Healthcare Management

Description

he assignment for Week 1 is based on the readings of the week, in which you learned that leadership needs to be fluid in this changing environment because there is much change and adaptation required in our current healthcare organizations. This fluidity has led to multiple problems, issues, and conflicts in the workplace that are a challenge for contemporary leaders. An examination of a particular issue will help you develop the needed leadership skills and understand complex healthcare systems.

This week, pick a problem, an issue, or a conflict from your current place of employment or previous employment that you feel is or was a result of changes in the environment, recent or past. Write a 1-page detailed description of the problem, the issue, or the conflict, providing adequate history, influencing events, and involved participants in a Microsoft Word document. Ensure that a complete and accurate picture of the problem, the issue, or the conflict can be determined from your paper.

Cite any sources using APA format on a separate page. Click

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The change is the way hospitals are dealing with going to results based care. Profits aren’t as high and companies are cutting costs, mainly in staffing.

Running head: MANAGING HEALTHCARE
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Porter-O’Grady, T., & Malloch, K. (2014). Quantum Leadership, Sudbury, MA: Jones &
Bartlett. ISBN-13: 9781284050684.
Hersey, P., Blanchard, K.H., & Johnson, D.E. (2013). Management of Organizational Behavior:
Leading Human Resources. Old Tappan, NJ: Pearson Prentice Hall. ISBN-13:
9780132556408.
Benson, S. G., & Dundis, S. P. (2003). Understanding and motivating health care
employees: Integrating Maslow’s hierarchy of needs, training and
technology. Journal of Nursing Management,11(5), 315–320.
Lynch, P. K. (2008). Motivating challenging employees. Biomedical
Instrumentation &Technology, 42(3), 203–204.
McConnell, C. R. (2005). Motivating your employees and yourself: How different
is the manager from the staff? Health Care Manager, 24(3), 284–289.
McGraw, K. (2007). The carrot principle: A low-cost, high-return employee motivator.OR
Manager, 23(8), 10.
Nohria, N., Groysberg, B., & Lee,L. E. (2008). Employee motivation: A powerful new
model. Harvard Business Review, 86(10), 133–134.
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From Quantum Leadership
Leadership and Normative Conflict: Managing the Diversity of a Multifocal Workplace
Cooperation is the thorough conviction that nobody can get there unless everybody gets there.
—Virginia Burden
The Process of Intuition by Virginia Burden Tower,
Theosophical Publishing House, Wheaton, Illinois, 1987.
Reprinted by permission.
Chapter Objectives
At the completion of this chapter, the reader will be able to
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Recognize the key principles of conflict resolution in dealing with a wide variety of conflict-based issues.
Apply conflict management principles and processes in the everyday exercise of the leadership role.
Distinguish between normal conflict management and the management of differences.
Formulate personal insights regarding how to apply conflict management skill sets as part of the leadership role.
Distinguish between identity- and interest-based conflict and describe the best approach to dealing with each type.
Conflict is central to all human interaction. Conflict simply codifies the deep and abiding understanding of the
fundamental diversity of the human experience. Managing conflict is the vehicle through which we negotiate our
differences and work to find passage to common ground. As a metaphor for difference, normative conflict represents
the foundational aspect of human interaction and communication. The challenge presented by conflict is that it is
often rife with pain and violence. However, that it frequently has those features is evidence of our inability to see
conflict as normal and to develop mechanisms for managing it well (Kriesberg, 2003; Levinger, 2013; Werner,
2012). Because it is so much a part of the human experience, we would do better to learn the dynamics of conflict
and incorporate its management into our human skill set. This chapter treats conflict as normal and offers a range of
techniques and methodologies for managing it in such a way as to ultimately achieve purposeful action and
improved relationships. The emphasis is on developing skills for facilitating the use of conflict as a tool for
promoting good interaction and advancing relationships. The chapter also outlines the difference between interestand identity-based conflicts and describes the processes used to address each.
Key Point
Conflict is normal. The challenge is to know what it is when it happens and what to do about it when it is recognized
for what it is.
Conflict is normal. It is present in every human relationship. It is a sign of the Creator’s commitment to
diversity and in fact represents diversity in action. It is the dynamic content of diversity. The management of human
conflict is essentially diversity being both valued and negotiated as we facilitate effective relationships in the human
community.
Conflict should never be avoided or suppressed. Instead, it should be embraced as a fundamental part of every
human interaction. Conflict is the most frequently occurring dynamic in human relationships. And yet it is the most
misunderstood and misused element in the whole arena of communication and interaction.
Embracing conflict is easier said than done, of course. A particular instance of conflict can involve a significant
emotional overlay that adds stress to the interaction. This emotional component takes the conflict to a level of
intensity that is uncomfortable and potentially destructive. At higher levels of intensity, the process of being in
opposition becomes its own end, and the purpose and product of the conflict disappear in the dust raised by living in
opposition. The emotional component creates so much unpredictable and untenable content that most people simply
back away from the conflict, unable to figure out how to deal with it or cope with its pain.
In making conflict normative, the leader creates a frame for conflict that turns it from an event to a process. The
more conflict is looked at as a normal occurrence, one that reflects the usual vagaries of human interaction, the more
likely it can be handled appropriately. This notion of normative conflict is a relatively recent understanding of the
role conflict plays in organizational dynamics. Good leaders recognize that the tensions associated with normative
human conflict simply represent the usual and ordinary differences that exist between people at all levels of the
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human community. Conflict itself is never a problem. However, unresolved conflict continues on a growth trajectory
that becomes increasingly problematic to the extent that it is ignored or unaddressed. The wise leader, therefore,
never ignores conflict; in fact, he or she searches for it in the human community and, always finding it, addresses it
in an appropriate and timely fashion.
The good leader recognizes that conflict cannot be avoided. In fact, this leader does everything not to avoid
conflict. What the leader does is create an environment that provides a safe space for identifying and expressing
conflicts. The leader recognizes that conflict management is the one fundamental obligation that he or she has in the
leadership role. Knowing that conflict cannot be ignored, the good leader embraces it. The best way to deal with
conflict is through the leader creating an environment that makes it comfortable and safe to engage conflict and a
culture where conflict is accepted as part the interaction of the human community. More important, the leader
recognizes that opening interactions to the noise, ambiguity, and challenge of expressing differences creates a safe
milieu for the expression of those differences, even though it can often be especially demanding for the leader to
manage.
Good leaders are responsible for creating a positive context for the work of others. Leaders are continually
attempting to provide a framework for work that is positive, encouraging, and growth oriented. A good part of
creating this context is building the kinds of relationships that evidence a high level of partnership, openness, and
trust. When managing conflict is considered a regular part of the manager’s responsibilities, confronting it directly
becomes a part of effectively expressing the manager’s role. The manager must begin to recognize that fear of
confrontation is a significant impediment to resolving interpersonal and relationship-based conflicts.
The best time to address conflict is early in its expression. Seeing a conflict situation emerge is a forewarning
that it is likely to blossom. The manager needs to know that conflict does not go away of its own volition. Because it
is normal for almost all human interactions, when left unaddressed, conflict simply changes its form and emerges
somewhere else in a kind of “wolf in sheep’s clothing.” The longer conflict simmers, the more difficult it is to
resolve. Conflict is never a static process that just sits there, failing to gather energy. It is common for unresolved
conflict to grow in intensity as it lies just below the surface, collecting energy and building toward a cataclysmic
eruption. Unresolved conflict always intensifies. The good leader has an intuitive sense of the potential for conflict.
This person knows that every interaction is rife with the seeds for conflict. Human differences drive its continual
unfolding. If not recognized early, the conflict continues to gather potential and to grow in possibility until its more
volatile expression becomes likely. The leader must do two things in the presence of the potential for conflict:
Address it early and address it appropriately.
Leaders need to recognize that early engagement of conflict means recognizing it soon enough to address it
without noise and/or overwhelming personal emotion. In the earliest moments of an interpersonal conflict, the
beginning signs of the impending conflict are always present. An attitude of disrespect, an unkind word from one
person to another, an offhand remark, or an inappropriate phrase can be early signs of the gathering storm of a
conflict. The leader lets no remark or behavior that represents anger, misunderstanding, or personal apprehension go
unaddressed. Each of these emotions is an indicator of an underlying set of concerns that begs to be addressed.
Interrupting the course of a conflict in these early stages gets the real issues out in the open and raises the chance
that addressing them will allay further opportunity for the conflict to accelerate.
In the earliest stages of conflict, the leader is constantly looking for people creating positions and taking sides.
Indeed, in the earliest stages, the conflict-driven individual creates boundaries and limits to a view or position as a
way of emphasizing the differences. This person often becomes exclusionary or exclusive to perceptions or notions
that represent his or her chosen position. Ownership and expression of the position and extreme defense of it create
the initial conditions and circumstances upon which further conflict can build.
Fear and avoidance of conflict are main causes of the problems that can arise when a conflict occurs. Another
problem is ignorance and lack of use of the legitimate processes of conflict management. When a person becomes
embroiled in a conflict, many feelings rush to the surface and begin to be expressed in one form or another, until
eventually the person is dealing with feelings rather than the conflict that generated them. As a result, the original
reason for the conflict can get lost in the interaction and may even be forgotten, replaced by another reason. In this
scenario, ending the conflict amicably does not resolve the underlying problem, which has the potential to bring
about another skirmish. The cycle can continue indefinitely, building layer upon layer over the underlying problem
and making it ever harder to discern and resolve.
