Conflict Management in Health Care

Nursing Management and Conflict Resolution

Conflict management,major and minor conflict,how and who to resolve or manage conflict in Runde and Flanagan Model effective and less effective responses.  

Resolve Dispute in Health Care

    Conflict resolution is an important part of the nursing supervisor's job. Managers are often involved in conflict management at several different structural levels. Managers may be involved in the conflict as individuals, administrators, or unit representatives, and sometimes at multiple levels simultaneously. They often have to confront staff individually or collectively when a problem arises, but they also act as mediators for the conflicting parties. Conflicts may be within the department, between parties from different departments, or between internal and external parties (for example, a conflict with staff in a particular unit).

Who will be Participate in Conflict Resolution

    Everyone involved in conflict negotiations must be realistic about the outcome. Inexperienced negotiators often expect unrealistic results. When two or more parties have ideas, attitudes, sentiments, or goals that seem mutually exclusive, it is extremely difficult to reach an amicable solution that meets the needs of both without the commitment and willingness of all involved (for example, Democrats and Republicans in The congress).

Initiation of Resolution

    Conflict management begins with a decision about whether and when to intervene. Lack of intervention can result in the conflict spiraling out of control, while early intervention can be detrimental to those involved, causing them to lose self-confidence and reduce risky behavior in the future.

Major and Minor Conflicts

    Some conflicts are so minor, especially between two people, that they require no intervention and are best left to the two people involved. Allowing them to resolve their conflict could provide a developmental experience and improve their ability to resolve conflicts in the future.

    Higher intensity can motivate participants to seek resolution, so it is sometimes better to intentionally delay intervention to allow conflict to escalate. It could escalate the conflict further by exposing the participants to each other more often without the presence of others and without an easy means of escape. The contestants are then forced to confront the conflict between them.

Delegation of Participants 

    Giving participants a common task or common goals that are not directly related to the conflict can help them understand each other better and increase their chances of resolving their conflicts on their own. The use of this method makes sense only when the conflict is not of great intensity, when those involved are not very concerned about it, and when the manager believes that the conflict will not affect the efficiency of the unit in the meantime. However, if the conflict could lead to significant harm, the nursing manager must intervene.

    If he decides to intervene in a conflict between two or more parties, he can use mediation techniques and decide when, where and how to intervene in a neutral place, unless the parties involved have unequal power. In this case, the attitude should favor the disadvantaged participant, thus balancing the power of it.

    An intervention location should be free from distractions and available for a reasonable amount of time. Since conflict management takes time, the administrator must be willing to give all parties sufficient time to explain their views and find an amicable solution. A quick fix that inexperienced managers often resort to is to assert positional power and make an early decision.

Runde and Flanagan Model

    Runde and Flanagan (2013) describe a useful model for influencing conflict processes that was developed in collaboration with the Center for Creative Leadership. Based on the 2001 work of Capobianco, Davis, and Kraus (cited in Runde and Flanagan, 2013), this model illustrates messages that are either constructive or destructive. Constructive messages are behaviors that minimize conflict, e.g. B. stay on task and solve problems. Destructive messages are behaviors that intensify or prolong conflict, such as B. Focusing on the personalities involved (Runde and Flanagan).

    Constructive responses to conflict include perspective taking, solution finding, emotion expression, expansion, reflective thinking, reaction delay, and adjustment. Destructive responses to conflict include: winning at all costs, showing anger, demeaning others, retaliating, avoiding, giving in, hiding emotions, and self-criticism (Runde & Flanagan, 2013). These responses are reflected in the basic guidelines found  to help two or more parties manage conflict processes.

Guidelines by Runde and Flanagan

    These guidelines come with a caveat. As Runde and Flanagan (2013) observed: “Every conflict is different. Therefore, conflict-competent executives cannot and will not follow a script 217). Conflict management is a difficult process that consumes time and energy from all parties. However, restrictive conflict processes often produce positive outcomes that not only resolve the immediate conflict, but also help build trust between the parties for future interactions.

    These strategies require a special effort on the part of the nursing manager as a mediator. In addition to carefully monitoring the situation according to the above guidelines and the commitment required, conflict competent nurses are also emotionally intelligent (Goleman, 2006). They monitor when their own emotions run high, from constructive behavior to slow response when emotions run high, and then work to determine what is really behind people's actions (Runde & Flanagan, 2013). This takes energy, confidence, self-development and practice, but the results are worth the investment.

Conflict Responses

    Response patterns to conflict have been studied for more than 50 years. There are a variety of conflict responses or conflict styles (eg, Filey, 1975: Thomas & Kilmann, 1974). These are briefly mentioned here so that you are aware of the language used to describe them.

