20Jones Leadership(F)-ch 20 1/14/07 3:52 PM Page 333 Constructive Conflict Management Assessment of the Conflict Situation A constructive conflict resolution is one that reaches an agreement and enhances future interaction Wilmot and Hocker (2001, p 93) note that the outcome of a conflict can be considered positive when agreements are made that are fair and durable and that consider the interests of both parties Such an outcome cannot be achieved without an accurate intial assessment of the conflict In the same way that a physical assessment can inform the diagnosis of a physical problem, an assessment of the conflict situation can direct the resolution of a conflict Sportsman (2005) described a framework, adapted from Weber’s Conflict Map and the WilmotHocker Conflict Assessment Guide (Wilmot & Hocker, 2001), for use in assessing conflict within the health-care environment The major components of the framework are reflected in the acronym PEPRS, which stands for: ■ ■ ■ ■ ■ Parties involved Events/issues Power Regulation of conflict Style of conflicts A description of each of the components will help in applying the framework PARTIES INVOLVED Assessment of the conflict situation begins with identification of all involved participants Conflict participants may include primary, secondary, or interested third parties All have some level of interest in the conflict, although their distance from the conflict situation dilutes the intensity of their concern (Sportsman, 2004) In situation A, the physican and the nurse manager are the primary parties Secondary parties include diabetic patients on that unit, the nurses on the unit who will implement the teaching protocol, other physicians who admit to that unit, and the nurse manager’s supervisors Interested third parties might include nursing and medical staff members on other units Identification of the parties involved is also important to determine the type of organizational 333 conflict For example, when the primary participants are involved in a vertical conflict between supervisor and staff, as in situation C, the dynamics are different than if there was a horizontal conflict as described in situation B EVENTS/ISSUES In an effort to determine the events or issues involved in the conflict, it is important to outline the triggering event, historical context, the level of interdependence among the participants, the “named” issues, available resources, and previously considered solutions Underpinning these elements are communication behaviors of each party and their perceptions of these behaviors Because behaviors not occur in a relational vacuum, the relationship between the conflict participants and the meanings ascribed to their relationship(s) are also important In other words, if the relationship is very important to all participants, the conflict will have much more meaning than if the relationship is a transient one This is particularly true if participants define themselves through the relationship The perceptions of these relationships are influenced by gender, culture, and socioeconomic status (Sportsman, 2005) For example, the attempt to introduce the new teaching protocol was the triggering event in situation A The historical relationship of nurses being “handmaidens” of physicians, based in part on traditional male-female roles, may also influence this conflict Despite this historical background, as previously noted, the physician and nurses are interdependent in their ability to care for diabetic patients In situation B, if the respiratory care director believes that nothing he can to demonstrate the needs of his department will outweigh the professional relationship of two nurses, he reduces the variety of behaviors he might use to resolve the issue Having the mindset that the vice president will always give the majority of the resources to the nursing director may reduce the energy he is willing to expend to advocate for resources for his department The financial, human, and/or emotional resources available to resolve the conflict also provide important information about the situation In situation B, if the hospital is experiencing financial difficulties, the options for resolving the need for 20Jones Leadership(F)-ch 20 334 1/14/07 3:52 PM Page 334 Skills for Being an Effective Manager respiratory and nursing staff may be very different than if the hospital is strong financially DIVERGENT GOALS The most significant factors to assess in order to define the event/issues are the divergent goals of the various parties involved in the conflict Goals inherent in a conflict are typically referred to as CRIP because they fall into one or more of these types: Content, Relational, Identity, and Process Content goals can be determined by asking “What I want?” Relational goals involve answering the question, “Who are we to each other, and how does this affect what I want?” Identity, or face-saving, goals can be determined by answering “Who am I in this interaction, and how does this affect what I want?” Process goals involve asking “What processes will be used in this interaction” (Wilmot & Hocker, 2001) In situation C, both the pediatric surgical-service nurse manager and the night charge nurse have a content goal of ensuring that children and their families get appropriate preoperative care The nurse manager also has the content goal of maintaining the flow of surgery Her relationship goal may be for her subordinate to follow her order The night charge nurse may also recognize that she is subordinate to the nurse manager; therefore, her