Managing Conflict in Rehabilitation

Original Editor - Mandy Roscher Top Contributors - Mandy Roscher and Tony Lowe

Introduction

Conflict is an inevitable fact of life. Where two or more people come together there will be the potential for conflict. Learning how to effectively manage conflict is a helpful skill. Identifying the cause of conflict and the various strategies of how to deal with conflict will enable you to be a strong team leader or manager. Conflict resolution in healthcare is especially important. A conflict that develops during the provision of healthcare services can result in serious consequences such as litigation.[1] Appropriate conflict management can also help to prevent staff burnout[1]

What is Conflict

Conflict has been defined as “an expressed struggle between at least two interdependent parties who perceive incompatible goals, scarce rewards, and interference from the other party in achieving their goals”[2]

Conflict can occur in any situation and in the healthcare environment it has been particularly noted in situations where there is not enough staff, people feel overloaded in their responsibilities, they are uncertain of their exact role and there is ambiguity with a scope of practice.[3] Conflict is usually seen as something that is negative but when channelled correctly conflict can be beneficial, useful and promote growth.[4]

Common Causes of Conflict[5] [6]

It is often helpful to recognise the root cause of conflict as this an essential step in the conflict resolution process[3]

Psychologists Art Bell and Brett Hart describe 8 common causes of conflict

1. Conflicting Resources

Resources can be anything from stationery to money to office space. When there is competition for available resources conflict is possible.

2. Conflicting Styles

Everyone has different personalities and ways of doing things. Conflicting styles can create animosity between 2 parties

3. Conflicting Perceptions

Peoples evaluation of a situation can be different. People beliefs are also different. These different perceptions can become a cause of conflict.

4. Conflicting Goals

Goals that are not aligned can be a major source of conflict.

5. Conflicting Pressures

Conflicting pressures are very similar to conflicting goals where conflicting pressures involve immediate and urgent tasks whereas conflicting goals are more long term

6. Conflicting Roles

When there is an uncertainty of who should perform what role and when conflict may arise.

7. Different Personal Values

Everyone has their own unique set of personal values. Being asked to perform a task at work outside of your personal ethical standards can be an example of conflict arising from different personal values

8. Unpredictable Policies

Confusion and change can be catalysts for conflict. When rules or policies are constantly changing or there is uncertainty around policies conflict is inevitable.[1]

A Leaders Role in Conflict[3][7]

There are different roles one can play when managing conflict. Conflict can be viewed as a continuum with situations that may start off as a mere disagreement and could escalate to a dispute then legitimate conflict and eventually to a crisis situation.[6] Different conflict management styles are more helpful in various stages of the continuum.  Negotiation is normally the first step. This is where both parties come together to work towards a mutual agreement.[1] Mediation involves a third party that helps to control the situation so that both parties can give evidence and provide witnesses if needed. The mediator is an unbiased third party who helps both parties come to a mutually agreed-upon settlement. Often mediation is not enough and then it would move towards arbitration. Arbitration is still a process that is outside of the judicial court system. Both parties agree upon an arbitrator and the arbitrator comes to a decision. Both parties agree to abide by the arbitrator’s decision and it becomes a binding contract. Finally, if the situation is in full crisis litigation may be required.

The Outcome of Conflict[6]

Any settlement that is reached will fall into one of the 3 following categories

1. Win-Win

This is the settlement that is most desirable. In win-win situations, both parties feel as if they have benefited from the agreement. This is the best outcome for fostering good future relationships and is normally achieved through co-operative negotiations.

2. Lose-Lose

A lose-lose situation is where neither party receives a desirable outcome and both may need to make compromises or sacrifices. While it may not be the most desirable outcome there is often a sense of fairness in lose-lose situations that can be important in the maintenance of the relationship.

3. Win-Lose

This is probably the least desirable outcome from a conflict situation. In this scenario, one party leaves satisfied and the other unsatisfied. This mismatch is undesirable as the relationship between the parties can be negatively affected by the uneven result.

Thomas-Killman Conflict Model[8]

The Thomas-Killman Conflict Model shows 5 different styles of dealing with conflict. The styles are categorised by their level of assertiveness and co-operation. Assertiveness is the extent to which someone is interested in their own concerns and co-operation is the extent to which someone is interested in other concerns.

