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Abstract
Health care practitioners such as nurses, physicians and doctors, work in stressful environments often prone to conflict. Positive outcomes may be witnessed as a result of some of these conflicts. However dysfunctional conflicts negatively impact delivery of quality healthcare services to patients in addition to employee satisfaction. It is therefore paramount for health care employees to identify and resolve any pre-causes of conflict to avoid any major consequences in the workplace. This paper will explore the causes, impact and aftermath of conflict among health care workers in healthcare delivery. Methods of resolution and management will also be reviewed.
Cheldelin and Fast, (2008) generally describes conflict as a process in which one party views that its interests as being negatively affected by one of another party. Most individuals would generally agree that avoidance of conflict is best even though there its presence may have positive impacts on a workplace such as competition among workers yielding to improved quality of service delivery. (Wright and O'Hair, 2013) elaborates on hospital employees dealing with conflict in the workplace due to its high-stress environment. This paper will seek to analyze the types of conflict, causes of conflict, and effects of conflict in the healthcare workplace. In addition strategies to manage and resolve negative conflict crisis in healthcare delivery will also be discussed not forgetting the implications for future research in the healthcare system as a result of promoting healthy conflict.
Introduction
Conflict is an antagonistic state that arises from opposing actions and ideas of parties (Simpson, 1998). Conflict is inevitable in any organizational setting and life in general. Everyone has his/her own opinion and sets of beliefs that every individual perceives to act as they deem it proper. Conflict is a dynamic process that can be dysfunctional or beneficial within a work environment. Conflict may arise among healthcare practitioners from a difference in professional values, poorly delegated roles and communication breakdown among colleagues. There are many types of conflict, the health care workforce may experience in a hospital setting. (Cheldelin and Fast, 2008) explains conflict as a complex behavior and occurs on different levels namely; Individual or Intrapersonal, Interpersonal, Intragroup and Intergroup or Organizational.
Individual or Intrapersonal conflict occurs within an individual with the most common being role conflict. It’s a psychological conflict that involves conflicting values, principles and thoughts. This type of conflict leads to uneasiness and may lead to depression if an individual’s inner struggle is not properly addressed. However one becomes empowered and encouraged if the situation is properly addressed thus evoking a positive change leading into one’s own personal growth.
Interpersonal conflict occurs between two individuals. This type of conflict mostly results due to a difference in personalities and incompatible opinions among individuals. It is a natural phase of daily interactions in life that may help in developing of relationships.
Intragroup conflict refers to a type of conflict among people within a team. Mostly arises from misunderstandings and differences in ideas among individuals in a team. This groups maybe healthcare professional groups, community agencies and healthcare provider organizations. These misunderstandings may involve observable behaviors that can be grouped as repressive, reactive and avoidant. Repressive behaviors include absenteeism, reactive behaviors includes inefficiency and high levels of unhealthy competition and avoidant behavior includes avoiding interactions with other team members or withholding information.
Intergroup conflict refers to conflict that occurs among different departments within an organization. For instance, in a hospital setting a misunderstanding may arise between the oncology department and cardiology department. Competition for resources is one of the main causes of intergroup conflict and may be detrimental to the facility. Constant competition for resources may create a strenuous relationship between members of different departments resulting in poor healthcare delivery to patients.
Unresolved conflict
According to (Pozgar, 2005) one recurring conflict in the health care setting over recent years has been between physicians and registered nurses. Physicians often exhibit forceful personalities and little to none interpersonal skills. Each party expects respect. Their continued conflict decreases efficiency and increases stress in the health care setting. Communication is poor resulting to one party withholding information for fear of creating conflict. Each of their professional associations continues to lobby for their contrasting ideologies and constant lobby the legislators to conduct reforms. This inter-professional tension remains unspoken but threatens severe division in the healthcare sector.
(Med league, 2017) in a recent survey published on their website, depicts how interpersonal conflict remains a recurring yet unspoken type of conflict in the healthcare setting. A case study is given of a physician known to be a bully to his fellow delivery and labor nurses. Their relationship is strenuous and information is often withheld by the labor nurses for fear of evoking an argument. They avoid calling the attending physician who happens to be a bully when a laboring mother starts to show signs of fetal distress. Precious time is lost as they hoard of this sensitive information for fear of altercation with the physician worsening the situation. Not until she portrays dire signs and symptoms that they choose to involve the physician.
From this case study it is quite vivid that severe interpersonal conflicts among health workers has negative impact on quality of health care delivery. Patients suffer the consequences in the event of a clash between nurses and physicians. Using the case study as an example the labor and delivery nurses will definitely be unsatisfied with their job and demoralized. In worse case scenarios they may seek a change to another hospital or file a lawsuit. (Howard and Veen, 2012) elaborates on how continued conflict results in stressed employees. Stressed people may suffer from psychosomatic ailments such as depression, headache and stomachache.
Interpersonal conflicts remain unresolved and recurring in the healthcare system. Some of them have been documented on scholarly articles and published on websites to act as examples and encourage others to talk about the issue to improve healthcare delivery. However others remain silent for fear of consequences and repercussions.