relationship goal may be to maintain a positive relationship with her supervisor The identity goals of these two nurses are influenced by the difference in their roles in the hierarchy For example, the nurse manager may be committed to demonstrating her power as a supervisor On the other hand, the night charge nurse, while recognizing her subordinate role, may see herself as the main advocate for the children preparing for surgery and their families The process goals in situation C may direct how the situation is resolved If the nurse manager’s process goal is to resolve the conflict by exerting her authority, she will be less likely to negotiate alternative outcomes, such as consulting the nursing literature or requesting feedback from other practice experts All types of goals are not present in all disputes, and they may vary in importance in any given situation Identity and relational goals typically underlie the content and process issues, which are more likely to be named as the goals in dispute (Wilmot & Hocker, 2001) For example, in the physician–nurse manager conflict in situation A, implementing the teaching protocol based on nursing research may be the content goal for the nurse manager His need, however, to have the worth of nursing research, and more importantly the worth of his own practice, recognized is an underlying identity goal in this conflict If only the content goals are achieved, the conflict is likely to remain (Wilmot & Hocker, 2001) For example, if the physician agrees to use the teaching protocol suggested by the nurse manager but continues to belittle the underlying research, the conflict has not been truly resolved As part of issue identification in the conflict assessment, goals must be clarified It may be difficult to define effective resolutions for vague goals because such goals cannot be quantified (Wilmot & Hocker, 2001, pp 91–92) For example, in situation A, if the nurse manager has the goal that “ the physicians in this hospital will respect nursing research,” it will be difficult to know whether that goal has been achieved Instead, if the goal is to implement the teaching protocol for diabetic patients based on specific nursing research, its achievement can be more easily determined POWER All conflicts are based, in part, on attempts to protect participants’ self-esteem or alter perceived inequities in power (Boule, 2001; Wilmot & Hocker, 2001) Therefore, examining the influence of power related to conflict participants is central to assessing and understanding the conflict Boule (2001, p 224) describes some assumptions about power in conflict that may be helpful in this examination: ■ ■ ■ There are many different contexts in which there might be varying levels of power Some of these are easy to observe, and some are not All participants in a conflict have some power This may come from money, knowledge, or the ability to damage or reward It may also be derived from rules, standards and principles, the morality of the situation, and/or the need to maintain or improve a reputation The perception of power may be more important than power itself The perception of power is fueled by certain assumptions about what constitutes power Kritek, 20Jones Leadership(F)-ch 20 1/14/07 3:52 PM Page 335 Constructive Conflict Management in Marcus, et al (1995), outlines assumptions about power as translated into privilege in the United States: ■ ■ ■ ■ ■ ■ ■ The wealthy are more privileged than the poor Men are more privileged than women Professional people are more privileged than laborers Healthy people are more privileged than the ill Strong people are more privileged than the weak Management is more privileged than employees People who act in a rational manner are more privileged than those who are emotional In addition to power drawn from societal influences, assumptions can also be drawn about power in organizations Wilmot and Hocker (2001, p 11), synthesizing research on organizational power, indicate that people have power in organizations when they: ■ ■ ■ ■ ■ Are required to deal with important problems Control valuable resources Are closely connected to the work flow of the organization Are not easily replaced Have a history of using their power effectively These characteristics are built on the “bases of power” work of French and Raven (1960), which describes power as coming from reward, coercive, legitimate, referent, and expert power bases All told, the powerful in work or personal conflict are those who have the advantage of physical and psychological strength by virtue of gender, education, health, or resources The extent to which this power is actualized contributes to the resolution of the conflict Therefore, it is important to assess the power base of each participant in a conflict The bases of power should be used as a starting point to assess the power of individuals Nonetheless, Wilmot and Hocker (2001, p 11) suggest that in a conflict assessment, power is typically defined too narrowly, and too much emphasis is put on the source of the influence They recommend including an assessment of the use of power within the relationship in conflict rather than simply the amount of power one participant potentially has over another For example, evaluating the decision- 335 making process within the relationship (who typically makes the decisions?) and the extent to which each participant attempts to control conversation can provide helpful information about the use of power in a relationship Identifying other methods of using covert power, such as passive-aggressive