Growth and Transformation
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All conflict provides a dynamic opportunity for growth and transformation, and leaders should treat conflict as
simply another tool of good leadership. Peter Drucker (Edersheim & Drucker, 2007) has often said that 90% of
leadership is addressing human behavior issues. A good proportion of this 90% involves addressing issues that have
some form of conflict at their base.
The secret of good conflict management is simple, but the process is not. The secret is to get the parties in
conflict to discern the root issues and mutually agree on actions to be taken. Actually building an effective process
to accomplish this goal, however, is a complex task.
Conflict management takes into account that people differ in a whole range of ways and that factors as broad as
culture, race, gender, social status, and income group and as specific as personal beliefs, family position, mental
health, intelligence, and emotional maturity all can influence the onset and process of a particular conflict (Exhibit
6-1). It also takes into account that typically the parties to a conflict are unequal in some way, that one party may
have a substantial advantage over the other (e.g., the lion’s share of power). If a satisfactory outcome is to be
obtained, the conflict management process must create equity at the table. It must utilize a mechanism that closely
reflects the character and content of the conflict and moves it toward a mutually agreed-upon resolution. This
mechanism must take into account the sources and contextual components of the conflict, as well as the content
elements. It must also address the power equation so that any unevenness can be accommodated and the process can
unfold in a balanced and fair way.
Point to Ponder
About 90% of the average leader’s responsibilities involve dealing with human behavior and human interaction.
Given that this is true, why do leaders spend so little time learning how to resolve the issues that arise out of human
dynamics?
Much of the structural inequity alludes to individual and collective issues generated out of personal insecurity
and inequality. In health care, there is an overwhelming and almost suffocating lack of scholarship and dialogue
around issues of gender, power, and role inequity. Although frequently alluded to, formal structures and processes
specifically directed to resolving conflicts related to inequity are few. The historical masculine and medical caste
structure of the health system represents a serious relational disequilibrium and generates a set of values related to
power, importance, significance, and value that subordinates roles and creates structural barriers to equity. As valuedriven healthcare reforms unfold with increasing intensity over the next decade, issues of collateral relationships,
interaction, value, and mutual contribution will come to the fore and require formal processes that help construct
more effective and collateral relationships among the disciplines. Even though the competencies and skill sets of
these practitioners bring a unique set of talents to the continuum of care, there remains a regulatory and structural
need to ensure these roles are bounded and subservient rather than collateral, partnered, and equity-based.
Exhibit 6-1 Sources of Conflict
Environmental Sources
• Culture
• Nationality
• Religion
• Class
• Economics
• Politics
• Society
• Resources
• Race
Individual Sources
• Ego
• Personality
• Identity
• Intimate relationships
• Beliefs
• Perceptions
• Perspectives
• Education
• Position and role
Nurses have a unique set of concerns regarding conflicts and their resolution. In some ways, the history of
nursing parallels the history of the women’s movement, including the subordination and powerlessness experienced
by both women and nurses (most of whom have been women). Recently, the education of nurses and other health
professionals has gone far toward creating intellectual and role equity, but long-standing medical practices and legal
constraints on the scope of practice for various health professionals make these professionals, including nurses,
uncertain of the agendas of physicians and administrators and skeptical of the processes that have been used to
resolve conflicts among the professions. In the view of many nurses, the relationship they have had with physicians
and administrators has historically been one-sided and biased against them, and their sense of being ignored or even
silenced has not created a good foundation for building equitable relationships and resolving conflicts, to say the
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least. Even as nursing practice has expanded to meet critical needs for advanced practice, pejorative enumerations
and identification of the role by other disciplines as “midlevel practitioners” or “physician-extenders” and the like
characterize these practitioners in subordinating and comparatively subservient roles to those of the historically
predominant superior role of physicians.
Group Discussion
It has been said that health care is both risk adverse and conflict adverse. Discuss this claim. First, consider whether
it is indeed true that health professionals avoid conflict to an unusually high degree. To reach a conclusion, it may be
helpful to look at the following questions: Does the structure of healthcare services create unusually clear lines of
demarcation between people? Is the hierarchical nature of healthcare services a promoter or preventer of conflict?
Are there fewer or more personality issues in healthcare settings than in other settings? How does the physician’s
role and position affect the incidence of conflict?
As a result, out of frustration, nurses are sometimes inclined to engage in passive-aggressive, hostile,
uncooperative, or avoidance behavior, even if the consequences are damaging to themselves. One explanation is that
they have not always been able to avail themselves of the maturity that comes with development, dialogue, conflict
resolution processes, and any aggregated measure of success. Another explanation may be that the practice and
service delivery models in use generally do not require nurses to interact at a high level outside of their own
discipline or with other disciplines. Most nursing work is designed to be performed by interdependent nurses or
nursing teams assigned to defined groups of patients acting inside of the nursing community. Nurses primarily speak
with each other regarding the specifics of nursing practice and the processes and values of nursing-driven decisions
and actions. This type of work involves little interdisciplinary interface and sharing and keeps nurses from the vital
multilateral interactions that would develop their broader relational skills. The conflicts among nurses and between
nurses and other health professionals fall into the category of identity-based conflicts, and their ultimate resolution
requires, among other things, reconstructing the relationship between nursing and the other professions.
Leaders, to do their job well, must acquire basic conflict management skills. Most lack these skills or have
failed to master them, and as a result in many organizations a whole range of conflicts festers and grows. The
avoidance of conflict is one of the singularly greatest sources of human relationship and interactional problems in
the workplace. The possession of well-honed conflict management skills has become even more important because
of the increasingly interdisciplinary nature of the workplace and because questioning or attempting to change these
historically uneven relationships can easily raise the potential for conflict.
Avoiding Unnecessary Conflict
Because conflict is an essential component of human interaction, trying to create conditions in which conflict is
completely absent is a pointless exercise. There is generally a prevailing sense that conflict is negative. Nothing
could be further from the truth. Conflict is simply the indication of the presence of differences. Ignoring essential
differences provides solid ground for encouraging unnecessary conflict. It is not a good use of the leader’s skill or
time trying to prevent inevitable conflict. Leaders instead should devote themselves to managing conflict, which also
includes preventing unnecessary conflict. Some of the conditions that help prevent unnecessary conflict are
described in the following sections.
An Environment of Open Communication
It goes without saying that creating a climate of openness and trust is an excellent way to facilitate work and
relationships. However, some leaders believe that tightly controlling work creates the fewest problems and that a
“tight ship is the best run ship.” This is not true for the normal activities of work. Leaders must realize that the
relationship between the members of the work team is the most critical factor influencing the extent to which any
conflict situation becomes a way of life. A sense that there is nothing that cannot be dealt with, that there are no
“undiscussables,” is essential to avoiding unnecessary conflicts.
The leader of an organization has enormous influence over the organization’s culture. The leader’s personal
style of relating to and communicating with others sets the tone for the workplace, and it does not take long for
others in the organization to discern what is acceptable to the leader and what is not. The leader’s behavior toward
staff and his or her responses to the stressors and challenges of the work create the model of acceptable conduct and
act as the framework for which topics can be approached and which behaviors are appropriate.
Key Point
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An environment that abounds with “undiscussables” is an environment that breeds mistrust and unnecessary
conflict.
Groups become very skilled at seeing and noting the permissible and the political. Group members know what
they must “work around” to get things done. What cannot be dealt with openly and directly is addressed secretively
and behind closed doors. It is when open communication is absent that the infrastructure of conflict begins to take
form and processes leading to irresolvable differences begin to emerge.
Congruence Between Organizational and Professional Work Goals
A good way to prevent conflict is to ensure that the goals of individual workers and the goals of the organization
support each other. It is commonly understood that complementary goals prevent conflict and competitive goals
generate conflict. The history of work in America is rife with instances where organizational goals and processes
were at odds with the goals and expectations of those doing the work and where inherent conflict sprang up as a
result.
When there is goal congruence, people are more open, cooperative, engaged, and supportive and less angry and
frustrated. When everyone is clear about expectations and processes and there is a supporting structure that
contributes to the meeting of expectations, less conflict is generated.
Of course, congruence between goals is not always possible. Therefore, people must be given the opportunity to
disclose what the differences are and how they are affected by these differences. If the reasons for the differences
and the character of the differences can be made clear, people find them easier to accommodate or accept. In
addition, they find them easier to accommodate or accept if they understand that all issues and situations are
transitional (subject to inevitable change) and all relationships operate within the context of the constantly shifting
human and relational journey (Figure 6-1 through Figure 6-5).
Key Point
Facilitators must understand that the conflicts they attempt to resolve never belong to them. A conflict is owned by
those who experience it, and transferring the locus of control is not good for the parties or the process.
Managing Conflict Productively
Leaders should devote more resources to the task of recognizing sources of conflict soon enough to handle disputes
in the right way at the right time than they should devote to avoiding conflict. Following are some rules for handling
conflict appropriately and productively.
