team members understand how decisions will be made to resolve the conflict
• Out-law Triangulation . Leaders must prevent team members from “ganging-up” on others that they may disagree with
• Be Accountable . Leaders must make sure that they follow through on their actions but also hold others to their actions as well
• Recognize and Reward . Leaders must be able to recognize successful conflict management and then reward it

Effective leaders know how to bring conflict situations out into the open so that all parties involved can begin to work towards a resolution that will benefit everyone. They manage conflicts in way that it is seen as an opportunity to build productive relationships (Guttman, 2004; Kazimoto, 2013).

Conclusion The means in which conflict is managed will determine whether the outcome will be positive and productive, or negative and destructive. Leaders are taught to lead change, development, and transformation in organizations. One way leaders can accomplish their goals is through effective conflict management. Conflict can be described as a disagreement among two parties that is usually portrayed as antagonism or hostility. Conflict can arise from three different sources: economic, value, and power conflicts. Conflict can also occur at different levels of the human experience, which include: interpersonal, intrapersonal, intergroup, and intragroup conflict levels.

Conflict management is the process of reducing negative outcomes while increasing the positive. Leaders must be able to utilize conflict management skills to provide direction and guidance towards a resolution. Leaders can use the Thomas-Kilmann Conflict Mode Instrument to help them recognize and understand their own conflict handling modes. The TKI model also helps leaders understand which conflict handling modes are most appropriate for each particular conflict situation.

Zhang et al. shows us that transformational leaders are able to effectively influence their teams to workout solutions to their conflicts. This shows us that transformational leaders are able to utilize conflict management effectively. Peter Northouse also tells us that an effective leader needs to be able to respond to a situation with an action that is required of that particular situation. Therefore, leaders must be able draw on their leadership skills to effectively employ conflict management strategies.

Conflict is certain to occur regardless of the setting and individuals involved. For conflict to result in a positive outcome, leaders and teams must recognize that conflict not only exists but is a necessity. Understanding conflict allows leaders to manage it more effectively and can provide a path to accomplishing positive outcomes. Conflict management can be an active force that will allow leaders grow healthy relationships within their organizations which can ultimately result in effective productivity.

Conflict management must be a part of a leader’s toolbox and be deployed when conflict arises within a team or organization. If conflict is not addressed in a timely manner, it can not only affect the moral of the team/organization but can create larger issues later. Once this happens it may be more difficult to resolve then it would have been if the conflict was addressed immediately and effectively. Leaders must be able to recognize that conflict can cause negative issues within their team or organization. If they are able to pull on their leadership skills and recognize which conflict-handling mode is required for each situation, they can create an opportunity to improve team structure and dynamics, and ultimately achieve their goal of changing, developing, and transforming organizations.

Leadership in Healthcare and Public Health Copyright © 2018 by Fadi Smiley is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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• v.26(4); 2013 Dec

Conflict Management: Difficult Conversations with Difficult People

Amy r. overton.

1 Division of Health Policy and Management, Department of Health Administration, School of Public Health, University of Minnesota, Minneapolis, Minnesota

Ann C. Lowry

2 Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, St Paul, Minnesota

Conflict occurs frequently in any workplace; health care is not an exception. The negative consequences include dysfunctional team work, decreased patient satisfaction, and increased employee turnover. Research demonstrates that training in conflict resolution skills can result in improved teamwork, productivity, and patient and employee satisfaction. Strategies to address a disruptive physician, a particularly difficult conflict situation in healthcare, are addressed.

Objectives: Upon completion of the article, the reader will: (1) Understand the importance of conflict resolution and management. (2) Recognize skill sets applicable to conflict management. (3) Summarize the steps necessary involved in a successful confrontational conversation.

Conflicts of various magnitudes occur frequently. You share a workspace with a colleague who consistently leaves the space disorganized and messy, which seems unprofessional to you since patients are seen in that office. Or a senior colleague insists being the first author on a research paper when you did all the work. In the preoperative area, the anesthesiologist disagrees with your surgical plan in the presence of the patient. A more extreme example would be a disruptive physician who yells or throws charts or instruments.

The frequency of conflict has been measured in several settings. In an observational study of operating rooms, conflicts were described as “high tension events”; in all surgical cases observed there was at least one and up to four high tension events. 1 Another study found on average four conflicts per operation emerged among operating room team members. 2 In a survey of 5,000 full time employees in nine different countries, 85% of employees dealt with conflict at work to some degree and 29% dealt with conflict frequently or always. 3 Another viewpoint focuses upon “toxic personalities” defined as “anyone who demonstrates a pattern of counterproductive work behaviors that debilitate individuals, teams, and even organizations over the long term.” 4 Conflict occurs frequently when working with such people. In a survey, 64% of respondents experienced a toxic personality in their current work environment and 94% had worked with someone like that during their career. 4 In another study, 91% of nurses reported experiencing verbal abuse. 5 The impact of these interactions on mood is significant. In a real-time study, employees recorded interactions with a coworker or superior at four random intervals daily; the employees rated the interactions as positive or negative and recorded their mood. The negative interactions affected the employee's mood five times more strongly than positive encounters. 6

Some would argue that conflict may be beneficial in certain situations, but in others it has negative consequences. 7 The proposed benefits of conflict include improved understanding of the task, team development, and quality of group decision making. The other line of thought suggests that conflict distracts from the immediate tasks and wastes resources on conflict resolution. Whether or not it is occasionally helpful, it is clear that many instances of conflict are harmful.

