Resolving Conflict: Conflict Resolution for the Helping Professions

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At the centre of all conflicts are basic human needs. Conflict occurs because our needs are unmet or because our needs are inconsistent with or in opposition to the needs of others. One of the first steps in helping health care professionals to manage conflict is to remind them that conflict is normal and common. Once we understand that conflict is natural, the next step is to look at where conflict comes from to better appreciate how we might start the process of resolving them.

Conflict arises from a clash of perceptions, goals or values in an area where people care about the outcome. The breeding ground for conflict may lie in confusion about or disagreement with a common purpose and how to achieve it while also achieving individual goals. In addition, and in health care particularly, the competition for limited internal and external resources as well as the interdependency of health care professionals feeds the development of conflict. Our ability to accomplish our goals and objectives depends on the cooperation and assistance of others, which increases the opportunity for conflict.

Understanding conflict

In health care, no one can do their job without the input of someone else. When the other person is late, has different priorities, misunderstands directions, challenges our decisions or values outcome over process, conflict is created. Recognizing and addressing the factors that give rise to the potential for conflict can have a positive impact on the health care working environment.

Conflicts are often multi-layered and complex and have various origins that overlap and interweave. Most conflicts involve the same factors to a greater or lesser degree. Understanding the various factors that contribute to conflict helps us begin to work toward resolution. Since communication is such a vital factor in the development and resolution of conflict, we will discuss it in more detail in the next section.

It has been noted that communication is at the heart of both conflict and conflict resolution. Open and effective communication is the means by which disagreement can be prevented, managed or resolved. The health care workplace is a fertile breeding ground for conflict because of the dynamics and interdependency of the various relationships that exist, including those between physicians and other physicians; physicians and nurses; physicians and administrators; and physicians, patients and family members.

While it seems obvious that good communication is an essential tool for successful relationships, communication is a skill that many of us do not excel at and yet, at the same time take, for granted. After all, we all know how to talk. However, most of us do not know how to talk so that others will listen, or how to listen so that others will talk. Listening for understanding is more than just taking in information; it is a multi-layered technique that entails listening without judgment, without planning a response and without devising solutions or offering advice.

Truly attempting to understand what is happening for another person requires centring, focus and presence. Taking in information that includes facts, emotions, body language and context enables the listener to develop an understanding of the needs, interests and values of the speaker. When another person is speaking, we are usually gathering our arguments and thinking up a rebuttal to the points we think the speaker are making.

Since we are not really listening, we do not really hear what the other person is saying. As soon as there is a break, we jump in to make the points we have been carefully planning in our heads. We cannot listen and think at the same time! At this point you are probably thinking that this sounds tremendously formal, as well as impossible and time consuming, and that in our busy health care environment there is no time for this level of interaction. In fact, this technique can be applied to every interaction without an additional commitment of time.

This approach may feel uncomfortable at first and it will probably take longer that your usual communication style. However, you will actually understand the underlying issues, which will enable you to address the correct problem rather than solving the wrong one. You will also understand what others are saying and they will understand you.

You will ultimately save time, decrease misunderstandings, errors and conflicts, and have better relationships. Unresolved emotion is a critical contributor to the development and exacerbation of conflict between health care professionals and between providers and patients. It has been reported that the ability to deal and cope with these issues changes as physicians proceed through their training. Residents express more frustration and confusion around ethical conflicts in their early years of training, and have reported that support from peers and other residents was most effective in helping them to deal with and resolve these situations.

While more senior physicians may become accustomed to dealing with ethical issues, the difficulty in handling the emotional tension surrounding ethical dilemmas remains a constant for all health care professionals. The emotional weight of decision-making is not shared with colleagues and is certainly never a topic for discussion at morbidity and mortality conferences, which routinely focus on the medical facts rather than the feelings of the patient or physician.

It is incumbent upon those responsible for postgraduate medical training to include study areas related to recognizing and effectively managing the emotional turmoil involved in ethical decision-making in the curriculum, as well as educational sessions and practical experience related to conflict resolution skills.

Just as crucial is the need for the topics of emotional responses to ethical dilemmas, the resulting moral distress and dealing with the conflict that arises from these issues to be understood and dealt with by those in positions of power within health care facilities and organizations. We have come to understand that moral distress occurs when health professionals know or think they know the ethically appropriate action to take, but are unable to carry it out for various reasons. Continuing to provide care to a terminally ill patient because the family is refusing to stop treatment is a common situation that creates moral distress for caregivers.

Improving collaboration and communication between and amongst care providers will allow for the positive management and resolution of these difficult situations.

Conflict Resolution Careers | University of Oregon School of Law

Providers may not agree at all times, and yet they can and must learn how to respect and support each other. Conflict is also created when medical errors occur. Albert Wu has identified the significant impact that critical incidents can have on health care providers.