One person does not only use one type of style. At some point, each of the 5 styles will have to be used. People do tend to have a preference and this often depends on their personality type and level of emotional intelligence. Of the 5 different styles, compromise and collaboration are seen to be the optimal conflict resolution style.[4]

1. Competing

A competing conflict resolution style is someone who is very assertive and is mostly interested in themselves and their outcome to the detriment of the other party.  They are not very interested in co-operation with the other party. They can be quite persuasive and decisive

2. Collaborating

A collaborative individual is both assertive and co-operative. They explore a conflicting situation and aim for a shared solution working with both parties.

3. Compromising

Compromise falls between assertive and co-operative. Fairness and equality are very important in a compromise situation, The outcome of a compromise is ideally a win-win situation but a lose-lose situation is also acceptable as it embodies the principle of fairness.

4. Accommodating

An accommodating individual gives in to the other party and is extremely co-operative normally t the detriment of themselves. Sometimes an accommodating resolution style can be effective when the goal is to build a relationship and the outcome of the disagreement is not so important.

5. Avoiding

Avoiding is neither assertive nor co-operative. This is someone who actively avoids conflict no matter the cost. They may avoid hoping it resolves spontaneously or to simply postpone awkward situations and discussions. This is often the conflict resolution style that can create the most tension and damage to relationships. Avoiding may be effective in situations to prevent further escalation of a conflict situation when the relationship is not as important.

Conflict Management Process

Conflict, left to fester can result in a toxic environment. The conflict management process outlined below is an example of a process to follow if you are involved in a conflict situation. It begins with identifying all the parties involved and the root cause of the conflict. You need to then decide if the separate parties can be engaged with together or separately. Together is always the prefered environment so as to prevent he-said-she-said situations known as triangulation[6]. Involving both partied is imperative to resolving conflict. It has been shown that when individuals, were not consulted or included in decision making the conflict resolution process, was obstructed[3].

Once you have decided on the above the 6 step process below can help to control the situation and allow optimal conflict resolution.[6]

  1. Clarify the Purpose of the Meeting
  2. Set Ground rules
  3. Explore the Issues
  4. Brainstorm Solutions
  5. Agree on Next Steps
  6. Identify Support

Self Reflection

Self Reflection post-conflict management is always helpful. It allows you to gain a better understanding of the situation and develop future conflict management skills.[3]  If you have facilitated the process as a negotiator, mediator or arbitrator it can be helpful to look back on what the outcome of the conflict management process was, evaluating what went well, what could have been better, analysing the process as thinking of what you could do differently next time.

References

  1. 1.0 1.1 1.2 1.3 Forbat L, Barclay S. Reducing healthcare conflict: outcomes from using the conflict management framework. Archives of disease in childhood. 2019 Apr 1;104(4):328-32.
  2. Hopkins MM, Yonker RD. Managing conflict with emotional intelligence: Abilities that make a difference. Journal of Management Development. 2015 Mar 2;34(2):226-44.
  3. 3.0 3.1 3.2 3.3 3.4 Almost J, Wolff AC, Stewart‐Pyne A, McCormick LG, Strachan D, D'souza C. Managing and mitigating conflict in healthcare teams: an integrative review. Journal of advanced nursing. 2016 Jul;72(7):1490-505.
  4. 4.0 4.1 McKibben L. Conflict management: importance and implications. British Journal of Nursing. 2017 Jan 26;26(2):100-3.
  5. Mind Tools. 8 Causes of Conflict. Accessed 01/12/2019https://www.mindtools.com/pages/article/eight-causes-conflict.htm
  6. 6.0 6.1 6.2 6.3 6.4 Giesbrecht J. Conflict Management in Rehabilitation Presentation Slides. Physioplus 2019
  7. Clay-Williams R, Johnson A, Lane P, Li Z, Camilleri L, Winata T, Klug M. Collaboration in a competitive healthcare system: negotiation 101 for clinicians. Journal of health organization and management. 2018 Apr 9;32(2):263-78.
  8. Gatlin J, Wysocki AF, Kepner K. Understanding conflict in the workplace. University of Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, EDIS; 2002.