Conflict is associated with significant cost to organizations. In the study of employees from nine countries, the average number of hours spent per week on workplace conflict varied from 0.9 to 3.3 hours. In the United States, the average was 2.8 hours. 3 The calculated expense based on average hourly earnings in 2008 was $359 billion in lost time. High rates of employee turnover and absenteeism are associated with environments where conflict is poorly managed.

Health care is a complex system that requires effective teamwork and cooperation to function well. Patient safety research reveals that patient outcomes are negatively impacted when conflict mismanagement and other dysfunctions occur. 8 9 10 Another consequence of poorly managed conflict is disruption of care. In a national survey of physicians, almost two-thirds of respondents reported seeing other physicians disrupt patient care at least once a month. 11 More than 10% of the respondents reported witnessing that behavior daily.

Frequent causes of conflict include lack of clarity with expectations or guidelines, poor communication, lack of clear jurisdiction, personality differences, conflicts of interest, and changes within the organization. 12 Behavior that results in conflict could include bullying, limited communication or not sharing important information, and verbal or physical violence. 13 Employees cite personality clashes, stress, heavy workloads, poor leadership at the senior and managerial levels, lack of honesty and openness, and lack of role clarity as the most frequent causes of conflict. 3

Although conflict cannot be avoided, it can be managed. Since conflict will always be present on an individual and organizational level, it is important to develop the skills to appropriately manage a difficult conversation or interaction. Experts agree that the skills necessary can be acquired; they believe that conflict competence can be defined and learned. One definition of conflict competence is “the ability to develop and use cognitive, emotional, and behavioral skills that enhance productive outcomes of conflict while reducing the likelihood of escalation or harm.” 14 The goal is to be competent in having difficult conversations. One model uses the terminology “crucial conversations and “crucial confrontations.” A “crucial conversation” is defined as “a discussion between two or more people where (1) the stakes are high, (2) opinions vary, and (3) emotions run strong.” 15 Confrontations are those face-to-face conversations in which someone is held accountable. 16

Real life examples prove their statements and the benefits of improved conflict management. One group demonstrated that teaching the necessary communication skills resulted in 10% improvement in their habits of confronting difficult issues. 16 With that change, customer and employee satisfaction, productivity, and quality also improved. An information technology (IT) group found that improved communication practices resulted in 30% improvement in quality, almost 40% increase in productivity, and near 50% decrease in costs. 16 CPP Global report “Workplace Conflict and How Business Can Harness it to Thrive” study found “training does not reduce the occurrence of conflict, but it clearly has an impact on how conflict is perceived and can mitigate the negative outcomes associated with conflict.” 3

Various models of successful conflict management have been proposed. 14 16 The models typically include discussions of common responses to conflict and ways to effectively address conflict. These models will be combined and summarized in this article.

The common underlying principles of all the models are that

• Conflict is inevitable and that both positive and negative consequences may occur depending on how the conflict is managed.
• The results are likely to be better with active engagement rather than avoidance.
• People must be motivated to address conflict.
• Behavioral, cognitive, and emotional skills can be acquired.
• Emotional skills require self-awareness.
• The environment must be neutral and feel safe.

Response to Conflict

To begin this process, it is important to cultivate self-awareness in regards to one's physical and emotional reaction to situations involving conflict. The most common responses on approaching conflict include: avoiding, accommodating, competing, compromising, and collaborating. 17 Avoidance (or silence) refers to an individual recognizing conflict in a situation and actively deciding to not engage or deal with the problem. Avoidance may be prudent when the issue is minor in nature, as a temporary response when emotions are high or when others can resolve an issue more efficiently. This approach would be the opposite of someone whose response is to compete, which is categorized as being forcing, uncooperative, and assertive in the situation. Competition might be appropriate in emergent situations or actions known to be unpopular need to be taken on an important issue. People whose response is to accommodate others generally do not have their own needs met. Accommodation may be necessary when one is wrong, if the issue is more critical to others or if the value of harmony in the situation outweighs the benefit of a conflict. When accommodation is used, the conflict is resolved but if the pattern repeats itself frequently residual resentment may affect the relationship. Accommodation is also referred to as yielding. 18 Compromise and collaboration are both a balance of assertiveness and cooperativeness. The difference between the two is that compromise is often a negotiation between two parties with equivalent power, whereas collaboration is focused on finding a solution where all parties involved have their needs met. Compromise is focused on fixing a problem with a set amount of resources and collaboration allows for a broader view on problem solving. A combination of compromise and collaboration has also been defined as a problem-solving response. 18 Although there is not a correct response, responses characterized by open-mindedness to the ideas and perspectives of others promote positive outcomes. 17

Conflict Management Skills

When a conflict exists, the first step is to decide whether to address it. That decision involves balancing the reward against price of addressing the issue; that balance is unique to each circumstance. Some general rules are that if the issue is troublesome enough that it is affecting your behavior or weighing on your conscience, it should be addressed. It is important not to confuse the perceived difficulty of the conversation with determination of whether it will be beneficial and appropriate to proceed. Perceived differences in power often impact a decision to address a conflict; however, lessons from aviation and other industries illustrate the benefits of open communication and the risks of silence even in situations of different levels of authority or power. 19 20

