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Learning Scope #405
1 contact hour
Expires Oct. 29, 2014
You can earn 1 contact hour of continuing education credit in three ways: 1) Grade and certificate are available immediately after taking the online test. 2) Send the answer sheet (or a photocopy) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.
Merion Matters is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 221-3-O-09), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.
Merion Matters is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).
- The author has completed a disclosure form and reports no relationships relevant to the content of this article.
The goal of this continuing education article is to review the theory and practice of resolving workplace conflict to assure the smooth functioning of the clinical team and to provide a satisfying working environment for everyone. After reading this article, you will be able to:
1. Define conflict, distinguish between substantive and affective sources of workplace conflict, and outline the stages of the conflict process.
2. Explain why effective conflict resolution requires a conscious decision to actively address substantive workplace issues, as well as the emotional concerns of the individuals involved.
3. Explain why taking a positive approach to conflict resolution benefits patients and staff, and supports the effective functioning of the clinical team.
4. Describe an effective approach to resolving conflict in the workplace.
Healthcare is delivered by people who work in organizations, large and small. Successful health outcomes depend on the efforts of many people within the organization, including clinicians, support staff and managers. All of these people, not just other nurses, are our colleagues. Each organization, in turn, depends on many other organizations, such as insurance companies, vendors and other healthcare organizations. Each individual is part of many groups, both formal and informal. Nurses may see themselves as members of the team on their shifts and their clinical units, as members of the nursing department, and as employees of their healthcare organization.
In this environment, being able to work well with other people, within and across departmental and other organizational boundaries, is essential to efficiency and effectiveness in patient care. As every one of us has observed, at least since kindergarten, an environment characterized by interactions among many people within a defined setting is conducive to conflict.
Unresolved conflicts interfere with the achievement of successful clinical outcomes, as well as with personal and professional satisfaction. Therefore, the goal of conflict resolution is "to prevent deadlock and recrimination and restore stability," as well as to foster wholesome and functional communication within the clinical team.1
What Is Conflict?
Conflict may be defined as "the active striving for one's own preferred outcome which, if attained, precludes the attainment by others of their own preferred outcome," or as a "process that begins when one party perceives that another party has negatively affected . something that the first party cares about."2,3
What these definitions of conflict have in common is the notion that conflict reflects: 1) perceived differences in values, beliefs and attitudes, and 2) actions by others that may interfere with the attainment of one's desires and expectations.
What Causes Workplace Conflict?
Distinguishing among the causes of workplace conflict makes it possible to develop effective approaches to managing the conflict.
In their classic work on managing workplace conflict, Likert and Likert distinguished between two kinds of conflict: substantive conflict and affective conflict.2 Conflicts may arise over concerns about accomplishing workplace goals, from interpersonal issues, or both. As the models discussed below suggest, successful conflict resolution depends on the relative emphasis given by individuals and the organizational culture to the substance of the work to be accomplished and personal styles of communication.
Substantive conflict may result from content issues (what should be done) or from process issues (how it should be done). Structural issues, such as conflicting individual or departmental goals, or competition for scarce resources, may lead to conflicts between individuals and departments in spite of everyone's good intentions. For example, the nursing unit may need to have a bed prepared for a new admission, while the housekeeper, who is assigned to cover two units, is on the other unit. Differing interests, such as the manager's interest in controlling costs or assuring compliance with organizational policies, and the nurse's interest in accomplishing a task quickly and easily, can become a source of substantive conflict.
Affective conflict may result from clashing personal styles, even between individuals of good will. People have different personalities, and some people may find it difficult to get along in spite of their best intentions. And, of course, affective conflict may result from pathology. Some people are what is commonly called "difficult" and have trouble getting along with many people.
Role conflict may be viewed as both substantive and affective. For example, a nurse who is at the patient's bedside may want to decide how to address an urgent problem, while the physician, who is elsewhere, may want to reserve the right to make that decision. When those two individuals have a good working relationship, based on mutual trust and respect, this issue can easily be resolved. However, without a good working relationship, this issue can quickly lead to unresolved conflict both over what to do and who is to make the decision.
A Model of Conflict Resolution
A number of scholars have developed models of conflict resolution that attempt to show the choice of an approach to addressing conflict leads directly to the type of outcome that is likely to be achieved.
