HCA 301 Leadership and Management in Healthcare Setting PDF

HCA 301 Leadership and management in healthcare setting CHAPTER 9 WORKING WITH CONFLICT AND DIFFERENCE Resource: Sullivan, E.J. & Garland, G. (2013), 2nd Edition. Practical Leadership & Management in Healthcare for Nurses and Allied Health Professionals. UK: Pearson HCA 301, CHSS, AHD, SEMESTER II-2...

HCA 301 Leadership and management in healthcare setting CHAPTER 9 WORKING WITH CONFLICT AND DIFFERENCE Resource: Sullivan, E.J. & Garland, G. (2013), 2nd Edition. Practical Leadership & Management in Healthcare for Nurses and Allied Health Professionals. UK: Pearson HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 1 Learning Outcomes 1. Define conflict and its complexity. 2. List the various responses to conflict. 3. Discuss conflict situations and its conditions. 4. Explain conflict management and conflict management strategies. 5. Demonstrate the leader/ manager’s role in managing conflicts. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 2 Introduction What is Conflict? Give some examples of Conflicts? HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 3 Conflict Conflict is the consequence of real or perceived differences in mutually exclusive goals, values, ideas, attitudes, beliefs, feelings, or actions. ◦ Intrapersonal conflict ◦ Within one individual ◦ Interpersonal conflict ◦ Between two or more individuals What turns differences into conflict is the meaning we attribute to the difference and how we respond. One of the most difficult problems managers and leaders face and learning how to deal with conflict is essential for success in any role. Learning how to prevent conflict, how to respond when you are involved in differences that could lead to conflict, and how to support those in conflict to restore good working relationships are important skills. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 4 Conflict Conflict is a dynamic process, rather than a state. ◦ Can be positive or negative ◦ Can be healthy or dysfunctional A certain amount of conflict is beneficial to an organization. ◦ Heighten sensitivity to an issue ◦ Stimulus for developing new ideas ◦ Helps people recognize legitimate differences within the organization or profession HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 5 The complexity of conflict Conflict arises in every human activity and in every relationship we create. Some theorists, such as Sigmund Freud, focused on intra-psychic conflict where the conscious mind battles with the unconscious mind. Others have focused on conflict between individual, within or between families, between nations, religions or cultures ( Strasser and Randolf, 2004). Sigmund Freud HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 6 The complexity of conflict Despite the word conflict having a largely negative connotation, writers such as Sacks argue that conflict has a positive side, that of reconciliation (Sacks, 2002). Sacks argues that conflict has a purpose : It can bring people together for the purposes of confronting issues and threats but more importantly conflict can lead to understanding and the groundwork for reconciliation. In effect, conflict is a powerful force that can generate creativity, focus efforts and deepen understanding or destroy relationships, waste time and endanger the quality of patient care. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 7 Conflict Process Model Conflict and resolution develop according to a process that may be characterized as a life span. ◦ Begins with certain preexisting conditions (antecedent conditions) ◦ Conflict is either resolved or suppressed. ◦ Outcome results in new or reinforced attitudes and feelings among the parties. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 8 Conflict Process Model Perceived and Felt Conflict ◦ Parties involved view situations or issues from differing perspectives. ◦ Perceived conflict ◦ Each party's perception of the other's position ◦ Felt conflict ◦ Negative feelings between two or more parties ◦ Often characterized by mistrust, hostility, and/or fear HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 9 Conflict Process Model Conflict Behaviors ◦ Result from the parties' perceived or felt conflict ◦ Behaviors may be overt or covert. ◦ Overt ◦ Aggression, competition, debate, or problem solving ◦ Covert ◦ Indirect tactics such as scapegoating, avoidance, and apathy HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 10 Conflict Process Model Conflict Resolved or Suppressed ◦ Resolution ◦ A mutually agreed-upon solution to which both parties commit ◦ Suppression ◦ One person or group defeats the other. Outcomes ◦ Optimal solution ◦ Both parties see themselves as winners and the problem is solved. This leaves a positive aftermath that will affect future relations and influence feelings and attitudes. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 11 Disruptive Conflict The conflict that consumes our time and energy at work is disruptive conflict. Differences that disrupt the flow of work. The parties involved are focused on the differences between them and often engage in activities intended to disadvantage, disrespect, misunderstand, overpower, belittle, embarrass or defeat the others involved. For example, a mental health team leader who is in a conflict with the head of occupational therapy may use disruptive behaviour such as refusing to attend meetings, not returning phone calls, or withholding information. In return, the head of occupational therapy is equally likely to cut off communication, avoid meetings, and control information. This type of conflict takes place with fear, anger and distress. Disruptive conflict can, in unusual circumstances, result in upsetting or even violent behaviour. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 12 Disruptive Conflict Whether a situation becomes disruptive conflict very often depends on the responses of those involved. Competition can be a stimulus for disruptive conflict or an opportunity for development. The most common sources of disruptive conflict at work are not competitions, they are differences in values, beliefs, opinions, actions and ideas. Examples of this type of conflict: two nurses disagree about the level of support a patient needs at home, a therapist and a consultant disagree on the readiness of a patient for discharge. These disagreements can become conflicts when communication breaks down, and the disagreement becomes a power struggle in which there can be only one winner. Being able to discuss differences and come up with a solution that is best for the patient will help to minimise the number of differences that turn into conflict. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 13 Conflict as a power for good A certain amount of conflict is beneficial to a relationship or to an organisation. It can bring issues into the open, lead to healthy dialogue, dissipate anger and tension, challenge existing a shortcomings of the system and provide a driver for change ( Crawley and Graham, 2002). Can also increase creativity by acting as a stimulus for developing new ideas or identifying methods for solving problems. Disagreements can help all parties become more aware of the range of perspectives, experience and solutions that are possible. Reconciliation: that is coming to a friendly resolution following a conflictcan be the start of a powerful, collaborative relationship. Conflict also helps people recognise legitimate differences within the organisation and serves as a powerful motivator to improve performance. For example, an interdisciplinary group planning a new service may initially be in conflict, but the process of airing differences, enhancing understanding and coming to agreement can set the stage for even more effective working in the future. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 14 Responses to conflict Each person develops their preference for conflict response through experience: We learn the consequences of fighting back, giving in and running away at an early age. Whichever strategy we choose in a present conflict situation will be based on our experience, our assessment of the risk, and the type of the outcome we want ( Crawley and Graham, 2002). A number of conflict style interventions use the following five styles: Competing, Avoiding, Accommodating, Compromising, Collaborating HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 15 Responses to conflict Competing (contending or fighting) Definition: Is an all-out effort to win, to defend, to be judged right, or to prevail in the situation. Competing is characterized by pushing and uncooperative style. Often accompanied by anger and aggression. Common behaviours: blaming, insisting, arguing, criticising, forcing and threatening are used to ensure victory HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 16 Responses to conflict Avoiding Definition: Is a failure either to confront the issue or to acknowledge that a conflict exists. Avoidance is low on both assertiveness and cooperation and is often based on fear Fear-Based: A fear of the other person , or fear of making things worse, fear of embarrassment or consequences. Typical Behaviors: Worrying, waiting for the situation to get better, absenteeism and doing nothing. Avoidance can also be seen in highly cohesive group where the group avoids topics that could lead to disagreement and therefore jeopardize the good feelings they have for each other. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 17 Responses to conflict Accommodating Definition: Giving in, giving up, or yielding in a conflict. Individuals prioritize the concerns of the other person over their own. Giving in can be beneficial, especially if it leads to future advantages. Positive Outcome Response: Accommodation can build rapport and goodwill, leading to reciprocal favors and respect. For instance, agreeing to trade shifts might result in gaining gratitude and respect from a colleague, fostering a willingness to return the favor. Passive Response: Accommodating out of fear can be a passive response, aimed at ending conflict or reducing tension. Power Dynamics: People are more likely to accommodate those they perceive as more powerful, such as higher-ups in an organization. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 18 Responses to conflict Compromising Definition: Making a deal that takes a middle position on assertiveness and cooperation. Balanced Approach: Both parties get some of what they want, but not all. Perceived as Best Solution: Often considered the best solution in a conflict but can be unsatisfying. Potential Issues: Parties may feel they have somehow failed, and underlying needs may go unaddressed. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 19 Responses to conflict Collaborating Definition: Is a strategy where both parties aim for satisfaction by sharing information, insights, concerns, and options. High Concern for Assertiveness and Cooperation: Parties prioritize both assertiveness and cooperation. Emphasis on Understanding and Satisfaction: Unwilling to agree until understanding is complete, and a solution satisfies all concerns. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 20 Responses to conflict HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 21 Responses to conflict HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 22 HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 23 Responses to conflict https://www.youtube.com/watch?v=GPrsDWYtrPM HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 24 Outcomes of conflict situations Conflict response can affect the outcome of the conflict situation. Covey (2004) identified three potential resolutions to a conflict situation: win- lose, lose-lose, and win-win. A win- lose outcome is often arrived at by competing or accommodating strategies that rely on unequal power between the parties. wherein one party dominates (often the party with formal power such as a manager or consultant) and wins, and the other party lose. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 25 Outcomes of conflict situations HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 26 Outcomes of conflict situations Negotiating can also lead to a win-lose outcome. Each party tries to get the best outcome for themselves and has little regard for the other side. Negotiation is a strategy commonly used to make a purchase. Example: Imagine you are going to buy a car. You want to buy at the lowest possible price and the car salesperson wants to sell at the highest potential price. If the price agreed is higher than the salesperson wanted, they will be the winner. This is a resolution to the situation but does not necessarily result in building goodwill or long-term positive relationship. Negotiation should therefore not be the first strategy chosen for conflict within the organization. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 27 Outcomes of conflict situations A lose- lose outcomes: settlement reached is unsatisfactory to both sides. Avoiding, withdrawing , and compromising may lead to lose- lose outcomes. Avoidance is a very common strategy that leads to a loselose outcome. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 28 Scenario: A staff member frequently arrives late for work, but the team leader avoids addressing the issue due to fear that the staff member might call in sick or become unhappy. A Consequence of Avoidance: The staff member perceives lateness as acceptable since it's not addressed. Effect on Team Dynamics Team members notice the leader's avoidance and perceive it as overlooking unfair behavior, resulting in loss of respect for the leader and undermining team cohesion. Negative Outcome: Everyone loses in this situation as the conflict remains unresolved, productivity may suffer, and trust in leadership diminishes. Avoidance strategy not only fails to address the root problem but also exacerbates the conflict and damages team dynamics. Addressing conflicts promptly and directly is crucial for maintaining a positive work environment and fostering respect and trust among team members. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 29 Outcomes of conflict situations A win- win outcomes: Are those where all parties are satisfied. Win- win strategies focus on goals and attempt to meet the needs of both parties. Two specific win- win strategies are consensus and integrative decision making Consensus Occurs when the problem is fully explored, the needs and goals of the involved parties are understood, a solution that meets these needs is agreed upon, and everyone can sign up to it and give it their full support. Integrative decision making Integrative decision-making focuses on the means of solving a problem rather than the ends. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 30 Outcomes of conflict situations Integrative decision making They are most useful when the needs of the parties are polarized. Is a creative thinking process in which the parties jointly identify the problem and their needs. They explore alternative solutions and come to consensus on a solution. The focus of this group is to solve the problem not to force, dominate, suppress, or compromise. The group works towards a common goal in an atmosphere that encourage the free exchange of ideas and feelings. The parties jointly identify the value needs of each, conduct search for alternatives that could meet the needs of each then select the best alternative. Like the consensus methods integrative decision-making focuses on defeating the problem, not each other. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 31 Conflict conditions Incompatible goals Even though the common goal in healthcare organisation is to give quality patient care, conflict in achieving this goal is inevitable because individuals have different views on what constitutes quality patient care. Values and beliefs Differences in values and beliefs frequently contribute to conflict in healthcare organisation. ▪ An individual’s value and believes develop from their socialization and experience. ▪ Each Healthcare discipline has different experiences during training and is socialised to certain beliefs. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 32 Conflict conditions Interdependent tasks and role ambiguity ▪Each member of staff has a number of roles and responsibilities related to their job. ▪Some responsibilities are common to every member of staff, such as health and safety, and some are unique based on profession and experience. ▪ Roles become unclear when one or more parties have related responsibilities that are ambiguous or overlapping. Structural relationships ▪The organisational structure creates potential for conflict based on differences in authority or power, group structure such as departments, and professional alliances. ▪Each of these structural elements affects communication, can lead two differences in priorities and perceptions, and can create competition for resources. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 33 Conflict conditions Competition for resources ▪Can be internal among different teams in the organisation or external among different organisations. ▪ Internally, competition for resources may involve reducing the establishment in one service and moving those resources to another. Different personality types ▪ Different personality types present the opportunity for conflict. ▪ In the 1920 Carl Jung, a Swiss psychiatric, was one of the first people to identify personality types. ▪This idea has spawned a raft of personality models that help us to understand the differences in the ways that people behave. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 34 Beliefs underlying conflict The line across the diagram represents the surface; above the line are the actions we see and below the line are the feelings, beliefs and assumptions we have. The beliefs, assumptions and feelings we have cause us to choose a particular behaviour. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 35 Beliefs underlying conflict The key to avoiding conflict and developing a healthy working relationship is to change your assumptions about the person. All people have assumptions about members of a group that cause us to be responsive or resistant. What is your view of traffic officers? Do you see them as people who protect the public and uphold the law, who are helpful, honest and trustworthy, or do you see them as people who set speed traps to take your money and stop you from getting to work on time? We all have assumptions about other people, based on our experience. Unexamined assumptions can lead us to behave in a resistant way, and this often lies at the heart of conflict. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 36 Conflict starters McCannon and McCannon (2008) have looked at the behaviours that often create the spark that ignites disruptive conflict. All these behaviours arise from a resistant way of thinking: i.e. considering the other person less worthy or important, less valuable than yourself. Following actions have been identified as conflict starters: Blaming, accusing, interrupting, patronising, contradicting, exaggerating, insulting, using hostile language, bringing up the past, making assumption using labels or put downs using absolutes such as ‘you always’ ‘you never’ and ‘you should’. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 37 Conflict management Involvement in conflict situations : Roles in conflict Managers may be participants in the conflict as individuals, administrators, or as a result of their role (team leader, senior therapist). Conflicts may arise due to differing perspectives, competing goals, or misunderstandings among team members. People in a formal management role may create conflict by confronting staff, individually or collectively when a problem develops. They may also serve as mediators or facilitators to conflicting parties. There could be a conflict within the department, between parties from different departments, or between internal and external parties, for example a tutor from the university may have a conflict with stuff on a particular department. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 38 Conflict management Anyone who seeks to resolve or manage conflict must be realistic regarding the outcome. When two or more parties hold mutually exclusive ideas, attitudes, feelings or goals, it is extremely difficult without the commitment and willingness of all concerned, to arrive at an agreeable solutions that meets the needs of both. Decision to intervene: Conflict management begins with a decision regarding if and when to intervene. Failure to intervene can allow the conflict to get out of hand. Early intervention may be detrimental to those involved, causing them to lose confidence in themselves and reduce risk- taking behavior in the future. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 39 Conflict management Managing conflict intensity: Some conflicts are so minor, particularly if they are between only two people, that they do not require intervention and would be better handled by the two people involved. Allowing them to resolve their conflict might provide and improve their abilities to resolve conflict in the future. When the conflict might result in considerable harm, however, the manager must intervene. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 40 Conflict management ◦ Increased intensity can motivate participants to seek resolution. ◦ Sometimes best to postpone intervention to allow the conflict to escalate ◦ When the conflict might result in considerable harm, the manager must intervene. Giving participants a shared task or shared goal not directly related to the conflict may help them understand each other better and increase their chances of resolving their conflict by themselves. This method is useful only if the conflict is not of high intensity the participants are not highly anxious about it the manager believes that the conflict will not decrease the efficiency of the department in the meantime. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 41 Conflict management strategies Several strategies can be used to manage conflict some tend to be more successful than others depending on the situation, those involved, and the organisation. Confrontation ◦ Considered the most effective means for solving conflicts ◦ Problem-oriented technique in which the conflict is brought out into the open ◦ Attempts are made to resolve it through knowledge and reason. ◦ Goal is to achieve win-win solutions. ◦ Most effective when delivered in private as soon as possible HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 42 Conflict management strategies Mediation Mediation is a process facilitated by an impartial third party to help parties in a dispute understand their differences and reach a mutually agreed solution (Crawley and Graham, 2002). It is particularly beneficial for resolving personal conflicts where emotions hinder working relationships. Many healthcare organizations offer workplace mediation services staffed by trained mediators. The mediation process should always be voluntary and separate from disciplinary procedures. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 43 Conflict management strategies Mediation The goal of mediation is to provide participants with the opportunity to express their feelings, identify desired changes in the working relationship, and focus on concrete behaviour changes agreeable to all parties involved. It might not be suitable for a manager to mediate conflicts between staff members who report to them (power dynamics may hinder openness). Managers equipped with basic mediation skills can effectively manage disagreements before they escalate and facilitate problem-solving among staff. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 44 Conflict management strategies The following are guidelines for mediating a conflict between two or more parties (Strasser and Randolph,2004): Protect each party self-respect. Deal with a conflict of issue not personalities. The point of mediation is not to assign blame. Each person will have a different recall of situations from the past, and a different judgement about the intention of the other party. Allow open and complete discussion of the problem from each participant. Maintain equity in the time allowed for each party. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 45 Conflict management strategies Encourage full expression of positive and negative feelings in an accepting atmosphere. Make sure both parties listen actively to each other words. Identify key themes in the discussion. Encourage the parties to provide frequent feedback to each other's comments. The participants are responsible for developing a solution to the problem not the manager. At an agreed- upon interval, follow up with the progress of the plan. Give positive feedback to participants regarding their cooperation in solving the conflict. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 46 Conflict management strategies Negotiation Involves give- and- take on various issues among the parties. Negotiation is particularly useful when the nature of the conflict is around competing priorities or mutually exclusive goals. It is also good for resolving immediate issues that are non-recurrent. Levenstein (1984) lists ten commandments for negotiators: 1. Clarify the common purpose. 2. Keep the discussion relevant. 3. Get agreement on terminology. 4. Avoid abstract principle, concentrate on the facts. 5. Look for potential trade-offs. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 47 Conflict management strategies Negotiation 6. Listen. 7. Avoid debating tactics, use persuasive tactics. 8. keep in mind the personal element. 9. Use logic logically. 10. Look for solutions that satisfy the other person's real interests. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 48 The leader/ manager’s role in managing conflict: Creating a positive conflict environment Conflict can be a driving force for change and a mechanism for improving understanding and strengthening relationships at work. It is important that managers and leaders enable differences to be expressed in such a way that it support improvement without turning into disruptive conflict. The following are some guidelines for creating a work environment that supports constructive challenge: ▪ Encourage and enable positive working relationships between and among people. ▪ Confront inappropriate behaviours. Make your expectations clear and trust the other person to be able to make the changes necessary. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 49 The leader/ manager’s role in managing conflict: Creating a positive conflict environment ▪ Encourage openness and honesty in all communication. Use natural language when setting expectations. Do not blame, label or belittle another person. ▪ Develop ground rules for work teams and committees. ▪ Replace BCD ( blame, criticism, and disrespect) with QRS (questions, respect, and support). ▪ Understand the antecedent conditions for the conflict and the positions for those involved. ▪ Enlist others to help solve conflicts. ▪ Select a conflict management strategy appropriate to the situation. ▪ Practice the conflict management strategies. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 50 What you know now ▪Conflict is a dynamic process, the consequence of real or perceived differences between individuals or groups. ▪ Conflict can be positive, and the first step in initiating change. ▪Antecedent conditions are not necessarily, the cause of conflict, they are conditions that exist in all organisations that make conflict more likely. ▪Conditions antecedent to conflict include incompatible goals, role ambiguity and overlapping tasks, structural relationships, competition for scarce resources and differences in value and beliefs. ▪A number of strategies exit to handle conflict, choosing the best one to use should be based on the situation and the people involved. ▪Learning to manage conflict is essential for success in management and leadership roles. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 51 Useful links What is Conflict? https://www.youtube.com/watch?v=qLEuBBhZaOs Conflict as a power for good https://www.youtube.com/watch?v=pUxLjXsQXxg Responses to conflict https://www.youtube.com/watch?v=eyUG-ZYpPaw Conflict management strategies https://www.youtube.com/watch?v=8aPQpJ5WQO8 HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 52 Useful links Conflict Management Styles https://www.youtube.com/watch?v=GPrsDWYtrPM Thomas-Kilmann Conflict Model Explained https://www.youtube.com/watch?v=HxgSjnWSzf8 HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 53