Once it is been decided to address the conflict, there are several steps involved in preparation for the conversation. One step is to determine the exact nature of the conflict. When considering the exact nature of the conflict, some authors offer the following guidance. 16 If the issue occurs once, it is appropriate to discuss the content of the issue; if it has occurred repeatedly, one should focus on the pattern of events. If the problem impacts your relationship with the other person or team members, then the topic should be your relationship. One pitfall of conflict management is allowing task or pattern type conflict to deteriorate to relationship conflict by overpersonalizing the issue. Another system appropriate for team conflict divides conflict into task, process, and relationship conflicts. Task conflict is similar to content conflict, while process conflict refers disagreement over team processes. 21

One must also thoroughly understand one's own position. It is critical to gather all of the background information and any data necessary to discuss the conflict. Then one needs to achieve clarity about what is desired from the confrontation as well as what one is prepared to give up or compromise. Another key element is awareness of which outcomes one considers undesirable. Part of the preparation is consideration of one's own motivations and goals as well as the motivations and goals of the other party. This step seems obvious but is frequently not done or only superficially evaluated. Considering why a rational and ethical person would have behaved in the manner troubling you often opens an alternative view of the situation. The authors of Crucial Confrontations label this preparation as “mastering your story.” 16 In short, it is understanding from as many vantage points as possible how the problem situation might have developed.

The level of intensity of the conflict is another consideration in determining how best to approach the issue. One model divides the intensity of conflict into five levels. 14 Level 1 is differences. Those are situations in which two or more people have different perspectives on the situation; they understand the other person's viewpoint and are comfortable with the difference. This level of conflict can be an asset for a team or organization because it allows individuals to compare or analyze without an emotional overlay. Level 2 are misunderstandings in which two people understand the situation differently. Misunderstandings are common and can be minor, but can also escalate when stakes are high. If there are negative consequences such as missed events or obligations people tend fault and accuse one another which adds negative emotions to the situation. If the misunderstandings are frequent, it may indicate problems with communication. Level 3 is disagreements; these are times when people have different viewpoints of the situation, and despite understanding the other's position they are uncomfortable with the difference. This level can also easily escalate if ignored. Level 4 is discord. In those instances, conflict results in relationship issues between the people involved even after a specific conflict is resolved. There is often constant tension between those individuals. Level 5 is polarization, which describes situations with intense negative feelings and behavior in which there is little to no hope of resolution. For those conflicts, the mandatory first step is the agreement to communicate.

Another aspect of preparation is to recognize your emotional response and how it might affect your view of the situation. Addressing a difficult situation when one is angry or frustrated is more likely to be ineffective than when one is calm. Several famous quotes illustrate the point.

“Speak when you are angry and you will make the best speech you will ever regret.”

–Ambrose Bierce

It is therefore important to postpone the discussion until one is able to think more calmly and clearly. It is helpful to have an awareness of behaviors that “push your buttons.” One list of possibilities comes from an assessment instrument, “Conflict Dynamic Profile (Center for Conflict Dynamics Eckerd College, St. Petersburg, FL)” that includes the following behaviors: abrasive, aloof, hostile, micromanaging, over analytical, self-centered, unappreciative, unreliable, and untrustworthy. 22 A technique to reduce tension is cognitive reappraisal or reframing which refers to looking at alternative perspectives and outcomes of the situation to “reframe” it in a different, generally positive, light. Some other suggested techniques to manage one's emotions are consciously identifying and addressing one's fears about the outcome of the conflict or possible consequences. Centering techniques, which are based on martial arts, offer a way to calm oneself and focus on the positive aspects of the situation. 14

“The great remedy for anger is delay”

–Thomas Paine

All conflict management research confirms that setting a safe environment is a critical element in successful management of conflict. In a safe environment, all participants believe they will be respected and treated fairly. The authors of Trust and Betrayal in the Workplace present a model that includes three different types of necessary trust. 23 One is contractual trust or trust of character which is confidence in the intentions of others. The second is communication trust or trust of disclosures. In an environment with communication trust, everyone is comfortable that people will share information, be honest, and keep private information confidential. The final type is capability trust; when present, the participants have confidence in others' abilities to deliver on promises. That model recognizes that trust can be harmed by betrayal, but also rebuilt.

Another description of a safe environment is one with mutual respect and mutual purpose. 16 Mutual respect involves using a tone of voice and words and facial expressions that convey respect for others as human beings. Mutual purpose is having the common goal of problem solving. Although the first model may seem difficult to achieve in all situations, mutual respect and mutual purpose are basic required elements for an effective discussion of a conflict.

How does one establish a safe environment? The conversation must be held in a private, preferably neutral, setting with enough protected time for the discussion. Some experts suggest that a potentially neutral way to establish the goal of joint problem solving is to start the discussion by describing the gap between the expected and observed behavior. Other options include asking for permission to discuss a topic or beginning with the facts from your perspective or your observations. It sets the wrong tone to start the conversation with your conclusion, particularly if it is harsh. One should share all appropriate and relevant information and avoid being vague. 16 Other tips to maintain a safe environment include asking open-ended questions, focusing initially on points of agreement and using “I” statements. Some examples of “I” statements are “I feel frustrated” and “I am concerned.” One must be aware of one's body language as well as tone and volume of voice.

Common mistakes to avoid are trying to soften the message by mixing it with complimentary statements or using an overly familiar tone of voice initially before addressing the problem. Most people feel they are being manipulated or treated dishonestly when the messages are mixed. Inappropriate humor or comments disrupt the rapport needed for a safe environment. Another common error is using nonverbal hints or subtle comments with the belief they can successfully address a conflict. This technique is risky because one is never clear on the other person's interpretations of the hints or comments. It also does not work to blame someone else for a decision or request you are making. It ultimately undermines any respect or authority you may hold. Asking people to guess the reason for the meeting, essentially to read your mind, is irritating and ineffective at problem solving.