behavior or “submitting but resisting,” can also be instructive (Wilmot & Hocker, 2001, p 113) The conflict in situation A between the nurse manager and the physician illustrates principles regarding power From an organizational perspective, both parties hold significant power Both deal with important relationships, control valuable resources, and would be difficult to replace Both are central to the work flow related to the care of patients To determine any inequities of power, one must analyze the specific relationship Questions that might help in this analysis include: “What are signs of dominance or passivity in their conversations?” and “What decision-making strategies have been used in past conflicts?” A broad assessment of power is critical to a constructive resolution of conflict because the relative power of each party and the power within the specific relationship can be used to generate possible solutions If the possible solutions to the conflict are only based on the power of each party in general, the range of possible solutions will not reflect the power distribution in their intimate relationship This narrow assessment will reduce the range of possible solutions to the conflict For example, observing the way the physician and the nurse manager in situation A relate to each other can give additional information about the power distribution in their relationship beyond what is assumed from their relative positions in the organization REGULATING RESOURCES The resources for constructive conflict management are available in every conflict situation These resources might include internal or external limiting factors, interested or neutral third parties, and various styles used to manage conflict Internal factors include common values of participants or the value of the relationship to each of them External factors might include an authority with the ability to intervene and force a settlement Third parties would include those trusted by both sides that can facilitate a resolution acceptable to all Possible con- 20Jones Leadership(F)-ch 20 336 1/14/07 3:52 PM Page 336 Skills for Being an Effective Manager flict management styles used by the participants, which will be discussed in the next section of the chapter, also have the potential for regulating the conflict (Wilmot & Hocker, 2001, p 204) Situation C illustrates various internal and external resources likely to regulate this conflict The nurse manager and the night charge nurse share the desire for patients to be prepared for surgery In addition, they recognize the interrelatedness of their work They also are both aware that others in the hospital hierarchy could intervene if necessary, providing an external regulator to this conflict Both participants value the need for adequate patient preparation; however, the nurse manager may value smooth collaboration between the operating room and the patient unit more than the night charge nurse The effectiveness with which the conflict is managed may be related to the extent to which regulating resources that support resolution rather than continued conflict are available Some conflicts are relatively easy to resolve; others are more difficult Lewicki, et al (2001, p 21) suggest that the ease of resolution depends, in large measure, upon the issue in conflict An accurate assessment, driven by identification of the conflict category, can help participants evaluate, in advance, the possible ease of resolution The size of “the prize” to be won or lost, the level of interdependence of the participants, and the extent to which participants must continue to work together influence the likelihood of a constructive resolution The extent to which the resolution process seems fair to each participant also contributes to a constructive resolution Similarly, the structure that is in place to encourage or discourage participant interaction and conflict resolution also influences the ease of resolution (Lewicki, et al., 2001, p 21) STYLE OF CONFLICT MANAGEMENT Conflict management styles are behavioral approaches used to regulate or resolve the conflict When these behaviors are used together over time, they become patterned responses These patterns develop over a lifetime, influenced by genetics, life experiences, and personal philosophy People tend to use the same patterns over and over in a wide range of conflicts In some situations, these patterned responses may effectively resolve the conflict In other circumstances, however, the same pattern of behavior may only escalate the conflict To be effective in conflict management, one must be able to choose consciously the behaviors that best fit the circumstances of the conflict There has been signficant research on conflict management styles in an effort to understand what behavior is most appropriate in various situations For example, three groups of researchers, Blake and Mouton (1964), Thomas and Kilmann (1974), and Rahin (1990), have described five styles or behavioral patterns that might be used in a conflict The styles identified by the three groups of researchers, although differently named, describe the same phenomena Competing, forcing, or dominating refer to a behavior pattern of being uncooperative and demanding one’s own way The results of such an approach are often categorized as a win-lose situation Sports analogies in conflict management usually refer to competitive situations in which achieving a goal takes place by blocking the opponent’s goal In these situations, only one goal can be met, resulting in a “winner take