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He notes that practitioners rarely receive the kind of support that is needed when an error is made. Health care professionals have difficulty providing emotional support to colleagues because they feel a need to stay dispassionate and detached. Empathizing with a distressed colleague makes people feel exposed and vulnerable to criticism from others. In addition, as Wu has pointed out, learning of the failings of others allows physicians to transfer or divest their own past errors, thereby making them feel less exposed. In addition to the factors noted above, there are other may other unique issues and situations within the health care environment that generate conflict.

Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively and encourage them to seek ethical consultation more frequently in assisting with the management and prevention of conflict. All of these factors combine to make health care environments particularly prone to conflict. It is therefore important for health care professionals and administrators to understand the origins of conflict and to develop strategies to manage the conflicts that they will experience.

In health care, the use of alternative approaches to conflict resolution has been slow to take hold.

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By and large, these methods have been variations on an adversarial theme, with the result that many parties, including patients, have been left out of the process. Many organizations are able to identify the direct costs of conflict, and consider them to be one of the costs of doing business. However, the indirect costs of conflict that exist in health care are hidden and often not recognized. The table below suggests just some of the indirect costs of conflict that are rarely quantified, although they are always in play.

Litigation e. Team morale effects e. Management productivity: time spent on resolving conflicts keeps managers from other work. Lost opportunities for pursuing capital purchases, expanding services, enhancing purchases. Patient condition can deteriorate due to delays in traditional dispute resolution approaches, creating increased costs for care than if disputes were handled more expeditiously.

Culture of poorly managed conflict causes fear; fear leads to non-disclosure and repeat errors; no learning takes place. Clearly, the ideas discussed above can be useful in improving health care environments and culture. A multi-faceted approach is often needed. The following steps can build conflict management strength within organizations.

Conduct an organizational conflict assessment Determine how your organization currently deals with conflict. Most organizations deal with conflict through avoidance, power plays, resorting to higher authorities or, less commonly, collaboration.

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An organization needs to determine which method or option is encouraged and rewarded. High-reliability organizations, that is, those with low rates of medical error, are more likely to use collaboration as the preferred problem-solving method. Organizations need to determine where they are now and where they want to be.

They must also identify the current resources available to assist with culture change and decide what extra resources will be required to move toward a culture of conflict management and positive collaboration. Design a conflict management system that incorporates prevention and early intervention as key components Staff and patients should have multiple entry points into the conflict resolution process; that is, there should be various ways in which a problem can be handled, including direct contact between individuals, access to senior management or human resources assistance and via identified internal conflict resolution mentors.

The process should be designed with loop-backs throughout. The nurse manager would encourage the patient to loop-back and discuss the matter directly with the physician. If this is unsuccessful, the patient could then access an internal mediator who could bring the parties together to discuss the situation.

Conflict Resolution Careers

Provide training in conflict prevention and management To ensure that staff, management and physicians are adept at managing conflict, organizations must commit resources to train everyone in basic conflict resolution and communication skills. This training must include opportunities for role playing and group exercises that give individuals practice in dealing with difficult situations. Talented internal individuals should be identified to receive additional training to act as internal conflict coaches and mediators. Maintain a roster of these individuals and ensure that their availability is widely known by staff and patients.

Provide ombudsperson services External ombudsperson services that can be easily accessed should be provided for those situations that cannot be resolved internally. Again this process should provide for a loop-back to the internal conflict coaches to complete the process if the external ombudsperson is able to resolve some of the outstanding issues. From a purely practical point of view, smaller facilities may find an external ombudsperson an economically preferable solution to trying to provide this service in-house.

Provide external mediation services as necessary A well-developed internal conflict management process should be able to handle most of the conflicts that arise. However, there will still be situations that require the assistance of trained, experienced health care mediators. The goal should always be that disputes will be handled internally, but people should also know that there is expert assistance available if required.

Summary of "The Handbook of Conflict Resolution: Theory and Practice (2nd Ed)"

We have looked at some of the myths that exist about conflict and identified realities of the nature of conflict. We have also identified where conflict comes from and the unique characteristics of health care that serve to generate conflict, and we have reviewed the direct and indirect costs of conflict to organizations. Now we turn our attention to the various ways in which individuals react when faced with conflict.

Each of us responds to conflict in a number of ways, and we all use various responses in different ways at different times and with different people. For example, we rarely respond to conflict at work in the same way that we respond to conflict at home. Our approach to a dispute with a colleague is often far different to our approach to a disagreement with a loved one. Once we understand the various approaches and responses that we may have to conflict, we can determine the approach that may work best and try to moderate those approaches that may not be effective.

Various experts have identified the ways that people respond to conflict. One tool that is widely used is the Thomas—Killman Conflict Mode Instrument, which identifies five ways in which people respond to conflict: competition, avoidance, compromise, accommodation and collaboration. In general, peoples response to conflict are determined by whether they are more concerned with maintaining or improving relationships with others or whether they are more concerned about themselves and their ability to win.