Once a decision has been made and a neutral environment decided upon for the conversation, there are key elements to conducting the conversation. One organization (CMP Resolutions) terms this first phase as scoping. 24 It includes the time to understand what is happening, each person's perspective of the conflict, and what is important to them, as well as establishing ways the involved parties can work toward a solution. The first step in the conversation is to allow all parties to state their opinions and their perspectives on the conflict. Before beginning, the ground rules regarding confidentiality and decision making should be outlined. Listening, respectively, to each participant during this step is very important. Asking clarifying questions without imposing one's own view of the situation is a skill that often requires practice. One must be aware of the tone and volume of voice to ensure that the environment remains respectful. Expressions of empathy such as “that sounds really difficult” are helpful in setting the tone and encouragement of information sharing. One should avoid judgmental or blaming statements. Listening skills are one of the primary skills to be developed when working on one's ability to manage conflict. Utilizing “AMPP” helps to remember four main listening skills that are helpful when faced with a problem. 16 “A” stands for ask which starts the conversation and allows the other person to discuss their feelings about the situation. Mirroring (M) is a tool to encourage the speaker to continue or offer more information when they seem reluctant. The technique involves statements about what you are observing (e.g., you seem down today) in the other person and then asking a question. The third technique, paraphrasing (P), is the restating of their responses in your own words which shows active listening and makes clear whether you both have the same understanding. Finally, prime (P) refers to priming the pump. It is useful when someone is clearly emotional about the issue but reluctant to talk despite the use of the first three techniques. With this method, one makes a guess out loud about what the other person might be thinking or feeling. One must choose the words carefully and use a calm tone to avoid worsening the situation. The goal is to make the other person feel comfortable speaking. Other potentially helpful acronyms to use during conflict management are seen in Table 1 .

The next part of the conversation is defining the problem. A consensus on the definition of the problem is necessary for participants to be able to compare and discuss solutions. As noted earlier, the problem might be defined as the issue with one occurrence, a pattern of episodes or the working relationship. After creating a mutually agreed upon definition, the next step is to brainstorm possible solutions to the conflict. If possible, these solutions should address the needs of all parties involved.

After a list has been created of alternative solutions, each participant should discuss their preferred solution. There also needs to be a “reality check” with the decision makers. Perhaps the ideal solution is too expensive or not feasible because of existing regulation or organizational policies. The goal is finding commonality and acceptable compromises that allow for all participants to feel like their needs are met and the conflict is being addressed. Once this solution is chosen, an action plan that outlines the “who, what, and when” of fixing the problem needs to be devised. Making sure that everyone involved understands their role and tasks are an important step to accomplish the solution.

Many models suggest that reflection on ways to prevent or more effectively handle similar conflicts in the future at the end of the conversation is beneficial. A follow-up plan is critical. If a plan with timelines is not designed and implemented, the behavior will typically change for a period of time but then slip back into old patterns. Whether the plan is another meeting, completion of certain tasks, or a system of monitoring, it should be defined clearly.

A particularly complex issue in conflict management is the disruptive physician. Historically, that issue has been addressed reluctantly if at all. The physician is often a high revenue producer and organizational leaders fear the consequences of antagonizing the physician or there is concern about a potential conflict of interest. The term is defined in various ways. One definition of disruptive physician behavior is “a practice pattern of personality traits that interferes with the physicians' effective clinical performance.” 25 The Ontario College of Physicians and Surgeons defined it as “inappropriate conduct whether in words or action that interferes with or has the potential to interfere with, quality health care delivery.” 26 An occasional bad day or overreaction does not constitute disruptive behavior. Rather it is the pattern of repeated episodes of significant inappropriate behavior.

The typical behaviors are often divided into aggressive and passive aggressive categories. Aggressive behaviors include yelling, abusive language, intimidation, and physically aggressive actions. Passive-aggressive behaviors include intentional miscommunication, impatience with questions, racial, general or religious jokes, and implied threats. Despite estimates that only 3 to 6% of physicians qualify as disruptive physicians, 27 the negative impact on the health care system is significant. The behavior undermines morale and productivity as well as the quality of care and patient safety. For example, nurses are less likely to call physicians with a history of disruptive behavior even when they need to clarify an order or report a change in a patient's condition. According to the Joint Commission, these behaviors “can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators, and managers to seek new positions in more professional environments.” 28 In an academic environment, this behavior is associated with poor role modeling for students and trainees. Because of the impact, both the Joint Commission and the Federation of State Medical Boards addressed the issue in their standards and policies. 28 29

If the pattern of behavior is recognized early, a conversation with a trusted colleague or physician leader using the techniques described above might be sufficient to change the pattern of behavior. One model of corrective feedback starts by preparing the physician for the meeting with advanced notice and provision of a private setting and respectful atmosphere. Often asking the physician to provide a self-assessment of their interactions with others is a good starting point that can be followed with the observations of specific disruptive behaviors. Strategies for change and improvement as well as set expectations and a monitoring program need to be discussed and articulated before concluding the meeting. 30

There is evidence that an organization that sets standards for behavior and uses the principles of “action learning” to address variances will have desirable outcomes with disruptive physicians. Briefly, the principles of action learning, which was developed by Reginald Revans, are that the best learning occurs through active questioning and reflection rather than instruction. 31 The people involved tackle a real-life problem by asking questions, discussing alternative solutions, reflecting on change, and monitoring progress. In an interview study of independent, single-specialty surgical practices representing 350 physicians, the investigator determined whether the use of action learning principles correlated with desirable outcomes with disruptive physicians. 32 Desirable outcomes include retention of the physician with a change in the troublesome behavior. In 20 practices, action learning resulted in successful management of the problem.

