Conflict Resolution

David Thompson, DNSc, MS, RNJill Marsteller, PhD, MPP

What is Conflict?

• Perception of mutual interference• A process that begins when goals of one party

are frustrated by another• Requires interdependence/interaction

Views of Conflict

• Conflict Good (interactionist view) G• Conflict Natural (human relations view) N• Conflict Bad (traditional view) B

• Conflict must be managed

Sources of Conflict

• Resource scarcity• Incompatible goals• Structural factors (size, routinization,

specialization, reward systems) • Conflicting perceptions, ideas, or beliefs• Differences between people• Conflicting thoughts/needs within an individual• Lack of communication (maybe)

Types of Conflict

– Task content conflict (differing opinions related to the task) G

– Emotional or relationship conflict (interpersonal conflict -- dislike, negative emotions) B

– Administrative or process conflict (disagreement on how to get the task completed — e.g., duties, decisionmaking technique) B to N

Goal of Conflict Resolution

• Confront problems, communicate openly and respectfully with someone of opposing opinion to provide optimal patient care

Why Address Conflict?

• Inevitable in dynamic environments• Can lead to feelings of powerlessness • Can cause anyone, especially subordinates, to

view administrators, attending physicians as adversaries and creates conflict and divided loyalties in the workplace

Assertion is

Being appropriately assertive means:• Organized in thought and communication • Competent technically and socially• Disavowing perfection while looking for

clarification/common understanding• Being owned by the entire team (this is not just a

“subordinate” skill set, and it must be valued by the receiver to work)

Assertion is Not

• Aggressive • Hostile• Confrontational• Ambiguous• Demeaning• Condescending

The Assertion Model

• Model to guide and improve assertion in the interest of patient safety

Helpful Hints in Applyingthe Assertion Model

• Focus on the common goal: Quality care, the welfare of the patient, safety – it’s hard to disagree with safe, high-quality care

• Avoid the issue of who’s right and who’s wrong• Concentrate on doing the right thing for patient-centered

care• Depersonalize the conversation• Actively avoid being perceived as judgmental• Be hard on the problem, not the people

Strategies for Conflict Resolution

1. Withdrawal—Little or no significance to either party (lose-lose)

2. Forcing—Force outcome regardless of the desire of one party (win-lose)

3. Conciliation—Giving in to preserve relationship with other party (lose-win)

4. Compromise—Concerned with both outcome and relationship (?-?)

5. CONFRONTATION—Meet the problem head on (win-win)

Confrontation is an Assertive means ofConflict Resolution

• Respectful negotiation• Effective Conflict resolution is what is right not

who is right.• Never Aggressive. Use to explain perspectives.

If handled appropriately may be an opportunity to educate the other party involved.

Two-Attempt Rule

• Using the elements of assertion make two attempts to reach a common goal.

• If your viewpoint is disregarded, traditionally continue up the chain of command or “escalate” to achieve resolution.– Charge nurse– Nurse manager– Fellow– Attending

Conservative Response

• Nonconfrontational method to gain agreement among two or more team members

• Used to ensure disagreement does not escalate to confrontation by seeking input and advice from another team member or outside consultant

DESC Script• What is it?• A structured, assertive, communication approach for managing and resolving

conflict.

• D Describe the specific situation

• E Express your concerns about the action

• S Suggest other alternatives

• C Consequences should be stated

• Ultimately, consensus shall be reached.

• When to use it?• Whenever you have a personal conflict with another health team member that

threatens your ability to perform your job well

• Key Points• Have timely discussion

DESC Example

• D--When you scream at me in front of my coworkers about the delay in care, you’re making it personal.

• E--This reduces my credibility with the patients and undermines my authority with staff. I feel you don’t respect me.

• S--If you are upset about delays or other patient care issues, pull me aside and I will address your concerns.

• C--If your outbursts continue, we won’t have a working relationship, and patient care will suffer.

LEEN--A Model for Conflict Resolution

L- Listen E- EmpathizeE- ExplainN- Negotiate

Conflict with Patients/Families

L--Can you help me understand why you are upset? E--That is understandable, I can see why you are upset.E--The reason we wanted to do this was because …N--Let’s agree on a path forward.

Conflict with Clinicians

• L--Can you help me understand how you see the situation, how you are weighing the risks and benefits?

• E--I can see how you see it that way.• E--Let me explain how I see things.• N--Let’s put the patient first and agree on a

plan.