Each of the various styles is discussed below, with tips on when each should be used and the disadvantages of each approach. In most situations, the best outcomes are achieved when the parties involved in the problem work toward resolution in a collaborative way. Using collaboration means that the parties who are in conflict focus on the interests or needs that lie beneath the conflict, rather than focusing on the positions that individuals may be proclaiming.

The goal is to work toward a resolution that allows everyone to get what they need, not to try to win or defeat the other person. Interest-based or collaborative approaches include negotiation, mediation and, to a lesser extent, arbitration. When people speak of ADR they are usually referring to processes such as negotiation, facilitation and mediation, as opposed to the legalistic and adversarial approaches that are found in litigation. In addition to being more timely and cost-effective, using a collaborative, interest-based approach also allows the parties to maintain their relationships and create long-lasting, mutually satisfying outcomes.

Throughout this article we have discussed the importance of recognizing the inevitability of conflict and the advantages of understanding the nature of conflict and its origins. We have discussed the role of communication, provided some examples of the types of conflict that physicians are likely to experience and offered some strategies to enable physicians to become more competent in managing personal and professional conflicts.

If none of the information presented here has created an interest in understanding more about how to manage conflict, perhaps discussing the unquestionable connection between unresolved conflict and the risks to patient safety will provide the impetus needed. Despite the fact that most health care professionals are dedicated to providing high-quality, effective patient care, the predominating culture of most health care organizations is not one of safety but of fear.

Patients fear becoming one of the statistics of the unsafe system that they hear about in the media. Administrators fear bad publicity, lawsuits and increased insurance premiums. What this really means is that health care professionals fear being blamed and punished for making a mistake and, most of all, they fear being seen as incompetent. Fear creates anxiety and mistrust, which lead to communication failures and a lack of collaboration and teamwork. The inevitable result is high levels of conflict among and between health care professionals.

However, while conflict is a daily, often hourly experience for most health care professionals, it is rarely acknowledged and even more rarely dealt with. As a result, mistrust persists, anxiety grows and conflict increases—creating and perpetuating an unsafe culture.

In this climate of fear, doctors and nurses are loath to report their errors or even their close calls. All of this unspoken fear and anxiety creates an environment of disarray and dysfunction. This dysfunctional state leads to conflict within disciplines, between teams and between clients and care providers.

We know that poor-quality work environments lead to an increase in errors. On the other hand, we also know that positive working relationships within health care teams have a significant effect on the safety and efficacy of the care given to patients. While the experts in the field of patient safety have identified the need for culture change in order to improve patient safety, little has been written about the fact that a significant contributor to unsafe cultures is the presence of unacknowledged and unresolved conflict.

The point is that the organisation and the individual representing them is not being supportive or caring, however well meaning, by making suggestions or giving advice in situations where they have no defined professional role to play:. The use of summaries of what a party has said provide an acknowledgement of their concerns - as long as the summary does not include opinions about what they have said.

When agencies such as the Police and Local authority and other organisations that make up the Helping Professions are not clear about the boundaries to their roles, and this is reflected in the responses of the individuals who represent them, the following will result:. Awareness of both the organisation's boundaries and the Helping Professional's personal boundaries combine to provide an effective response to those who have difficulties that are not within the remit of the agency.

This sort of sounds obvious, but the lack of clarity over these boundaries is an enormous source of stress and wasted resources within the Helping Professions and a major cause of unnecessary dependence by members of the public on agencies to resolve their personal disputes for them. Comments Have your say about what you just read! Leave me a comment in the box below. A Guide to Effective Communication for Conflict Resolution introduces the 9 Principles that are also described on this site to help the reader develop a 'mindfulness' in relation to their communication in a way that supports the resolution of conflict.

In this book. Alan shares his observations and learnings from working as a Mediator and Conflict Coach with regard to the ways that people become stuck in unresolved conflict but also how they go on to create more effective ways forward in their difficult situations. A brilliant book and I will recommend it to everyone. It is refreshing to find reading material that informs and inspires and can provide a good resource for small organisations such as ours. We learned so much about how we listen and the consequences of not listening well that I was asked to purchase your book and have another Listening Meeting.

My team just launched a project that could have whipped the team members and executives into a tremendous conflict. I required everyone to follow your rules for listening and it has been the best implementation we have had in 10years. Thank you for your generous and comprehensive communications and conflict resolution information. It brings forward some very key points about the phenomenon of "bullying" which I have been pondering for some while.

How can this happen without implying that the recipient is somehow responsible for the bullying behavior? Allan Barsky's book entitled Conflict Resolution for the Helping Professions: Negotiation, Mediation, Advocacy, Facilitation and Restorative Justice is reviewed based on content, style, and relevance to the field of conflict resolution.

The third edition offers an expanded exploration of conflict resolution across practice settings, making it an instructive read for diverse professionals interested in learning how to best help others resolve conflict. Volume 56 , Issue 1. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username.

Family Court Review Volume 56, Issue 1. Michael Saini Corresponding Author E-mail address: michael. Read the full text. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access.