However, most disruptive physicians require more intensive intervention. Reynolds argues that “constructive change in disruptive physicians comes through requiring adherence to expected behaviors while providing educational and other supports to teach the physician new coping skills for achieving the desired behaviors.” 25 A comprehensive evaluation including medical, chemical, and psychiatric evaluation is the first step. It is important to identify an underlying treatable condition. A program of remediation including educational and psychological training to foster new coping skills is outlined. A critical part of the program is long-term follow-through and monitoring. For most disruptive physicians, it is the threat of imposed consequences rather than internal motivation to improve that guides their compliance with the program. 25 Several well-established programs offer resources for the training including the Physician Assessment and Clinical Education (PACE) program at the University of California School of Medicine, San Diego 33 and the Distressed Physician Program at Vanderbilt University School of Medicine in Nashville. 34 A composite case study of transformative learning to address disruptive physician behavior illustrates the process used. 35

Conflict occurs frequently and often results in significant disruption and cost for individuals and organizations. Although often avoided or poorly managed, evidence suggests the skills for effective management of conflict can be learned. Multiple studies confirm when conflict is successfully addressed, and multiple benefits accrue to the organization and individuals.

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Conflict Management in Healthcare

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Introduction

Concepts of conflict management

Key issues in these three articles, insights and challenges, the usefulness of the insight and strategies in nursing practice, conflict resolution strategies in nursing practice, self-growth.

• Abd-Elrhaman, E. S. A., & Ghoneimy, A. G. H. (2018). The Effect of Conflict Management Program on Quality of Patient Care. American Journal of Nursing Science, 7(5), 192-201.
• Babiker, A., El Husseini, M., Al Nemri, A., Al Frayh, A., Al Juryyan, N., Faki, M. O., Assirs, A., Al Saadi, M., & Al Zamil, F. (2014). Health care professional development: Working as a team to improve patient care. Sudanese journal of paediatrics, 14(2), 9-16
• Baddar, F., Salem, O. A., & Villagracia, H. N. (2016). Conflict resolution strategies of nurses in a selected government tertiary hospital in the Kingdom of Saudi Arabia. Journal of Nursing Education and Practice, 6(5), 91-9.
• Better Health Channel. (2018). Workplace conflict. Retrieved from A. M. (2017). Enhancing communication to improve patient safety and to increase patient satisfaction. The health care manager, 36(3), 238-243.
• College of Nurses of Ontario. (2018). Conflict Prevention and Management. Retrieved from S., Bochatay, N., Ma?tre, F., Laroche, T., Muller-Juge, V., Blondon, K. S., & Savoldelli, G. L. (2019). When Team Conflicts Threaten Quality of Care: A Study of Health Care Professionals' Experiences and Perceptions. Mayo Clinic Proceedings:Innovations, Quality & Outcomes, 3(1), 43-51.
• Evan. B. (2013). Types of Conflict - Four Classifications. Retrieved from B. (2013). Conflict Management Styles - How to Deal with Conflict. Retrieved from S., Bayhan, P., Metin, S., & Ergeneli, A. (2011). Do stages of moral development matter in the preference of conflict handling styles with peers. International journal of humanities and social science, 1(7), 223-230.
• Ibrahim, S. A., Mohamed, H. A., & EL-Gazar, H. E. (2018). The Effect of Conflict-Management Enhancing Strategy for Head Nurses on the Quality of Vertical Dyad Linkage with Nurses. International journal of Nursing Didactics, 8(04), 25-34.
• Jerng, J. S., Huang, S. F., Liang, H. W., Chen, L. C., Lin, C. K., Huang, H. F., , Hsieh, M. Y., & Sun, J. S. (2017). Workplace interpersonal conflicts among the healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center. PloS one, 12(2), e0171696.
• Johansen, M. L. (2012). Keeping the peace: conflict management strategies for nurse managers. Nursing Management, 43(2), 50-54.
• Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: An integrative review. Journal of multidisciplinary healthcare, 9, 537-546.
• Leksell, J., Gardulf, A., Nilsson, J., & Lepp, M. (2015). Self-reported conflict management competence among nursing students on the point of graduating and registered nurses with professional experience. Journal of nursing education and practice, 5(8), 82-89.
• Overton, A. R., & Lowry, A. C. (2013). Conflict management: difficult conversations with difficult people. Clinics in colon and rectal surgery, 26(04), 259-264.
• Rubio, M. A. E., & Picardo, R. L. (2017). Leadership, management and conflict management styles among nurse middle managers. University of the Visayas-Journal of Research, 11(1), 105-112.

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Conflict Management in Organizations

Introduction.

Conflict, by nature, is an integral part of any dynamics in the organization, and so it remains true to the Healthcare organization. Rather than avoiding such difficulties, this report suggests harnessing conflicts as facilitators of developmental processes and increased organizational efficiency. To resolve conflict, the initiative faces challenges concerning harmonizing and integrating a comprehensive framework that systematically addresses conflicts and disputes at every organizational level. This creates a culture of seeing challenges as opportunities for betterment and improvement (Thomas, 2015). This proposal report will suggest the companywide conflict management initiative within the Healthcare Organization. Understanding that conflict situations are unavoidable and may significantly affect organizational dynamics, this project considers a systemic approach to address disputes to encourage a positive organizational culture based on information and research studies from five critical articles. The report justifies the importance of an effective conflict management initiative while revealing many best practices for implementing it.