Stages of Conflict
There are four stages that help describe the development of conflict (Combs, 2004).
Latent stage exhibits injustice and great differences between parties, which will potentially lead to an active conflict. As per the above case study, the nurses conquer and recognize the presence of an attending physician who acts as a bully to them. We can see an active conflict building up as the delivery nurses avoid contact with the physician at the expense of a patient’s health.
Perceived stage is a stage where the involved parties are aware that a conflict exists. In relation to the aforementioned case study, the labor and delivery nurses are conscious of the existing tension between them and the physician whom they perceive as a bully.
Felt stage is a stage where the existing parties begin to develop feelings such as anxiety, anger and stress as a result of the conflict. Avoidance by either party may be exercised at this stage as a means of preventing escalation of the conflict. However it sometimes does not prove to resolve the issue as it can be witnessed by the case study. The case study depicts that the nurses
avoid confrontation with the physician as a way of preventing conflict between them only to prove detrimental to a patient’s health. Trust, opinions and openness are key values at this stage. As the affected parties way their options on if the conflict may be resolved.
Manifest stage is a stage where the conflict is vividly observable and can either be destructive or constructive. The aforementioned case study shows the delivery nurses choosing to avoid the physician to prevent any altercation between them. Their existing conflict is destructive as it worsens the condition of a laboring mother who experiences fetal distress. Not until her health deteriorates that they choose to involve the physician but at which precious time has being lost.
Effective strategies to resolve conflict
Understanding how conflicts arise is essential in any healthcare setting to prevent it. The various prevention techniques include appropriate allocation of resources, clear communication and allocation of roles among health care workers. Conflicts if not properly addressed have implications as formidable as employee resignations and patient deaths. According to (TKI) Thomas-Killman Instrument (Runde and Center for Creative Leadership, 2010), there are five styles of handling conflict; Avoidance, compromising, accommodating, competing and collaborating. Avoidance and compromise are two temporary styles of conflict resolution common among physicians and nurses (Yoder, 2013).
Avoidance can be used strategically though it’s not advised. It is often considered as the last approach in to avoiding conflict. Parties who use this style tend to avoid confrontation with the conflicting party at all costs or accept decisions without question. This style is appropriate when the issue is minimal.
Accommodating refers to when a party gives up what they want so as to allow the other party to have their way. This style is commonly used to preserve harmony. This style is not effective though appropriate when one party realizes they are in the wrong or the issue at hand is important to the other party. However it may not be ideal if the solution will not be permanently solved.
Compromising style refers to a situation where each of the conflicting parties gives up something that eventually contributes towards conflict resolution. It is an appropriate conflict resolution technique where power delegated between the conflicting parties is equal whereas it is inappropriate where a variety of needs must be met with extreme urgency.
Collaborating style aims towards finding a mutual solution to both conflicting parties especially when their interests are too important to be compromised. It is appropriate when the outcome of the decision is of great importance and involves a large number of people from different teams. It is inappropriate when a decision needs to be made urgently.
Competing style is often perceived as aggressive and a negative way of managing a conflict. It is characterized by low cooperation and involved parties strive to win at all costs. It is appropriate when an unpopular decision needs to be made quickly and one party is trying to take advantage of the situation. However it is inappropriate when the parties involved are sensitive and the situation is not urgent.
Negotiation is a critical element in conflict resolution or worsening the situation. Mediation as an example of negotiation can be very structured where the conflicting parties fail to agree. To achieve conflict resolution, the involved people are required to discuss resolution in a manner that is acceptable to all of those involved. Conflict resolution includes the use of a variety of skills and strategies. Essential strategies and skills are communication, listening, and respecting different points-of-view. (Deutsch and Marcus, 2006) outline the four needs of negotiation as clarification, performance, questioning, and expectations. Firstly clarification of all of the issues and parties who are involved in the conflict takes place. Performance and potential outcomes are established. Questioning is important throughout the conflict resolution. Management and the involved parties need to be clear about expectations and provide these in writing, which helps to decrease conflict over critical issues in the future.
Nurse Managers should be vigilant and proactive in conflict resolution in a healthcare setting to prevent any major outbursts from the conflicting parties that would bring great consequences in the workplace (Swansburg and Swansburg, 2002).
Conclusion
Without doubt recurring and unresolved conflict can hinder and negatively impact organizational performance (Rout and Omiko, 2007). Healthcare workers should strive to solve any differences among them as recurring conflicts translate effects on patient safety. Proper management of conflict is possible even though elimination of unhealthy conflict in the health care setting is merely impossible. Concerned healthcare Managers should be address negative conflict as soon as it is discovered. Awareness of the health care workers is also an essential requirement for them to be equipped with effective conflict resolution techniques. It is also vivid that there still is a huge gap in literature and scholarly articles on how conflict resolution should be managed in a healthcare setting. There is also absence of sufficient material to equip healthcare workers with conflict resolving techniques.
References
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