Figure 6-1 Structural Conflicts
Figure 6-2 Value Conflicts
Figure 6-3 Information Conflicts
Figure 6-4 Interaction Conflicts
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Figure 6-5 Interest Conflicts
Time and place can play a role in diffusing or inflaming a conflict. For example, if a conflict arises in public,
the wise leader acts to remove the parties to a private place where the issues can be dealt with directly and freely. In
many cases, a conflict first reveals itself at a critical or stressful moment, fooling the participants into believing that
the situation is the source of the conflict rather than simply an occasion for its expression. In such a case, trying to
deal with the conflict within the context of the situation will likely escalate the conflict, and so it is better to put the
participants into a different environment or deal with the conflict at a later time when everyone can focus the
dialogue on the issues, not the event.
Remember, conflict is primarily about behavior, not about people (although see the section titled “IdentityBased Conflict,” which follows). In dealing with a conflict, the leader needs to be clued in to the behavioral patterns
and concerns and their impact on the parties’ relationship because the ultimate goal is to sustain their effective
relationship. The leader is looking for accommodation and the ability to develop a working relationship that
evidences the values and commitment necessary to do the work and sustain it. In addition, the goal is to fix the
problem, not to affix blame. No conflict is unilaterally driven—there is always enough fault to go around (thus,
faultfinding is a waste of time). Wasting time and resources on trying to affix blame invariably delays long-term
resolution of the conflict.
The resolution of a conflict depends on the achievement of some level of agreement about the parties’ behaviors
or responses. Further, the agreement must be clearly articulated and must be understood by all parties. In addition, at
some point the parties must formally/publicly define their common ground in a joint meeting.
If a conflict is to be resolved, the parties must have a sense of ownership over their own feelings and the
resolution agenda. The leader must ensure that the parties own their feelings and do not cast them onto the shoulders
of others and that they do not interpret what others mean without confirming that their interpretation is correct. The
use of “I” approaches is critical to the dialogue. By making certain that each party’s insights, feelings, and views are
expressed from the party’s own perspective and in his or her own language, the leader keeps both parties away from
“us versus them” and “you” statements. The leader also can help maintain the focus and flow of the dialogue by
making certain it stays within the limits of self-directed communication and personal ownership of the dialogue.
A flip chart or other visual tool can be used to get the conflict elements out in front of the parties in a twodimensional way. The use of visual tools can overcome some of the obstacles likely to be raised by poorly chosen
language and place the ideas of all the parties before their eyes in a way that automatically creates equity. It also can
help balance the dialogue and move the issues closer to real resolution by expanding the foundation of
understanding between the parties.
Vagueness must be constantly fought. Although a certain amount of ambiguity is unavoidable as people sort out
their issues, continuing vagueness obscures the issues and stops the dialogue. The leader must work to facilitate
clarity around every issue of concern. By naming names, identifying events, describing situations, and illustrating
behaviors, the leader seeks to get down to basics. The goal is to ensure that the real issues and processes are laid out
on the table in clear enough terms that all the players can see them plainly.
Each party is looking for something, and unless this something is obtained or willingly given up for something
else, the conflict will not end. First, each party must articulate what he or she wants and what the other parties want
in a way that all can understand and agree to. Second, each party must leave the conflict with a sense that he or she
obtained something valuable, and each must feel good about what the other party got as well. In other words, the
parties must view the resolution as equitable. This does not mean that what everyone gets is equal. It means instead
that the resolution dispensed to each party is enough to satisfy that party, regardless of how important what was
given or obtained may be to any of the other parties.
This advice on how to manage conflict is not all inclusive. For instance, leaders must take into account both
situational and cultural factors when trying to facilitate the resolution of a conflict. The flexibility necessary to
incorporate these factors is part of the conflict management skill set.
Team-Based Conflict Issues
Working together to provide healthcare services can be intense and difficult and can easily lead to conflict. To
reduce the chance of unnecessary conflict, leaders must pay attention to relationship issues and create and keep an
open and honest context for the work. Still, even in the best circumstances the behaviors and characteristics of
people can lead to conflict (Behfar, Peterson, Mannix, & Trochim, 2008; Payne, 2010).
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Different personalities deal with conflict in different ways. Some folks are naturally generators of conflict,
whereas others are skilled avoiders of it. Most of us fall somewhere in between these two extremes. Because
different interests and personalities are present in the workplace, there is always opportunity for conflict to emerge.
The leader of a healthcare organization should always be on the lookout for the potential for conflict. Because
conflict eventually arises in any human environment, its potential is always present, at least to some degree. Further,
if a conflict can be detected in its very early stages, it can be addressed soon enough to keep it from becoming
critical and requiring extensive intervention. In general, the amount of effort needed to resolve a conflict is directly
related to how early in the conflict’s development the issues are dealt with.
Leaders must be aware of the main factors that lead to team-based conflict. Some of these are as follows. If
team members believe they are on the receiving end of unfair or inequitable treatment, they will descend Maslow’s
hierarchy of needs. Conflict and acting out inevitably occur unless everyone is given an equal opportunity to provide
input and have an impact. Another source of inequity is the tendency of people to use each other or the team for their
own agendas or advancement. All team members must try to be just and fair in their dealings with each other to
ensure the playing field is level and even and everyone is treated impartially.
Point to Ponder
The team, not the individual, is the basic unit of work. The individual must always be seen in the context of his or
her relationship with others. Because work is the aggregation of the efforts of many people, for work to result in
sustainable outcomes these efforts must be coordinated and integrated. The task of any team leader is to synthesize
the efforts of the team members and take advantage of the resulting synergy to achieve the team’s goal efficiently
and effectively.
Everyone does not need to know everything, but there must not be a lack of essential information, especially the
information people need to do their work and to function and relate efficiently. In addition, team members must
have a common understanding of the information and be able to see it within the correct context. It is common for
people to believe they have the information they need but to discover upon further investigation that each has a
different understanding of it, and so the team leader must make sure that everyone shares a common understanding.
At the end of an interaction, session, or meeting, it is always wise for the leader to poll the group regarding their
level of mutual understanding of what has been deliberated and decided on prior to anyone undertaking action. Also,
team members need to share their knowledge, insights, and experience in a way that can influence the team and what
it does. Expressing what they know and believe is critical to their own sense of value and place on the team and is
likewise critical to the viability of the team.
Game playing always leads to conflict. The team leader must therefore be certain that the members are singing
off the same song sheet. The rules that govern the team’s activities should be clarified to and by the team members
at the outset and often along the way. The members also need to be reminded that they will be held accountable for
respecting the rules. Although any team must be able to accommodate different personalities, the interaction of team
members must keep within certain boundaries. Processes that impede good interaction and communication between
members ultimately lead to conflict.
Not acknowledging everyone’s unique contribution can be a source of trouble. Every person approaches his or
her work differently, has a different array of talents and skills, and has a different background and set of
experiences. The team leader must not only recognize the differences between team members but must use them to
advance the work of the team. For instance, some members are more reflective, and others are more active. The
leader usually does not need to prompt the more active members to make themselves heard—they are usually the
first to initiate dialogue or action—but the leader may have to ask the more reflective members for their views.
Because the reflective members often have excellent insights and thoughtful opinions, they also must be involved in
the team process to ensure the team’s work is fully effective. Thus, the leader must recognize that the presence of
personality and role differences can actually enhance the team’s effectiveness and that getting the full range of
contributions from members avoids conflict because no one feels unjustly neglected.
Behavior based on hidden agendas is a prevalent source of team conflict and is extremely difficult to address.
Almost every team has members who are not “on board” because they are pursuing their own agendas. They attempt
to realize their goals by manipulating others and preventing others from attaining their objectives. They tend to see
the world solely from their own position and treat others simply as a means of advancing their own interests.
Whether they keep the team from growing or move the team in the direction of their choosing, they damage the
integrity of the team and its sense of purpose. The team leader must try to detect these patterns of behavior early in
the team process and correct them before they do serious harm. If members are allowed to pursue their own agendas
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with impunity or for a long period of time, they reduce the team’s effectiveness and eventually cause the team to
descend into a state of chaos and conflict.
Lack of mutual appreciation among team members impairs team integrity. An old Zulu adage says, “I can only
be me through your eyes.” Who people are and the gifts that they bring are sacred and important. All team members
should believe they have value and are there because they have a unique contribution to make. They should know
what it is they offer and be acknowledged for it by the other members. Each member should be aware of the
character and role of any other member and understand how to advance and honor his or her own role. By clearly
articulating the gifts that everyone brings to the table and the value of those gifts, the team leader keeps all the team
members mindful of everyone’s importance and thus diminishes the potential for conflict and breakdown.
Key Point
Power is a sensitive issue in health care. For example, the word power is rarely used by health professionals, as if
they do not really believe it operates in their relationships with each other. Of course, it always does. It is vital that
the issues of power and authority be open for discussion because they are critical elements in the interaction of team
members at every level of the system.
Power issues are a common source of conflict. How power is dispersed and used has a great influence on the
occurrence and intensity of conflict within a team. In particular, conflict inevitably occurs if the expression of power
is not seen as competent or balanced, or if the location of power is not seen as appropriate. A team operates like a
community, and the team leader has the responsibility to maintain a sense of community among the members. The
leader is always looking for breaks and potential problems in the relationship between members as a way of
anticipating conflict and dealing with it before it develops into a major crisis requiring substantial time and resources
(Zedeck, 2011).