Why We Need to Do This

As elaborated in the articles, this approach focuses on the importance of proper conflict management to ensure success in organizations. Managing conflicts will bring out positive results. This aspect is quite relevant in Healthcare because decision-making relies heavily on different people giving their opinions to offer the best working environment where diverse ideas can be brought forward for better clarity and patient care. Proactive conflict resolution is indispensable. Therefore, An approach is called upon that does not just pose with evasion of difficulties, but changes said conflicts into openings for change as in neither organizations nor development.

The Benefit of Creating This Understanding

In the health industry, it is essential to note that these approaches lead us to positive results. The various viewpoints characteristic of the field make conflict management critical in boosting decision-making, encouraging collaboration, and resulting in quality patient care (Young, 2013). The relevance of addressing conflicts constructively at the health organization is its ability to initiate a conducive environment accommodating all employees. With good management, conflict becomes an improvable factor that can result in positive changes, innovations, and enhanced organizational performance (Williams, 2005). However, in healthcare settings where different views are vital to making decisions and relating with patients, conflict resolution helps teams that work together have clear objectives. Such proactiveness improves communication and teamwork, leading to better patient outcomes. Furthermore, an effective conflict resolution process increases employee satisfaction and reduces workplace stress while providing a basis for improvement. This makes the health organization to be resilient and adaptive.

The Advantages of Creating a Policy and Implementation Plan

Developing a detailed conflict management policy and plan for implementation helps the Healthcare Organization benefit in many areas. When such a policy is in place, it provides an organized system that ensures conflicts are detected, brought to attention and followed up appropriately, hence ensuring consistency and fairness throughout the organization ( Hasson, 2006). Policy clarity is characterized by its centrality in leadership and governance. Training in cultural sensibility becomes a part and parcel, where every possible misunderstanding is avoided, thus making the environment respectful and helpful (Williams, 2005). In addition, well-defined policy and implementation plans ensure that the negative impact of conflicts is adequately prevented beyond reactive measures. In addition to avoiding confusion, such an inclusive method develops a culture of respecting different views at the workplace, improving teamwork and fostering innovation. A clear policy and implementation plan serve as preventive instruments. This helps the organization foresee crises and deal with them way before they erupt, reducing the impact of low employee morale, which is likely to hinder productivity levels (Behfar & Goldberg, 2015). The transparency enforced by these policies helps to develop employee trust, leading to a healthy organizational culture. It encourages openness and a keen role in building a positive and robust organizational culture.

Reconciling the companywide conflict management initiative with Healthcare’s continued success is imperative. By adopting conflicts as well, realizing their merits and implementing a policy guideline inclusive of the implementation approach, we can build an organizational culture that indulges collaboration and innovation. With the outlined changes, this report acts as a way for positive change initiation in the organization. It will continue to perform well with its doctrine of delivering excellent health service.

Behfar, K., & Goldberg, R. (2015). Conflict Management in Teams. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2974840

Hasson, R. (2006). How to resolve board disputes more effectively.  MIT Sloan Management Review ,  48 (1), 77. https://www.proquest.com/openview/aff29191fb8232e82c00145140a6f488/1?pq-origsite=gscholar&cbl=26142

Thomas D C. & Kerr Inkson (2018). Communicating, Negotiating and Resolving Conflicts across Cultures Guilford Publications. https://www.hbsp.harvard.edu/product/BK0005-PDF-ENG

Williams, M. J. (2005). Stay calm with them.  Teoksessa Dealing with difficult people , pp. 57–65. https://studydean.com/wp-content/uploads/2023/05/don_t_avoid_conflict.pdf

Young, D. W. (2013). Note on Conflict Management.  Business Horizons ,  43 (5), 19–28. https://hbsp.harvard.edu/product/TCG316-PDF-ENG

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Crisis Communication and Conflict Management in Health Care Environment Essay (Article)

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Crisis Communication

Conflict management, risk management, experience and training.

American health care organizations face unique challenges presented by crises and conflicts that pose risk to the attainment of the organization’s goals (Borkowski, 2011). Conflicts arise out of stressful and emotional encounters and form a natural part of relationships. Conflicts are necessary for organizational growth depending on their management.

In hospitals, the unexpected is always arising and personnel are always dealing with life-and-death issues that require most immediate actions and there are no provisions second trials. Health care organizations are social systems that involve people interacting with each other to preserve the health and personal integrity of patients.

Damaging crises may befall hospitals at any time. Disasters like staff-related disgrace immediately put the specific hospital on the limelight. Crisis communication determines the impact of the crisis on a health care organization.

Crisis communication and response have a large significance in restoring the organization’s status and their effectiveness depends on skills of the crisis communicators and their understanding of crisis management (Braun, Wlneman, Finn, Barbera, Schmaltz, & Loeb, 2006). The healthcare system is of particular concern when it comes to the concept of crisis communication because the lives of people are at stake.

In every case, crisis in health care organizations affects the physical, emotional or privacy aspects of an individual’s life. This paper offers an in depth exploration of crisis communication and conflict management in health care organizations and adds a risk management aspect to the discussion.