Some models categorize the approaches as "rational" and "emotional," or as "concern for results" and "concern for people."1,4 These categories are analogous to the "substantive" and "affective" factors identified by Likert and Likert as causes of conflict. One model categorizes approaches to conflict resolution as "active" and "passive." The authors of this model postulate that active solutions result in high "payoffs" and passive solutions result in low "payoffs."5
The table below illustrates a simple model of conflict resolution. It offers a relatively straightforward way of understanding the consequences of various approaches to conflict. The table is adapted from models by Krogerus and Tschäppeler and Yoder-Wise.1,6
Table: Conflict Resolution Approaches
- Avoid (Passive):
- Compete (Active):
- Give up (Passive):
I Win-You Lose
I Lose-You Win
- Accommodate (Passive):
- Compromise (Active):
- Collaborate (Active):
Win-Lose / Lose-Win
This model makes it clear passive approaches to conflict resolution - avoidance, giving up and accommodating - are likely to result in poor outcomes for one or both parties. Competing, an active but aggressive approach, also is likely to result in poor outcomes for one or both parties. (While both parties may compete to win, it is entirely possible both may lose, particularly if the outcome adversely affects the subsequent working relationship.) This leaves compromising and collaborating, both of which are active and rational approaches. A compromise, in which each party gives up something and gains something, may be rational, but emphasizes the affective goal of assuring neither party will feel they were forced to give up everything. Collaboration, on the other hand, gives greater weight to the substantive goal of achieving optimal workplace results than it does to affective concerns.
Selecting an Approach
The four stages of the conflict process are: frustration, conceptualization, action and outcome.6 It is apparent that, within this schema, there are multiple decision points. You can ignore or act on the feeling of frustration; you can conceptualize the problem as intentional, accidental or the result of a structural or process issues; and you can take action in a variety of ways, based on your personal style and the expectations shared within the organization.
Because conflict resolution is a process involving both thoughts and feelings, effective conflict resolution requires intentionality, i.e., the conscious decision to actively address both substantive workplace issues and the emotional concerns of the individuals involved. Selection of an approach to conflict resolution also depends on the culture of the workplace.
Role of Organizational Culture
The culture of the organization will determine, to a great extent, the selection of an approach to conflict resolution. In the past, it was common for many organizations to foster competition among departments and individuals. In that environment, active and rational approaches to conflict resolution are likely to be mistaken for subtle attempts at aggression, and individuals who attempt to negotiate a compromise or develop a consensus have difficulty engaging their colleagues in meaningful and productive interactions.
In recent years, management philosophy has been much more supportive of teamwork and cooperation. The logic of this approach became obvious once it was articulated by Deming and others.2,7 The mission of a healthcare organization is to deliver efficient, high-quality healthcare services to patients across the entire continuum of care. This only can be done if all departments and clinical disciplines work well together. For example, patients will not be satisfied (and are less likely to experience optimal outcomes) by a successful surgical procedure bracketed by poor emergency department care and poor inpatient care. To achieve high levels of patient satisfaction and optimal clinical outcomes, healthcare organizations have found it beneficial to foster teamwork and cooperation.
In this environment, positive approaches to conflict resolution are viewed as critical to the success of the organization, and individuals who actively address workplace conflict with positive approaches that emphasize both concern for results and concern for people are more likely to be successful.
Putting It All Together
The selection of a conflict resolution process should be based on the longer term goal for the relationship. If both parties want to maintain or must maintain the relationship, the solution and, especially, the process should be designed to support the ongoing relationship. Conflicts are more likely to be resolved successfully if the process and the resulting solutions are balanced and meet the needs of both parties. In the workplace, this almost always should be your goal.
The first step in conflict resolution is to determine whether the other party is even aware that there is a conflict. We often assume other people's behavior is intentional when, in fact, they may not be aware their actions are causing difficulties for someone else. In an environment characterized by open communication and mutual support, many conflicts can be resolved simply by pointing out the problem. If the problem is phrased as, "It would help me if ." rather than, "You are (or aren't) doing .," colleagues are very likely to respond positively.
If the problem cannot be resolved this easily, the selection of a negotiating strategy should take account of assessments that determine: 1) the cause of the conflict; 2) whether the issues are important or inconsequential; and 3) whether resolution of the issues is urgent or may be delayed.
Determining the cause of the conflict is more challenging than it may appear at first. In recent years, many organizations have adopted a team problem-solving approach to identify the causes of complex interdepartmental conflicts. This approach can be productive and satisfying and can be used for interpersonal conflicts. Approaching the other party with a request for help in identifying the cause of a problem may create the basis for a collaborative approach, while avoiding unnecessary conflict.