Getting ahead of the conflicts that emerge is the best possible method for diffusing them and mitigating their
consequences. The team leader should set up the team’s structure and processes to make conflict a normal part of the
interaction and relationship among members. The leader should not ignore conflict but instead implement strategies
to expose the essential differences between members early enough to resolve the inevitable episodes of conflict as
quickly as possible. By valuing and validating differences among team members and accommodating them, the
leader reduces the number of conflicts and at the same time decreases the chance that any of them will become
crippling.
Identity-Based Conflict
Conflicts generally fall into two categories: interest-based conflicts and identity-based conflicts. Interest-based
conflicts arise from circumstances or interactions and often can be resolved quickly. Identity-based conflicts go
much deeper and last longer. Rothman (1997), in laying some foundations, suggested that identity-based conflicts
are rooted in threats to people’s need for dignity, recognition, safety, control, purpose, and efficacy. For these
conflicts to be adequately addressed, their origin and their meaning to the opposed parties must be adequately
appreciated. In general, identity-based conflicts have the following characteristics:
•
•
•
•
•
•
Reflect the parties’ culture and beliefs
Involve questions of identity and sense of self
Arise out of the parties’ commitment to their values
Are of long duration
Are the most difficult conflicts to resolve
Can be passed on from one generation to next
Sources of identity-based conflicts include the following:
•
•
•
•
•
•
•
Values
Religion
Language
Heritage
Culture
Family
Community
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• Country
Each person has a unique background and set of life experiences and brings a personal and a cultural framework
to any dialogue or deliberation with others. Further, because everyone is a unique individual, relationships and
interactions exhibit a dynamic pattern and identity-based conflicts are possible. The differences between people
create life’s mosaic—its fabric. The richness of human experience is driven by the broad diversity that is
characteristic of human life and that forms the foundation for human interaction. It is no surprise that for conflict
resolution activities to be successful, they must be based on an understanding of the ingrained differences between
the parties and must encompass a respect for and appreciation of these differences.
Group Discussion
Look around the room at the other occupants and write down as many differences as you can in a few minutes. After
listing all the differences on a flip chart, discuss how each might lead to a conflict. Also discuss how the resulting
conflicts might affect relationships, interactions, and the work environment. Then, identify how the different types
of conflict are related to each other and consider the possibility that together they could result in an irresolvable state
of conflict. Finally, discuss how the conflicts identified could escalate and describe the impact such escalation could
have on patient care.
Conflict is a normal part of all human affairs, from marriage to politics. Recognizing this fact encourages us not
to ignore conflict, downplay it, or leave it unaddressed. The best strategy is to accept that conflict is inevitable and to
acquire the skills and methods for safely and effectively dealing with it, including paying attention to what it means
and the positive direction it is trying to move us toward.
Identity-based conflicts are very difficult to either define or resolve. Because they are rooted in historical,
psychological, cultural, and experiential factors, their boundaries and content are hard to determine. Because they
are deeply embedded in personal sentiments, the contending parties are less willing to compromise. Therefore, they
demand a deep and creative engagement.
Protracted religious, ethnic, tribal, regional, and national conflicts are the best examples of the persistence of
identity-based conflicts. Long-term, persisting “enemy images” create a permanent “other” that influences notions of
equality, equity, value, and identity. Enemy images that are believed to be valid and that are stereotypic are
embedded in a group’s set of beliefs, hypotheses, or theories about another group. Over time these images become
normative and set up intransigent images that reinforce the stereotype and hostility toward it. Group consensus
around the beliefs and stereotypes reinforces acceptable enemy characterizations and socially entrenched opposition
behaviors as normative parts of the sentiments toward the “enemy group.” These behaviors, in fact, become a way of
life such that not having them would be inconceivable. Because the idea exists over a sufficiently long time, the
“enemy other” often becomes inherently inequitable, less than, innately subordinate, often subject to the grossest
maligning, objectification, and the worst levels of inhuman violence. Such hostility reinforces hostility, generates
more intensive hostility, and sustains hostility over generations. Like all conflicts, the longer it remains unresolved,
the more entrenched it becomes and the more difficult it is to resolve.
Giving the Parties a Voice
When confronted with an identity-based conflict between two or more parties, a “third-party” leader must facilitate
the resolution of the conflict. Acting as facilitator, the leader’s first job is to give the parties a voice and listen to
their essential insights and their perceptions of the conflict. They must be allowed to express where they are located
in the conflict and what their feelings are about the conflict. Note that their perceptions do not have to be correct,
right or wrong, because the main goal is to simply lay out what each party has experienced from inside the
experience. The stated perceptions of each party constitute a personal expression of his or her experience of the
conflict and of course are bound to be different from the stated perceptions of the other party. In some cases, the
parties’ perceptions are so different that an objective third person may wonder if each is describing the same
situation, condition, or scenario.
Key Point
Difference is a cause of conflict and, as a prerequisite of dialogue, part of the solution to conflict. In fact, both
difference and dialogue are necessary for good and sustainable human interaction.
Point to Ponder
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Although conflict is normal, unresolved conflict is dysfunctional. Further, a particular conflict will remain
unresolved if it remains unnamed or undiscussed.
Getting the parties to give expression to their perceptions of the conflict is an essential first step in
understanding and resolving the conflict. The way the perceptions are formulated should reflect the feelings and
sentiments of those who have the perceptions. This stage, when the parties give voice to their sentiments and
perceptions, is not the time for structured clarification and process. The facilitator needs to allow the expression of
perceptions to be natural and unconstrained. The result is sometimes uncomfortable because the emotion can be
intense and raw. Yet intensity of feeling indicates to the parties how critical the process is and just what the stakes
are.
These perceptions are accompanied by sentiments and emotions that are largely not grounded in sound facts or
occurrences. Historical perceptions of a wrong or fault have often been embellished by story and mythology over the
long term to the extent that it becomes difficult to separate the myth from the real, fiction from fact. As has often
been done in emerging nations where ethnic groups have played enemy roles for generations, grievances have been
acknowledged and accepted as true by all stakeholders, recognized as undeniable, and simply acknowledged as a
part of history. Such processes are always followed by significant national or ethnic symbols of forgiveness and
separation so that a new foundation or demarcation can be laid, upon which a fresh and emergent pattern of social
compatibility can be structured between former divergent (“enemies”) groups, representing a level of mutuality and
agreement about the future that all parties can agree to.
For there to be movement toward resolution and/or acceptance, the facilitator must make sure that all the issues
and all facets of the issues believed by the parties to be critical are laid out in detail, including issues related to
dignity, recognition, value, and meaning. There is nothing more threatening to the process of resolution than for a
party to believe that his or her story was not told, the story has not been fully heard, or the origin of the conflict has
not been fully appreciated and, as a result, that the process is skewed and therefore flawed.
Identity-based conflicts are rooted in the parties’ need to protect their value and identity (Exhibit 6-2). They
believe there is a threat to who they are—a threat to the very foundation of their being—and they often respond by
going on the attack. For example, conflicts between nurses and physicians over practice are rooted in their notions of
who they are as professionals and their sense that their value and even survival are threatened by the other
professional group. Physicians believe that nurses jeopardize their independence as practitioners and their economic
well-being, and nurses believe that physicians obstruct their ability to practice, grow, thrive, and contribute. In fact,
each group views the other group as a major threat to its own interests, predisposing members of both groups to let
their negative perceptions of the conflict inform every interaction they have on issues of practice and service.
Exhibit 6-2 Identity Characteristics
•
•
•
•
•
Needs
Self-image
Insight
Knowledge
Skills
•
•
•
•
•
Balance
Clarity
Investment
Breadth
Ownership
Interest-based conflicts, if left unresolved long enough, can and often do become identity-based conflicts, but
the latter, no matter what their origin, require strategies different from those used to resolve conflicts that are simply
interest based. For instance, legalistic and negotiation-oriented strategies tend to alienate the parties to an identitybased conflict. These strategies limit the amount and types of dialogue that occur, preventing the parties from
establishing the kind of relationship they need to deal with the issues affecting them. Using resolution strategies
aimed at getting to an early agreement can poison the conversation and keep the parties from finding common
ground and some points of mutual value and shared identity. People are not willing to compromise those things that
they believe are fundamental to their own identity and survival. For them some issues simply are not subject to
negotiation.
Key Point
Identity-based conflicts take longer to resolve than do interest-based conflicts. They arise out of people’s identity—
who people are as opposed to what they do—and often have substantial historical content. In an identity-based
conflict, to reach a resolution the two parties must come to appreciate each other’s value and respect each other’s
uniqueness—a very challenging task given the passionate attachment of each party to his or her own identity.
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Time and Patience
In trying to resolve an identity-based conflict, it is a mistake to begin by pushing the parties to compromise, often
the strategy of choice for interest-based conflicts. Another mistake is to try to get the parties to separate their
feelings from the so-called facts of the conflict because their feelings, especially their sense of identity, are at the
root of the conflict. Using a strategy that threatens their identity makes the parties more suspicious of each other and
of the conflict resolution process.