No single professional group is consistently responsible for the hospital’s preparedness to handle crises. It becomes problematic for community groups to define the suitable hospital contact. Crisis communication protocols deliver reliable communications and thwart concerned persons’ efforts of seeking care unnecessarily (Braun, Wlneman, Finn, Barbera, Schmaltz, & Loeb, 2006).

Halbesleben, Cox and Hall (2011) report that open communications in hospital settings show up inform of personnel speaking up and alerting others through sharing of pertinent issues usually referred to as red flags. When raised, red flags create alertness for every personnel on possible delays or other implication caused by the red flag.

Therefore, conflicts that may arise out of the misunderstanding that may ensue are limited. Miscommunication in hospital settings like theatre wards result to silo-effect working behavior for team members. In such cases, staffs fail to pass critical patient information to other staff by choosing to stay mum.

Overall, miscommunication leads to a higher probability of patient mishandling and contributes to patient crisis reports. Silo-effect mainly arises out of a lack of trust and communication among team members in the hospital or health facility (Halbesleben, Cox, & Hall, 2011).

In crisis communication approach, the communicators of the risk are supposed to use every device to move their audiences to take appropriate action (Lundgren & McMakin, 2009). In the case of a flood, messages from the communicators should cause the audience to vacate to higher ground and refrain from becoming obstacles to the work of rescue groups.

Crisis communication must be limited to the relevant information causing action and anything else is extraneous. Hospitals and health care institutions know what is best for their patients therefore; their crisis communicators should affirm the impression in their audience.

People are likely to respond when they only know the ‘why’ reason of moving rather than the ‘how’ and ‘what’ reasons of moving (Lundgren & McMakin, 2009).

For an effective crisis communication, health care institutions adapt the following steps for developing messages involving infectious diseases crisis or other public health issues (Lundgren & McMakin, 2009): a description of the audiences reachable, which encompasses their relationship with to the crisis, as based on risk communication principles.

Secondly, the purpose of the message is articulated and finally the message delivery mechanism is noted, it include either the media or internet among others (Lundgren & McMakin, 2009).

When including the media in the crisis message delivery, a thematic explanation of the crisis comes out strongly than an episodic one. News media favors positioning the organization as the center of a crisis in causing it or acting on it. The media scrutinizes the organization’s systems, policies and environments in relation to the cause of the crisis and its management.

Focus on individuals usually forms an insignificant part for news media such as focusing on an employee or other individuals like the CEO. Therefore, crisis communication managers of relevant health care organizations involved in the crisis take a special notice on how the media is likely to frame the issue (An, Gower, & Cho, 2011).

For crisis occurring inside health care organizations such as patient mishandling accusations, the media assigns blame for individual employees to the whole organization’s responsibility unless, it is the top management who are responsible for the crisis. Crisis communicators need to factor in the media interpretation of their messages to benefit from a proper relaying by the news media (An, Gower, & Cho, 2011).

During crisis communication of a preventable crisis, health care organizations are likely to apportion blame on individuals to distract public attention from the root of the problem such as the organizational systems (An, Gower, & Cho, 2011). People assume a high level of controllability and intentionality for preventable crises and think that organizations should control or prevent them.

Therefore, despite a scapegoat approach by organizations to allocate blame to individuals, overall public opinion is for the organization to demonstrate a high degree of ethics and responsible behavior (An, Gower, & Cho, 2011).

Health care organization executives need to have a grasp of the structures and procedures that are present in their organization for managing crisis communication. They should be conversant with all crisis teams, internal and external crisis communication protocols and the compilation of emergency plans (Faustenhammer & Gossler, 2011).

During a crisis management, it is fundamental to ensure safety and survival of victims. In this stage, communication should be about explaining events in logical manners to shocked victims or employees immediately after the incident as it can yield negative results (Faustenhammer & Gossler, 2011).

Conflicts arise out of stressful and emotional encounters and form a natural part of relationships. Conflicts are necessary for personal growth and organizational growth. In health care environments, individuals satisfied with the status quo who are opposed to new ideas and other people start conflicts (Harris & Roussel, 2010).

Effects of unresolved conflicts include, reduced productivity rates, increase in health care costs, lowering of staffs and patient morale and self-esteem, apathy increase, inappropriate responses and violence in extreme cases. Failure to manage conflict arises from passive behaviors, ineffective communication skills, apathy and pretending that the conflict is nonexistent or not worth solving. (Harris & Roussel, 2010)

Conflict needs proper management to protect health care safety and quality, Leadership group conflict in health care organization arises in accountabilities, policies, practices and procedures (Joint Commision Resources, 2009).

To manage conflicts individuals require skills necessary for organizational implementation of conflict management. Management of conflicts is possible without resolve of the conflicts. Conflict management aims at reducing the adverse effect of patient care and safety caused by conflict in the health care organization (Joint Commision Resources, 2009).

Executives of health care organizations face high levels of organizational conflict (Taylor & Taylor, 1994). Their management of conflict determines the realization of beneficial or destructive effects of conflicts on the organization and the people involved.

The organization structure of healthcare makes it difficult to measure organizational effectiveness by outcomes and this presents plenty of room for arguing on the right thing to do and how to do it (Taylor & Taylor, 1994).

In hospitals, the unexpected is always arising and personnel are always dealing with life-and-death issues that require most immediate actions and there are no second trials. These factors combine and intensify to create a built-in sense of rage or a constant management of crisis (Taylor & Taylor, 1994).