all” scenario Avoiding or withdrawing refers to avoiding the conflict so that it cannot be resolved The result may be categorized as a lose-lose situation Accommodating, smoothing, or obliging/capitulation refers to being cooperative yet unassertive so that only the other person’s needs are met The result may be considered a lose-win outcome Compromise or sharing suggests that each party relinquishes something, which might be described as a no-win no-loss resolution, because no one gains or loses everything she or he wanted Collaboration or problem solving, which is the most timeconsuming process, may be considered a win-win situation, in which new ideas are generated that resolve most of the issues in the conflict The important point to understand is that each of these styles has some merit; there is no one right way to manage conflict The style that is most effective in reaching a constructive outcome to the conflict depends on the participants and the context of the conflict Effective collaboration or problem solving results in the greatest benefit (win-win) for all involved in a conflict, so logically this should be the conflict management style most often used In reality, other styles are frequently chosen over collaboration In some cases, particularly for short-term gain, it may even be appropriate to choose avoiding (lose-lose) as a solution This choice may be made intention- 20Jones Leadership(F)-ch 20 1/14/07 3:52 PM Page 337 Constructive Conflict Management ally, after comparing the time required for collaboration with the impact of the problem being resolved In situation C, for example, if the nurse manager knows that the night charge nurse will be resigning in a short time, it might be in everyone’s best interest, including the patients’, to avoid a confrontation about this schedule Table 20-1 reviews the five conflict management styles outlined by Thomas and Kilmann (1974) and gives examples of circumstances in health care in which each of the five styles might be appropriate CONFLICT STYLES IN NURSING AND HEALTH CARE No place is the need to use various conflict management styles more important than in the complex world of health care Health-care organizations are TABLE 20-1 337 particularly vulnerable to the negative effects of conflict among providers because of multiple stakeholders with competing interests and values (Marcus, et al., 2001) There is some evidence to suggest that increased positive interaction among health-care disciplines positively influences outcomes of care for patients (Bartol, Parrish, & McSweeney, 2001) Conversely, according to data from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), breakdown in team communications is a top contributor to sentinel events (AACN, 2005) Poor communication is often the result of unresolved or poorly managed conflict Constructive conflict management is an effective strategy in improving communication and, in effect, improving patient safety Despite the recognition that use of a variety of conflict management styles is necessary for constructive conflict resolution, many people uncon- Conflict Management Styles STYLE SITUATION Competition (win-lose) ■ ■ Accommodation (lose-win) ■ ■ Avoiding (lose-lose) ■ ■ Compromise (no-win no-loss) ■ ■ Collaboration (win-win) ■ ■ When patients’ well-being is clearly at stake and the opposing position would harm it When working with a peer who would take advantage of you if you did not compete When other staff members care about the results of the monthly schedule more than you To counteract previous negative feelings, you agree to adopt a treatment protocol that is not your first choice but appears to have positive patient results When you know that an employee wants to discuss the promotion that you are not prepared to give, you cancel a scheduled appointment with the employee The employee loses because she is unable to ask about the promotion, and you may also lose the support of the employee, who sees you as unresponsive When staff wants to buy a new piece of equipment, but administration has indicated that no new equipment will be purchased for the next months When two hospital units need a new staff member but there is only sufficient funding for one new employee and a 0.5 FTE position is assigned to each unit When a new electronic charting system is scheduled to be implemented in months but accreditation processes require a change in documentation of a particular instance immediately When a new 23-hour unit is being opened as a cost-reduction strategy and the opinions of multiple stakeholders are in conflict about how to proceed; the support of all the stakeholders is needed to make the unit successful When the discharge planning process is being revised and there has been long-term animosity between the social workers and nurses; when representatives from the two groups interact to revise the process, positive relationships may be forged Adapted from Thomas and Kilmann (1974) ... conflict management styles outlined by Thomas and Kilmann (1974) and gives examples of circumstances in health care in which each of the five styles might be appropriate CONFLICT STYLES IN NURSING AND. .. an effort to understand what behavior is most appropriate in various situations For example, three groups of researchers, Blake and Mouton (1964), Thomas and Kilmann (1974), and Rahin (1990), have... implementing the teaching protocol based on nursing research may be the content goal for the nurse manager His need, however, to have the worth of nursing research, and more importantly the worth of his