The resolution of identity-based conflicts takes a great deal of time, especially the first stages of the process.
However, these stages are the most crucial and warrant the extra time and patience. Naming and certifying issues,
feelings, and positions clearly at the outset establish a firm foundation on which to construct a process that moves
effectively to a successful outcome.
In a traditional negotiation process, the parties try, through compromise, to arrive at a place where they can
essentially split the difference. This process works best when the issues are clear, the goals are well defined, and the
parties are reasonably clear on what the common ground looks like. Unfortunately, the underlying issues in an
identity-based conflict are blurred, and the parties feel especially vulnerable because the stakes are seen as so
consequential. The parties therefore are hesitant to compromise early in the process, and moving too quickly toward
a resolution could threaten the process itself and prevent the parties from dealing with the underlying issues, in
which case these issues would ultimately give rise to another episode of discord.
Building Trust
Much of the early work in the resolution process is directed toward getting the parties to change the way they think
about each other and agree on a process and method for interacting. The parties are essentially suspicious of each
other. Their suspicion is itself a great source of conflict, and getting to a place where the rules of engagement are
clear and can be used as the vehicle for dialogue increases the probability that the parties can work out their
differences.
In an interest-based conflict, the root issues are not always put on the table, and the negotiation strategies are
typically as important as the issues. In contrast, in an identity-based conflict, posturing and positioning are generally
ineffective because the parties need to disclose their powerfully held sentiments and beliefs—those things that reveal
who they are and what they do. To build a proper foundation for resolving the conflict, they must fully understand
these sentiments and beliefs—their own and those of the other party—and identify whatever common ground exists.
Point to Ponder
Conflicts love to hide in ambiguity. If a conflict remains unclear or undefined, it also remains elusive and hard to
eradicate. The parties, only able to deal with the symptoms, almost certainly will allow the conflict to have an
impact on all their joint activities, leading to negativity and uncertainty far beyond the boundaries of the conflict
itself.
Because of the high stakes involved in an identity-based conflict, the facilitator should move the parties toward
negotiations slowly, after a trusting foundation has been established. Often, using informal familiar and familial
interaction and relationship development humanizes the participants, makes them real to each other, gives them an
opportunity to witness common frames of references related to children, family, and community. These informal
opportunities at relationship help again humanize those who had lost their humanity through enemy metaphors of
prejudice, objectification, humiliation, and subordination. In the initial stages of dialogue, the facilitator should
encourage the parties to set practical goals, such as arriving at a common view of the conflict and agreeing to a
description of the issues in a common language. By achieving these goals, the parties are more inclined to accept
that resolution of the conflict is a real possibility and can feel comfortable with the resolution process. In short, the
parties must develop a sense of relationship with each other before moving further along toward resolution.
The facilitator must realize that building a trusting atmosphere and getting the parties to recognize they each
have a substantial stake in resolving the conflict are both essential steps. By showing the parties their relationship to
the larger context, the facilitator helps them see where their common values lie and what might be a resolution
equitable to everyone.
The facilitator is likely to find that one or both parties exhibit a currently prevailing pattern of behavior
characterized by deviousness, secretiveness, manipulation, and a sense of “us against the world.” This pattern
provokes a response of unilateral defensiveness that is hard to break through. To fight against it, the facilitator must
try to nurture cooperative inquiry, establish credibility, and engage in relationship building. A good part of the
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resolution process must be devoted to creating a common identity around the issues in a way that allows all the
parties to believe they are mutually contributing to a justifiable end of the conflict.
The parties must arrive at a place where they can honestly say what they value and believe. Getting them to this
place may not be easy because the parties may have strong emotional blocks that prevent them from articulating
their real issues. Sometimes the parties believe they are articulating the issues by stating how they feel, but in doing
this they are focusing on the results of the issues, not on the issues themselves. The facilitator must get them to focus
on what caused these feelings—the conflicts that lie at the heart of their emotions.
The long-term work involves helping the parties reconceptualize the conflict, perceive their relationship in a
new way, change the language they use to describe the conflict, and even change the nature of the conflict
altogether. The conflict may be rooted in a lack of clarity, and one or both parties may say things that are
inconsistent with what they do. They both need to achieve a good understanding of their own motives and desires
before attempting to move toward an end to the conflict. Otherwise, each will be unable to hear the other and
understand where the other is coming from.
Finding Differences
As mentioned earlier, each person is a unique blend of differences, and their differences from each other are what
make people exciting and intriguing to each other. We celebrate our differences and honor diversity in culture and
personality. Yet differences can become an impediment to understanding and relationship, and given enough time
any human relationship will give rise to some level of conflict. When it does, those in the relationship must
understand that it is not the conflict that is problematic but its nonresolution.
Group Discussion
In any organization, unresolved conflict eventually creates a culture of conflict, increasing the incidence of conflict
at every level (LeBaron, 2003). After identifying personally experienced unresolved conflicts in the workplace,
discuss the impact that each conflict had on relationships in the workgroup. In talking about this issue, consider the
following questions: What kinds of factions formed? Did the one conflict lead to others? Did the group leader take
any action to ensure that the conflict would be resolved? That it would not be resolved? What was the long-term
impact of the unresolved conflict? Was the conflict ever resolved? How?
To figure out just what caused a conflict, the parties to the conflict must frame the issue in a way that gives it
focus. One method is for each party to ask, what do I want here? To answer this question, each must be clear on how
he or she stands on the differences between the two parties. Framing their notion of the conflict or of their position
in relationship to it gives the parties a foundation on which to take a position. To get there, they need to ask
themselves some specific questions.
Do the parties remember the period before the conflict existed? Looking at the before and after can help the
parties give the conflict a time and a frame of reference, allowing them to identify its elements in a way that makes it
real. Furthermore, the parties, in reviewing the period before the conflict, give the facilitator an opportunity to see
how each perceives the beginning of the conflict and to detect any differences in their perceptions.
What antagonisms emerged? What did they look like? How did they feel? Here, the focus is on perceptions of
the moment of conflict. The issues of resentment, behavior change, and cultural and personality differences get
expressed in the unique language of each party. Both parties begin to express their special insights about the feelings
and animosities that emerged and grew as a result of their differences, and the individual flavor of the conflict starts
to become clear. The parties now get a chance to express not only how they felt but why and what it meant to them
at the time, allowing the circumstances to be reflected through the lens of personal experience. This process
disciplines their insight and forces them to focus on the conditions and circumstances that give form to their sense of
the conflict.
Who is to blame and what is he or she to be blamed for? Answering this question is a good way to get to the
dynamics of the conflict. In almost every conflict, a strong element of blame lies at its heart. The parties need to get
some idea of what the blame is, where it resides, and what form it takes. Not only is it important to uncover the
blame, the facilitator must push each party to describe the content of the blame it points at the other party and
explain why it is justified. The explanation is likely to make reference to stress, pain, or anguish experienced by the
party doing the blaming and indicates how the other party was responsible for it.
These questions get at the fundamental antagonisms causing the conflict. The parties’ perceptions and feelings
need to be articulated at the beginning of the resolution process for two reasons. First, both parties must see and say
where they are in relation to their notion of the conflict. Second, the facilitator must get some sense of where the
parties are at the start of the resolution process. The agenda for building the process and achieving reconciliation is
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constructed at the very beginning of the process. By getting the parties to delineate the differences in their
perceptions and positions, the facilitator gains information about the work yet to be undertaken.
To get this information, it is best to talk with each party independently. The facilitator should keep the meetings
informal and focused on gathering information and helping the parties get ready for their work within the process.
These meetings also offer a good opportunity to discuss the rules of engagement that will be used when all the
parties are at the table. Note, however, that the rules of engagement must be finally deliberated and agreed to when
both parties are present.
Who Wants What?
People in conflict generally know what it is they believe they want. When individuals or groups are at the point of
conflict, they generally have reached the stage of holding black-and-white positions—positions that are mutually
exclusive and sit at some distance from each other.
To bring the positions closer, the facilitator must be steeped in the resolution process and look for every
opportunity to foster congruence, strengthen trust, and improve the interface between the parties as their relationship
begins to grow. As noted previously, the parties to an identity-based conflict must establish a relationship and not
simply obtain a resolution of their issues. The facilitator helps them do this by knowing them as well as possible and
being familiar enough with their issues and positions so as not to miss opportunities for bridging differences and
constructing common ground because such opportunities rarely are presented twice. The facilitator’s knowledge is
his or her main tool for advancing the process and moving the relationship through the tough times.
ARIA Conflict Engagement Theory
In his seminal work on identity-based conflicts, Rothman (1997, 2013) suggests a format for the resolution process.
The stages of the format, which he calls ARIA Conflict Engagement Theory, are antagonism, resonance, invention,
and action. They are outlined in the following subsections.
Antagonism
In this first stage the facilitator pushes the parties to express their antagonism, which, besides helping the facilitator
move the process along, helps the parties lay out their raw emotions in plain view and, in so doing, diffuses them,
thereby reducing the temperature of the conflict. Given the proper context, this initial expression of antagonism also
provides extra motivation to do something about the conflict and the negative feelings that it generates—to end the
pain and discord and move to a better place, where there is more peace and stability and opportunity.