An effective conflict management begins with a diagnosis to determine if the conflict manifestation is real. Diagnosis determines the level of operation and the type of conflict. There are three types of health organization conflicts. First, there is goal conflict occurring when the desired states and outcomes for different parties are incompatible.

Secondly, there is cognitive conflict occurring when ideas or opinions are not compatible due to misunderstandings. For example, nurses thinking pharmacist are slow at providing prescriptions while the pharmacist seeing nurses as mistaken in their recommendations.

Lastly, affective conflict happens when feelings and emotions do not match up. These conflicts while appearing to be between persons are indeed real organizational conflicts because the individuals represent units and levels in contest over resources (Taylor & Taylor, 1994).

Dealing with conflicts requires that identification happen on the two dimensions: concern for self and concern for others. Concern for self depends on the assertiveness of the person in pursuing personal goals; on the other hand, concern for others depends on the person cooperativeness. Avoidance is an unassertive and uncooperative behavior used to stay out of conflicts or ignore disagreements by remaining neutral.

This conflict resolve method is incomplete and leaves a residue of feelings that are sure to impact future conflicts. Another conflict resolve method is forcing, which is an assertive and uncooperative reflection of win-lose attitude. This method assists individuals to achieve their goals but regular use breeds fear and hatred.

Thirdly, accommodating is a cooperative but unassertive method often referred to as lose-win strategy. Collaborating is a highly cooperative and assertive win-win method. Collaborating managers see conflicts as natural and leading creative solutions, when handled properly. Compromising is an intermediate cooperative and assertive method with a give and take approach (Taylor & Taylor, 1994).

Health care organizations seek ways to identify and reduce risks threatening their existence (Caroll, 2009). Health care risk management began to emerge after the malpractice crisis of mid-1970s as hospitals and related entities faced a crisis characterized by a speedy rise in claims cost, insurance premiums and saw an exit of several medical professional liability insurers.

As a result, the American Society for Healthcare Risk Management (ASHRM) came into existence in 1980 (Caroll, 2009). Risk management on health care organization considers an unnumbered complex legal, regulatory, politics, business and financial risks facing the organizations.

Now risk management is moving to embrace more strategic orientations and professional risk managers are morphing into chief risk officers. Their new roles now demand a detail examination of their career factors such as higher education, business, financial and technical skills as risk management returns to the realm of patient safety (Caroll, 2009).

Risk management strategies are a mix of techniques aimed at preventing or reducing potential losses and preservation of the organization’s assets. They encompass a set of written policies and procedures that promise uniformity and consistency of the program with greatly boosts communication between the affected parties and the program (Caroll, 2009).

Risk management professionals have to be very visible in the organization because they rely on feedback and cooperation from fellow organization members.to remain visible, they communicate, educate and raise consciousness to nurture an awareness of risk management (Caroll, 2009).

Risk professionals have to be insiders who get information of impeding crises and organizational conflicts early in the due diligence process, so that they effectively advice senior management on risk implications of new business arrangements. Risk implications are of high priority but executives who are not in agreement with risk management matters and specific indemnity requirements overlooked them (Caroll, 2009).

For health care organizations effectiveness in goal achievement, personnel ought to share a vision of what they are striving to achieve. There also needs to be ways to recognize and resolve conflicts before they escalate. Members of any organization need to have ways of keeping conflict to a minimum. Solving problems caused by conflict prevent major obstacles from affecting a health care organization.

Hospital preparedness to handle crisis, is not dependent on a sole discipline group. Hospitals need to a crisis communication protocol to manage effectively concerns and anxiety from crisis-affected persons.

An, S., Gower, K. K., and Cho, S. H. (2011). The level of responsibility and crisis response strategies of the media. Journal of Communication Management, 15 (1), 70-83.

Borkowski, N. (2011). Organizational Behavior in Health Care (2nd ed.). Sadbury: Jones and Barlett Publishers.

Braun, B. I., Wlneman, N. V., Finn, N. L., Barbera, J. A., Schmaltz, S. P., and Loeb, J. M. (2006). Integrating Hospitals into Community Emergency Preparedness Planning. Annals of Internal Medicine, 144 , 799-811.

Caroll, R. (Ed.). (2009). Risk Management Handbook for Health Care Organizations. San Francisco, CA: Jossey-Bass.

Faustenhammer, A., and Gossler, M. (2011). Preparing for the next crisis: what can organizations do to prepare managers for uncertain future? Business Strategy Series, 12 (2), 51-55.

Halbesleben, J. R., Cox, K., and Hall, L. (2011). transfer of crew resource management training, a qualitative study of comminication and decision making in two intensive care units. Leadership in Health Services, 24 (1), 19-28.

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IvyPanda. (2019, May 3). Crisis Communication and Conflict Management in Health Care Environment. https://ivypanda.com/essays/crisis-communication-and-conflict-management-in-health-care-environment-article/

"Crisis Communication and Conflict Management in Health Care Environment." IvyPanda , 3 May 2019, ivypanda.com/essays/crisis-communication-and-conflict-management-in-health-care-environment-article/.

IvyPanda . (2019) 'Crisis Communication and Conflict Management in Health Care Environment'. 3 May.

IvyPanda . 2019. "Crisis Communication and Conflict Management in Health Care Environment." May 3, 2019. https://ivypanda.com/essays/crisis-communication-and-conflict-management-in-health-care-environment-article/.

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Bibliography

IvyPanda . "Crisis Communication and Conflict Management in Health Care Environment." May 3, 2019. https://ivypanda.com/essays/crisis-communication-and-conflict-management-in-health-care-environment-article/.