If the issue is inconsequential, a passive approach (avoidance or accommodation) may be perfectly satisfactory. If the issue is important, an active approach (compromise or collaboration) is required to resolve the problem.
If the issue is important but not urgent, there is time to plan for an appropriate approach to conflict resolution. If the issue is important and urgent, e.g., issues involving patient safety, it may be necessary to adopt a competitive strategy. This should be done with caution. There are fewer issues of this sort than we may imagine and, even in an urgent situation, there may well be enough time to listen to other opinions. Adoption of a competitive strategy requires that we be prepared to document our clinical rationale and apologize to our colleagues afterward.
The next step in conflict resolution is to select both a preferred approach and a contingent approach. Conflict resolution is a transactional process, i.e., it involves negotiation. While each party may prefer a particular approach, preferences may change when faced with the other party's approach. For example, I may enter the negotiation hoping for a compromise, but when faced with the other party's intention to compete, I may decide to compete or give up; or I may decide to continue trying to achieve a compromise. Conversely, if I enter the negotiation prepared to compete, I may be convinced by the other party's approach to collaborate in a search for consensus.
Steps to Negotiation
The process of conflict resolution involves negotiation. This takes time and requires effort. The process has a better chance of success if it is not carried out "in the heat of the moment." Setting aside time for the discussion and, preferably, finding a quiet, comfortable space in which to talk improves everyone's attitude.
The negotiation should begin with both parties saying what they want and what they need. That makes it easier for each party to negotiate, because both parties will be working from realistic mental images rather than assumptions that may be based on stereotypes or, worse, based on internal anxiety, e.g., the fear that "they are trying to get me." One way of doing this is to imagine how the situation might appear to the other party, and then validating that assessment by asking if it is correct. This has several benefits: 1) it demonstrates that you are interested in the other party's concerns; 2) you are likely to gain a better understanding of the other party's concerns; and 3) it helps to set a positive tone for the discussion.
If you have a good idea of the issues involved, prepare in advance to concede something. Sometimes, a satisfactory compromise is all you can hope for, and knowing in advance what you can concede allows you to compromise without feeling that you are giving up. This also makes it easier for the other party to agree on a workable compromise, and it increases the likelihood the other party will be willing to talk the next time an issue comes up.
Listening is as important as talking. Workplace conflict, unlike interpersonal conflict, is about workplace issues, but all conflicts involve people. People generally are willing to work collaboratively once they are satisfied their feelings have been heard and their needs have been taken into account. This is important because: 1) we have to return to work with the same people tomorrow; and 2) successful workplace outcomes require teamwork and cooperation at all times.
Sometimes, after unsuccessfully attempting to resolve a conflict between individuals or departments, it is necessary to move the issue to a higher level. When this happens, both parties need to acknowledge the impasse and state clearly that the issue will be raised with their supervisor or with the heads of their respective departments. This should be done openly and without rancor. Referring an issue upward within the organizational hierarchy is not necessarily an admission of defeat; it is necessitated by the realities of the workplace.
A Conscious Decision
Resolving conflict in the workplace requires intentionality and active approaches that support workplace goals. Effective conflict resolution requires a conscious decision to actively address substantive workplace issues, as well as the emotional concerns of our colleagues. Taking a positive approach to conflict resolution benefits patients and staff, and supports the effective functioning of the clinical team.
1. Krogerus, M., & Tschäppeler, R. (2012). The decision book: 50 models for strategic thinking. New York: W.W. Norton & Co.
2. Likert, R., & Likert, J. (1976). New ways of managing conflict. New York: McGraw-Hill.
3. Robbins, S. (2001). Organizational behavior. Upper Saddle River, NJ: Prentice-Hall.
4. Blake, R., & Mouton, J. (1970). The fifth achievement. Journal of Applied Behavioral Science, 6(4), 413-426.
5. Blake, R., Shepard, H., & Mouton, J. (1964). Managing intergroup conflict in industry. Houston: Gulf.
6. Yoder-Wise, P. (2007). Leading and managing in nursing. St. Louis: Mosby.
7. Deming, W. Out of the crisis. (1986). Cambridge, MA: Massachusetts Institute of Technology.
Ken Stanton is a staff nurse in behavioral health services at Alta Bates-Summit Medical Center, Berkeley, CA.