In addition, it can reveal to the parties their own limitations and constraints. They are able to see how their own
intensity of emotion polarizes their views and positions. Although unlikely at this point to be able to make
substantial changes, they can at least get a picture of what their positions look like and how strongly they hold their
views, possibly opening a window to understanding. Indeed, expressing their antagonism and hearing it reflected
back in the language of the facilitator may surprise them and finally make them realize just how fixed, strident, or
polarized they have become. After all, the flames of antagonism are fanned by a wide range of emotions that,
regardless of their legitimacy, are strongly felt and often just as strongly expressed.
Key Point
Parties to a conflict must be allowed to express their feelings, even their passionate feelings. If not expressed, these
feelings become intensified and move deeply inward, poisoning every interaction and preventing a resolution from
being achieved. Therefore, facilitators must create a safe space for the parties to get their feelings out.
Point to Ponder
Blame keeps the parties from owning their part of the conflict—from naming their own issues and identifying them
as causes of the conflict—and thus keeps them from achieving a resolution. In pointing a finger, each party focuses
exclusively on the other party’s actions, whereas each should instead attempt to see clearly and admit to his or her
role in the conflict dynamic.
In a typical conflict, one or both parties blame the other side to strengthen their own position, at least in their
own eyes. Blame serves to escalate the conflict and give it a justification. It creates an “us and them” position,
locates the enemy, and defines the terms of opposition. It puts the other party at fault and provides a reason to be
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angry at and in conflict with the other party. The natural tendency to place blame is best exemplified by the common
childhood claim, “He hit me first.”
Blame helps the parties avoid focusing on their part in the conflict. By concentrating on why it is the other
party’s fault, each party evades having to reflect on the role he or she has played. The parties never have to consider
how they might have acted differently, experience the pain of admitting their own contribution to the conflict, or
engage in the work of reaching a resolution. Indeed, blame suggests that a resolution to the conflict is not possible.
Blame helps keep the conflict external—safe and free of personal content. It puts the responsibility for resolving
the conflict in the other party’s court and suggests that if the other party would make certain changes or act
differently, the issues and the conflict would simply disappear.
Blame never has any real inherent or intrinsic value. The facilitator’s best strategy is to pursue naming the
feelings of each party and their intensities. Even when restating accusations of blame, the facilitator does not spend
time in the blame. Discussing the blame that has been leveled merely helps the facilitator figure out (1) where the
parties are in relation to each other and to the issues at the root of the conflict and (2) how to move the parties
toward reconciliation.
Blame also generalizes feelings and perceptions and keeps the parties from being specific and reaching clarity.
The facilitator’s role is to get the parties into and through the blame and on to focus on the particulars and delineate
their own positions.
Group Discussion
Greg Shue, manager of a hospital department, was angry with the head of critical care. She had beaten him out of a
part of the budget he needed to make programmatic changes in his own department. He occasionally referred to her
in derogatory terms and seemed unable to get past his anger, which was beginning to have a serious effect on the
relationship between Greg and the other department head and on the entire organization. You are the conflict
mediator in this case. How would you begin the conflict resolution process? What would you do to get Greg to own
his anger? What would you do to induce Greg to move beyond his feelings and begin dealing with the real issues?
Posturing and positioning commonly act as intensifiers of conflict. They support the culture of justification and
rights and lead to rationalizations of the polarization that typically occur in a conflict. The parties give reasons for
the polarization and construct a whole logic to support it. In other words, they “circle the wagons” and make the war
their cause, rather than the issue at the root of the war. They then devote more time and energy to conducting the
war than they ever did in pursuing the underlying issue.
At this stage, the conflict has taken on a life of its own. Nothing the other party does with regard to the issue is
right or appropriate. Further, because each party is acting out of his or her own identity, the other party not only does
the wrong thing but becomes wrong. The next step is to describe the other party as bad and to conclude that he or
she must be opposed. If the one party did not oppose the bad party, the former would be bad too, and in the same
way. This would be untenable. Thus, each side builds the polarization between the parties and raises the intensity of
the conflict.
Also, as the characterization of each party by the other grows increasingly negative, the less necessary each
believes it is to resolve the conflict. Who would want to resolve a conflict if it meant giving up a justifiable fight
against what is bad, perhaps even evil? In the mind of each party, what needs to happen is for the other party to stop
being bad. If that occurred, the conflict would automatically end.
The facilitator must realize that each party has a selective memory. Each vividly remembers events that led to
the conflict and for which blame could be laid on the other party. On the other hand, each tends to forget
contributing events for which he or she was responsible, not to mention their own dishonorable motives.
When the negatives run high, each party’s desire to resolve the underlying issue wanes. Their energy is instead
devoted to building a culture of opposition and to placing themselves in the right. They act to strengthen their
position and get it validated by prospective allies. Correspondingly little energy is devoted to pursuing strategies that
might lead to a resolution of the conflict.
As time goes on, each party becomes increasingly critical and disapproving of the behaviors, practices, and
even culture of the other party. Words and actions become opportunities for the one party to challenge, skewer, or
demean the other and further validate continuation of the conflict.
Projection is commonly used by parties in a conflict to strengthen their positions. Projection involves attributing
to others problematic behaviors we engage in or embarrassing characteristics we possess. It is universally
understood as a defense mechanism for avoiding responsibility for such behaviors and characteristics. In a conflict,
one party, in addition to viewing the other party as fundamentally different, might project, for example,
unacceptable motives onto the other party and thus avoid confronting the fact that these are his or her own motives.
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If this occurs, the facilitator’s goal of getting the parties to see what they share in common becomes even
harder. Each party resists admitting that the other could in any way be similar because doing so might involve
acknowledging parallel objectionable behaviors. Though daunting, the facilitator’s task at the outset is to achieve as
much clarity about the antagonism as possible, and his or her initial activities largely are spent on getting the parties
past this part of the conflict so that they can pursue resolution strategies.
Group Discussion
The parties to a conflict each possess values and beliefs. If the conflict is identity based, their ownership of their
values and beliefs and their sense of who they are unavoidably have an impact on their interaction with each other.
Assume you are assigned the job of facilitating the end of an identity-based conflict between two people. How do
you break through the identity issues to get the parties to talk with each other? What should you explore and settle
with the parties separately before you bring them together? Break the discussion group into two and give each
subgroup the role of acting as one party in an identity-based conflict (a conflict arising out of a difference in
nationality, ethnicity, religion, or politics). List the elements of conflict as they come up during the ensuing
dialogue.
Resonance
Resonance is the process of moving away from antagonism and toward the identification of common ground.
Through reflexive reframing the parties begin to articulate their values and concerns and seek commonalities on
which to build dialogue.
In the preceding phase, the focus of each party is on the behavior of the other. Each party’s view is outward and
other oriented. Reflexive reframing refocuses the gaze of the parties back to themselves so that they can clarify who
they are and what they want before trying to fashion a resolution.
An identity-based conflict is likely to involve intangible and subjective issues. The facilitator might have a hard
time believing the two parties are talking about the same concerns. In point of fact, they may not be. The two parties
are likely to have different cultural and experiential backgrounds, have different perceptions of the conflict, and use
different language to express their perceptions. The notion of objective truth is irrelevant because each party cannot
help seeing the conflict through his or her own eyes and treating his or her own perceptions as true.
However, by expressing their deepest feelings and values, the two parties start to fashion a common frame of
reference. Each begins to sense that the other shares certain sentiments and each develops a fuller picture of the
other. By going deeper into their own experiences, the parties build the foundation for future dialogue. They
discover that their initial views and positions—those expressed during the first stage—are inadequate and cannot be
supported. The personal and “why” questions they ask help turn the conversation into a vehicle for learning about
each other’s different perspectives and values.
Reflexes come in two varieties, the automatic reflex to external stimuli and the reflective response based on
study and assessment. The latter type is characteristic of good conflict management. It requires the ability to step
back and look at issues and concerns from a far enough distance to see the whole landscape related to the conflict.
The goal of the facilitator is to get the parties to take the necessary step back. Ideally, they would see each other’s
pictures of the conflict, understand the circumstances and variables placing them in the conflict, and understand how
all of that stands in relationship to everything else. Ultimately, the facilitator wants to create a double-loop
experience for the parties. Once each has articulated his or her experience and completed the circle of experience,
the two parties would link their experiences in a way that exposes their similarities and intersections. Common
elements and frames of reference begin to emerge as a result, and the relatedness of the elements become clear to the
parties and form a foundation for further dialogue.
The two parties also need to see clearly that both have the same fears, uncertainties, meanings, and values and
to recognize that they could find themselves saying the same things. When one party says, “I am concerned,” “I am
afraid,” or “I am angry,” the other should be able to admit honestly that he or she could easily utter the same
statement. Furthermore, through the “I” form of the expression, the individual ownership of thoughts and feelings
ultimately becomes mutual. It is precisely because of the deep ownership each has of his or her own insights and
feelings that mutuality can begin to emerge without causing the threats of challenge, accusation, or alienation. It is
hard to reject in another what you just affirmed in yourself.