Effective Technique

    Confrontation is often seen as the most effective means of resolving conflict in a temporary situation. This is a problem-oriented technique, bringing the conflict to light and trying to resolve it through knowledge and reason. The aim of this technique is to achieve win-win solutions. The facts should be used to identify the problem. The desired outcome should be explicit, for example: “This is the third time this week that you have not been here for the report. Per hospital policy, you are expected to be changed, washed and ready for report in the waiting room by 7:00 a.m.

    A confrontation is most effective when it takes place in private as soon as possible after the incident (Sullivan, 2013). The respect of the employees and the credibility of the manager are two important considerations when a situation calls for a confrontation. A more direct confrontation helps both the employee and the manager sort out the relevant facts. However, in an emotionally charged situation, it may be best for the parties to wait and see. Regardless of the moment, the message is often more effective when the manager is detailed and empathetic.

    The negotiations involve give and take on various issues between the parties. Its purpose is to reach an agreement, even if a complete agreement is never reached. Therefore, the best solution from the point of view of one of the parties or the organization may not be reached. Bargaining often becomes a structured and formal process, such as collective bargaining. However, negotiation skills are important in reaching an amicable solution between two parties. Employees learn to negotiate schedules, advanced practice nurses negotiate reimbursement with third-party payers, insurance companies negotiate discounts with providers and hospitals, and clinic administrators negotiate employment contracts with physicians. Although skillful communication skills are necessary tools for negotiations, their usefulness revolves around issues of conflict. Without differences of opinion, there would be no need for negotiation.

    Collaboration means mutual attention to the problem, using the talents of all parties. When they work together, the focus is on solving the problem, not defeating the opponent. The goal is to work on a solution that takes into account the concerns of both parties. Cooperation is useful in situations where it is important to compromise the goals of both parties.

    Compromises are used to split the rewards between both parties. Nobody gets what she or he wants. Compromises can serve as a backup to resolve conflicts when collaboration is ineffective. Sometimes it's the only option when opponents of equal power disagree on two or more mutually exclusive goals. Compromises also make sense when a solution is needed quickly.

    The competition is an absolute bid to win, no matter what the cost. Competition may be necessary in situations involving unpopular or critical decisions. Competition is also used in situations where time does not allow for more cooperative techniques.

    Accommodation is a cooperative and unassertive tactic used when people neglect their own concerns for the interests of others. Adjustment is often used to maintain harmony when one person has a legitimate interest in an issue that is not important to the other party. Suggestions in which conflict is discouraged are often deleted. Suppression could even include the removal of one of the conflicting parties through transfer or termination. 

Less Effective Technique

     Less effective conflict management techniques include withdrawal, softening, and coercion, although each type of response is useful in certain situations. In avoidance, the participants never acknowledge that a conflict exists. Avoidance is the conflict resolution technique commonly used in highly cohesive groups. The group avoids disagreements because its members don't want to do anything that might affect their good feelings for one another.

    Withdrawing from the conflict means that one of the parties withdraws, making the situation impossible to resolve. The problem remains unresolved and feelings about the problem may inappropriately resurface. If the conflict escalates into a dangerous situation, evasion and withdrawal are appropriate strategies.

    Softening is accomplished by praising the opponent, downplaying differences, and focusing on smaller areas of agreement as if there were few disagreements. Smoothing may be appropriate for dealing with minor problems, but it produces the same results as retracting in response to larger problems.

    Forcing is a method that brings about an immediate end to the conflict but leaves the cause of the conflict unresolved. A superior may resort to giving orders, but the subordinate lacks commitment to the required action. Coercion may be appropriate in life and death situations but is otherwise inappropriate. Resistance can be positive or negative. It can mean resistance to change or disobedience, or it can be an effective approach to dealing with power differences, particularly verbal abuse.

    All of these answers are commonly discussed approaches to working in conflict situations. Discovering your own preferences for participating in conflict talks is an important first step in interacting with others, especially in conflict situations. Find resources for inexpensive self-assessment tools at the end of this chapter. Being aware of your own conflict resolution style preferences is the first step in working through a conflict conversation. 

    It contributes to reflexivity, a level of self-awareness, particularly awareness of possible ways of understanding a conflict and one's role in a conflict (Littlejohn & Dominici, 2007). Using Littlejohn and Dominics' (2007) model of engaging these recruits, consider how a thoughtful director of nursing might manage conflict.

    Do not see the conflict as an obstacle but as an opportunity to solve the problem. Reframe the issue of emotional response to substantive issues. Turn the situation into an opportunity to build respect Present or generate a variety of possible solutions.

    Shift attention from positions to interests and then to common interests (such as safe, quality, patient-centred care).