Identity-based conflicts can exhibit elements of reaction. Each party’s sense of self may actually be formed in
opposition to the other party’s sense of self. The parties’ discernment of who they are not can sometimes be as
important as their definition of who they are. For instance, they might see themselves as not having characteristics
that they attribute to the other party, possibly just because they perceive the other party as having them. They are
likely to view themselves not just as possessing different interests, but as being fundamentally different. Religious,
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cultural, ethnic, national, and sexual differences often serve as the basis of identity-based conflicts. After all, there is
nothing any of us can do about our gender, nationality, ethnicity, or religion, and so these are seen as defining us and
differentiating us from the “other.”
In health care, discipline, role, function, and license can similarly act to divide people in fundamental ways and
create a priori positions that are hard and sometimes impossible to get around. For example, “I am the doctor; the
buck stops with me” or “I am the nurse; I manage the processes of care” or “I am the caregiver; I do the work of
health care.” Each of these statements is partially true, but by holding to them the parties can become polarized and
entrenched. Moving them from their positions is a challenging task, but it can be done by persuading them that no
role is the most special, important, critical, powerful, or viable and that no person can do what needs to be done if
the other parties fail to meet their responsibilities. The fact is that “I am because you are.” That is, we are all
interdependent, and indeed the clearer I am as to how I stand in relation to you, the clearer I am as to who I am and
who I can become. It is essential that the parties understand the interdependence of their roles so that they can reach
a sustainable resolution of their differences.
Key Point
Fear keeps people from disclosing how they really feel and focusing on resolving the issues at the root of a conflict.
Therefore, early in the conflict resolution process, the facilitator must give the parties a strong sense of safety so that
they can confront their anxieties and talk openly and honestly.
The parties to an identity-based conflict are faced with a fundamental choice: They can continue to maintain an
isolated identity against the world, or they can search for and uncover their common roots and frames of reference
and find their mutuality. To get them to do the latter, the facilitator should help them move
•
•
•
•
•
•
From blaming to articulating their sense of self
From antagonism toward the other to identification with the other
From the attribution of negatives to understanding
From projection to ownership
From anger to acceptance
From fear to a sense of safety
As the parties move through these initial stages of the conflict resolution process, they clarify the conflict,
obtain ownership of the process, and explain to each other what is most present in themselves, thereby deepening
their self-understanding and establishing a foundation for the later stages.
Invention
During this stage, the parties begin to see some payoff for the work they have done. The focus is on inventing
solutions that can take the parties to a place where they can live in peace and engagement. In short, they begin the
work of resolution.
Their main task is to look at solutions through a larger lens or use a greater frame of reference—in other words,
to think outside the box. They should try to develop new ways of looking at the conflict and come up with new
solutions. As noted, in identity-based conflicts negotiating a compromise is fraught with difficulty because the
parties would view compromising as giving up something of who they are, not simply something they have, and
would thus find it unacceptable.
Instead of seeking compromise, the facilitator must challenge the parties to apply a broader framework and see
the situation in a new way. They both have a stake in the outcome and stand to gain from a solution. They must
therefore reconceptualize the conflict, which is the purpose of the invention process. This process is about
developing whole new ways of seeing the issues and working through them. It demands a focus on the practical and
the real, and by going through the process, the parties should be able to develop a different vision of their concerns
and a different image of each other. In particular, they should recognize that they are interdependent and need each
other and that the resolution of the conflict requires everyone to get on board.
The first step is to develop and agree on statements of objectives. These are derived from statements of the
issues. They help the parties see and say what they want to get from the process, especially as relates to their
fundamental needs for safety, security, value, dignity, and so on. They also inform the more detailed discourse the
parties will engage in regarding the steps and processes intended to move the parties to where they would like to be.
Point to Ponder
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In trying to resolve an identity-based conflict, the facilitator should help the parties differentiate themselves and
develop a clearer sense of who they are and what they bring to the table.
This step includes components that allow the parties to educate each other on what they need and to explain
their reasons why. The education expands on what has already been shared but with a new focus on safety, security,
values, and so on. Because the issues at the root of the conflict are identity issues, the parties must try to explain how
what they are asking for advances or protects their identity.
Working out the details is critical. Watching negotiations, uninformed observers often believe that the haggling
that occurs over the smallest detail is disingenuous and foolish. In an identity-based conflict, each detail has
implications for the identities of the parties after the resolution, and thus each one counts.
Note that there is a significant difference between interests and needs. Interests generally play a central role in
resource- or interest-based conflicts but a subsidiary role in identity-based conflicts, where needs are primary.
Consequently, in an identity-based conflict, the most critical task is to get parties to express their needs and then to
reach an understanding of their interests based on their needs. For example, as they see it, the nurses in a healthcare
organization need to give care to patients unconstrained by financial considerations. On the other hand, the
managers, as they see it, need to ensure the financial health of the organization. Both needs—the nurses’ need to
give good care and managers’ need to ensure financial viability—relate to a common interest, ensuring the existence
of enough financial resources to render good service to the public. If the two groups understand that because of their
needs they share an interest, they are more likely to reach a resolution of their conflict.
Of course, achieving a resolution does not mean that the parties get everything they desire. At best, they can
negotiate a method for meeting their needs—a method that may involve working together, such as one of those
described next.
Sometimes differentiating between the parties more clearly, that is, accentuating and enumerating their
differences, can lead to a more suitable resolution for each. Although their needs may differ, clarifying them and
seeking alternative ways to satisfy them through common action can help move the parties to a new place. For
example, imagine a respiratory therapy union is seeking greater recognition for its members and a stronger role for
its leaders, whereas the management wants a reduction in complaints and grievances instituted by the union. Both
groups agree to apply a different method of problem solving, one in which the union leadership plays a more direct
role. The result is less use of the grievance procedure. Here, the different needs of the two groups provide a basis for
resolving their conflict creatively.
Group Discussion
Nina Conners really did not want to settle the issues she had with Frank Kliener. They had been feuding for 3 years.
Both she and Frank used their conflict as a way of getting more for their own departments and keeping their staff
energized and competitive. However, the organization has been paying the price, and its goals are sometimes held
hostage to the war between the two departments. Discuss how a mediator would begin to resolve this conflict. What
are the apparent issues? What might be the real issue? How would the mediator structure the resolution process? As
part of the exercise, create a resolution plan that contains steps for addressing the issues and resolving the conflict.
A second technique involves expanding the playing field so that the parties can each get more of the resources
they need. For example, nurses may request more staffing, and management may want to save more money. The two
groups may agree that if the nurses meet set productivity targets, management will use part of the savings to hire
more nurses. By consenting to work together to expand the organization’s resources, they each help meet their own
needs and those of the other party. The result is a win–win resolution of their conflict. To reach a mutually
beneficial resolution, the parties usually have to identify joint activities that move them past the issues that
prevented them from ending their conflict in the past.
If the parties find that their needs are seemingly irreconcilable, the solution may lie in offering compensation for
not meeting a certain need by bestowing something different of equal value. If one party is asking for money that the
other party cannot afford to give, it may agree to accept something it views as equally valuable, such as more
vacation time. The two parties must engage in clear and creative dialogue to ensure that the substitute is truly
viewed and explicitly accepted as equivalent; otherwise, the issue of just compensation will likely arise later and
cause problems and further conflict.
The leader-facilitator must look for signs of enough movement and energy to take the parties to the next step—
or provide the necessary energy. There is nothing like a small success now and again for maintaining the
momentum. Once successes begin to occur, they serve to spur the process and move it in ways that nothing else
could. The process, energized by the successes already achieved, begins to change the dynamic, the emotions, and
the relationship of the two parties without any further intervention. Through good timing and careful pushing, the
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facilitator can get the parties to work on the more difficult issues in the midst of good momentum, increasing the
chance that they will be finally settled.
Key Point
Conflict resolution is a process with its own timing and techniques. It requires training and experience. Leaders
should develop the necessary skills and practice using them until they are adept at bringing parties in conflict step by
step through the process to a sustainable settlement of their differences.
The inventing stage is when the parties’ interaction changes from being oppositional to being collaborative. It is
an essential stage on the journey to a resolution, and the techniques of differentiation, expansion, compensation, and
momentum all have the potential of increasing the probability that the parties will achieve an end to the conflict.
Action
The final stage is devoted to crafting a plan of action. There is nothing more disheartening than to get through the
touchy issues and concerns, establish a strong commitment to pursue possible solutions, build an effective
relationship, and then have the process fall apart because an action plan either could not be constructed or was not
detailed enough to guide the parties to a final resolution.
As the process progresses toward action, the parties need to reaffirm where they have come from and where
they believe they are in relation to their own needs and their interaction with each other. The mutual understanding
that results serves as the ground for the subsequent focus on action. In the action phase, the new questions are what
to do, who is to do it, why is it being done, and how to do it.
The first step is to set the agenda for action. What are the priorities of the agreements reached? Where do the
parties start? What are the items that must be translated into substantive work, enabling the agreed way of relating
and behaving to be realized? These questions serve as the basis for the next level of critical dialogue. Here again
patience and attention to detail are required from both parties and from the leader-facilitator.
Setting the agenda includes deciding the priority of actions, their timing, their criticalness, and what other
actions must be done in preparation. It also includes reaching an agreement on who is to be accountable for the
actions.
New kinds of structures and institutions may have to be constructed as vehicles for implementing the actions. If
built early on, they provide a framework for implementing the actions and evaluating their progress. They also help
ensure that the issues important to the parties are addressed as expected and that any problems or concerns that arise
are defined precisely (Moore, 2003; Ramsbotham, Woodhouse, & Miall, 2011).
Once problems are defined, they need to be solved, which means building problem-solving mechanisms into the
implementation process. Unaddressed problems have the potential to negatively affect the relationship between the
parties and eliminate the progress made to date.
The parties need to clarify immediate and long-term goals and priorities based on the critical elements identified
during the reflexive reframing process (which occurs in the second stage of ARIA). They also need to ensure that
the principal, pivotal, and relational items are handled first during the implementation.
The facilitator must try not to upset the delicate balance achieved between the parties. The facilitator’s tasks
include determining the specific needs each party wants to satisfy as a result of the implementation process and
devising an evaluation schedule so that progress can be assessed at critical points. Evaluating the process regularly
keeps the parties on board and ensures the process remains in line with their expectations.
Point to Ponder
A conflict resolution facilitator must keep the parties centered by reminding them what is at stake and which issues
need to be addressed. The facilitator must also remind the parties of the expectations agreed to so that these can be
reaffirmed or altered as the process moves forward.
Equally critical is the assignment of accountability for specific outcomes. Who does what should be a practical
rather than a political issue, yet at this stage politics often take precedence in a way they never should, typically
because the skills, talents, and roles of the participants have not been discussed in advance of the assignment.
These must be ascertained before the point of assigning accountability if political machinations are to be kept at a
minimum.
Content (goals) must always be placed before process (methods). Once the parties set their goals, however, they
need to choose methods for achieving them. In thinking about methods, they need to anticipate potential
impediments and select those methods that are most likely to succeed.
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The parties should keep in mind that each is going to judge the other by his or her actions because these actions
are the visible evidence of that party’s commitment to the agreement. They represent what the one party has done on
the other’s behalf. The parties’ actions therefore require as much attention as any of the other components of the
resolution process.
The leader-facilitator must always keep the parties focused on what is at stake and how important it is. The
parties must have the sense that they are a part of a meaningful effort that is larger than their own contributions and
that will lead them to a better place.
In any conflict resolution process, no matter whether the conflict is interest or identity based, the leaderfacilitator must establish his or her neutrality at the outset. If that cannot be done, the leader-facilitator may consider
relinquishing his or her role. A facilitator who is seen as too close to the issue or unable to act in a neutral manner is
more of a hindrance than a help.
The facilitator must be as committed to the process as to the parties. He or she has an important position of trust
and is responsible for moving the dynamic in critical ways. If not careful and skillful, the leader-facilitator will cease
to be credible to the parties and will lose their confidence, thereby crippling the process and ensuring that further
problems will arise.
The facilitator must make it clear at the outset that he or she is working for the whole, not one side or the other,
regardless of how he or she got there. Further, the parties must agree to the notion that the facilitator is neutral or the
process simply will not progress. If one side or other is paying for the facilitator’s services or the facilitator holds a
specific role in the organization, accommodation may have to be made at the outset of the process to ensure that the
parties trust and support the leader-facilitator equally.
Although identity-based conflicts are the most difficult of all conflicts to deal with, they can be resolved using
the processes and mechanisms outlined here. Many of them are allowed to continue because leaders have no idea
that these tools even exist and mistakenly try to use approaches suitable only for interest-based conflicts.
In the current world of health care, the potential for conflict is greater than ever. The various disciplines and
workgroups are being forced to revise their relationships and their boundaries—or even establish them for the first
time. Team-based and continuum-driven approaches to service place a great emphasis on who people are rather than
simply what they do (Caspers & Pickard, 2013; Cooperrider, Whitney, & Stavros, 2008). Thus, a vital part of the
leadership role in the new age of health care involves working through the differences between professionals and
building mutuality as a basis for preventing unnecessary conflict and resolving unavoidable conflict when it arises.
Interest-Based Conflict
Interest-based conflicts are situations that present the potential to affect or compromise the impartiality of a person
or an issue because of the likelihood of a conflict between an individual’s self-interest and professional interest or
public interest. In legal terms one representation of interest-based conflicts is a situation where an individual party’s
responsibility to a second party limits the first party’s ability to discharge its responsibility to a third party because
of interest conflicts. In negotiating interest-based conflicts, the substantive assumption is that parties in conflict are
much more amenable to reach mutually satisfying decisions when their respective interests are honored and met in a
way that suggests mutual advantage or satisfaction.
Most interest-based conflicts involve questions related to the distribution of interest among the disputants, often
related to money, property, personal benefit, or obligations. With these sources of conflict, questions relate more to a
symbolic “pie” and just how equitable the pieces of that pie can be distributed among the stakeholders that have
some investment or interest in all or parts of the pie. Interest-based negotiation depends much more strongly on win–
win processes, and many of the elements of interest-based dialogue and negotiation are directed to achieving that
kind of outcome.
Types of Interest-Based Conflicts
Like any other human dynamic, conflict has content, particular elements, and specific processes. Kinds of conflict
generally fall into relationship-based, value-based, structural-based, data-based, and related interest–based
categories. Each one has its own characteristics and elements that mark it as unique. The leader becomes skilled at
identifying the kinds and characteristics of conflict being dealt with and the responses that best address them.
Because the leader is always looking for specific conflicts, it is wise to become skilled in identifying the
particular characteristics of conflict that most often appear within the culture of the service or department. Each
setting is unique with regard to the makeup of the staff and the stressors on them and the work that they do. The
good leader makes a conflict-potential assessment as a part of delineating which strategies are going to be most
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21
helpful in dealing with conflict. In this assessment, the leader attempts to get a handle on those specific potentials for
conflict that will most often be a concern in the ordinary management of the service.
The leader looks at the makeup of the staff, the demographics (both cultural and age related), the breadth of the
work, and the skill level of the staff. Embedded within these factors is the potential for specific kinds of conflict that
may recur. In this manner, the leader makes the potential for conflict a normal and usual part of her or his
organizational and resource planning. This leader knows that the greater the awareness of the circumstances and
characteristics of conflict, the earlier it can be addressed appropriately.
Relationship-Based Conflicts
In any work environment, there are a number of personalities and situations whose vagaries create conditions that
can lead to conflict. Differences between people always provide a source for a variety of relationship-driven crises
or conflicts. Differences in personality create problems in interaction and communication and often lead to
misunderstandings. These differences can frequently lead to specific altercations reflecting emotional involvement
and personal animosity. Left unaddressed, these differences can escalate and create real polarization between the
involved parties and those who relate to them. Relationship conflict is the most frequently experienced conflict in
most organizations. Communication irregularities emerge and miscommunication becomes common. Negative
behavior becomes repetitive and, if not resolved, becomes a way to sabotage and offend the opposing party, which
can affect the work, workers, and those they serve.
The good leader recognizes the potential for this conflict early in the process. Usually, unkind words, snide
comments, asides, negative comments to others, and avoiding behaviors are the early signs that a relational conflict
is present. Because the leader always expects some level of conflict to exist, she or he is able to see these signs and
begin to take action right away.
The leader first must get at the originating source of the conflict. Confronting both parties separately with
regard to the behaviors expressed is the critical path to getting at the root problem underlying the behaviors.
Beginning the questioning with an open-ended approach is best. The leader might say one of the following:
I’m noticing that …
Can you tell me …
I’m wondering if I’m seeing …
Help me see if I’m perceiving this right …
At this stage, the leader is just trying to get a level of understanding about the existence of a problem and the basic
perceptions of what the problem might be through the words of each party. Through this process, the leader is
simply validating whether a problem exists and the underlying nature of the concern. The leader is also ascertaining
the degree of perceptive agreement that exists between the parties regarding their issues. The leader initially
responds to emotions and feelings. It is impossible to get at the problem without first going through the emotional
content of each party’s issues. In relationship conflict, the parties are reacting to their own feelings and impressions
of what has happened to them and how they are feeling about it, rather than to the real issue that may be the
causative factor.
If the leader tries to get to the causative issues too soon, the parties may block and refuse to move there because
they have not had an appropriate opportunity to work through the emotional content related to the issue. Sometimes
the leader might need to carefully move individuals through their feelings by validating and supporting the person
while clarifying the underlying issues along the way. The leader attempts to get the individual to a more realityoriented place from which some rational work might be done as the individual moves through the conflict. At some
point, the parties must be in the same place to move the conflict closer to resolution. The leader attempts to prepare
each to understand where both individuals are in relation to feelings and content. The leader, acting as a neutral,
seeks to have each party express his or her feelings with a language that accurately expresses feelings without
further polarization, energizing a new level of emotional intensity.
As the process moves toward engagement, the leader seeks to focus on expression and rules of engagement as
well as to remind each party of the expectations regarding communication and conflict management in the service or
the department. Having created an appropriate milieu for conflict management, the leader wants to ensure that
the parties are aware of the expectations and need to resolve issues that impede the ability of the staff to
communicate and deal with differences. The leader identifies the conflict resolution process as one of the
mechanisms that exemplifies the components of communication within which the unit operates. It is only at this
point that the leader begins to bring the parties together to a dialogue and to work through their differences.
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22
Values-Based Conflicts
Perhaps one of the most difficult classes of conflict to resolve is one…
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