conflict

HCM 502 – module 6 - Critical Thinking: Healthy Conflict Resolution (100 Points)

First read Case Study 14-7, Healthy Conflict Resolution, on page 322 of Organizational Behavior in Health Care.

Write a paper that addresses the following questions:

· What is the conflict?

· What is the basis/cause of these conflicts?

· If you were the manager in this case, how would resolve the situation?

Your well-written paper should meet the following requirements:

· Be 4-6 pages in length, not including the required cover and reference pages

· Formatted according to Saudi Electronic University and APA writing guidelines

· Provide support for your statements with in-text citations from a minimum of three scholarly articles from peer-reviewed journal articles.

Conflict Management

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ID ---------

HCM 502 – Organizational Behaviors and Human Resources in Healthcare

Saudi Electronic University

Dr.

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Conflict Management

Working in healthcare organizations revolve around different healthcare workers in which conflicts could happen. Conflict occurs when there is incompatibility or disagreement over issues between social entities (Rahim, 2010). Disagreements can be too intense in which fight or flights principles are pushing people to their extremes (Nelson, 2012). Conflicts may range from simple disagreements to major arguments that may lead to violence (Ramsay, 2001). In healthcare, they can affect work productivity and patient care. Unresolved conflicts can result in high employee turnover. The effects resulting from conflicts in healthcare can be negative or positive. Organizations often decide to encourage the conflicts within their departments as a way of improving work productivity and competitiveness (Turkalj, Fosić & Dujak, 2008). Constructive conflict can improve decision making and creativity among employees (Zakari, Al Khamis & Hamadi, 2010).

A conflict can challenge healthcare workers to improve their work or suppress their abilities and decrease work productivity. For example, interpersonal conflict is a daily challenge for healthcare workers in projects, competitions, controlling resources or reacting to opposing opinions (Wilmot & Hocker, 2001). If a conflict arises continuously in a healthcare organization without proper management and resolution, it may be negative to the organization and indicating a loss of quality or a decline in competitiveness among healthcare workers (Apipalakul & Kummoon, 2017). Efforts to improve health care services and patient experience depend on effective teamwork jeopardized by conflict and communication barriers between physicians and others (Zwarenstein & Reeves, 2002). A proper conflict management and resolution need to be implemented in healthcare organizations.

This script is describing a conflict case study between a receptionist named Cindy with Dr. Jones a senior physician in hospital-owned multispecialty group. Dr. Jones decided to leave work early and asked Cindy to reschedule his afternoon appointments. Many patients were waiting to see him for more than three months. His clinic was cancelled twice in a month which led to double booking of appointments. He informed Cindy that she can control the situation and to tell them he was called for emergency. Cindy was upset and called her supervisor. The situation was escalated to higher authorities. After several weeks, they returned to work together. Dr. Jones was labeled as disruptive physician and Cindy was unwelcomed in any departments because physicians were afraid of her targeting them. This script is defining conflict, causes of conflict and conflict management and resolution to the mentioned case study.

Analysis of Conflict

Interpersonal conflict is the interaction of personal or functional human factors in an organization (Bercovitch, 1983). Definitely, each individual is different from others and people are not identical. Dr. Jones is different from Cindy in personality, work and thoughts. Being a senior physician can bring an attention to his qualities and skills but still a conflict has occurred due to their different thoughts, attitudes, standards and needs. Each individual has a role to do in a healthcare organization which involves Dr. Jones as a senior physician and Cindy as a receptionist. In workplace, there are scopes of practice and work expectations that need to be fulfilled with great performance. However, the role of Dr. Jones was incomplete to meet work expectations and patients’ needs which led to functional conflict to occur. Physicians need to be aware of professional code of ethics, follow healthcare policies and adhere to clinical practice guidelines for better healthcare delivery (Cabana et al., 1999).

Interpersonal disagreements between people can lead to disruptive actions and negative outcomes (Burnett, 1993). An affective conflict occurred when Cindy realized that Dr. Jones was leaving the clinic asking her to reschedule appointments for patients who were waiting more than three months to see him. Her disagreement was based on ethical considerations of patients’ rights and healthcare standards of the hospital. Affective conflict is considered disruptive and causing frustration (Myers & Anderson, 2008). Awareness about code of ethics will guide physicians’ clinical practices and will encourage them to work in professional manners to decrease the influence of conflict (Zakari, Al Khamis & Hamadi, 2010).

Dr. Jones was continuously cancelling his confirmed appointments and leaving clinic early which indicates it is also a relationship conflict. A relationship conflict is an emotional conflict related to disagreement derived by interpersonal incompatibilities that involves personality, attitudes, respect and honesty (Zhang & Zhang, 2012). A relationship conflict can repeatedly occur in interactions resulting in dissatisfaction and decrease performance (Zhang & Zhang, 2012). His frequent negative behaviors have a clear negative affect on Cindy in which she was angry and immediately called her manger. To maintain good teamwork and positive patients’ experiences, strong conflict management and resolution strategies are needed once conflict occurs.

An observation of an employee violating policies, not adhering to hospital standards or not fulfilling job requirements need to be documented and discussed to find solutions. Then, to be escalated properly to supervisors for investigations and interventions if all previous attempts of conflict resolution failed. Persistent violation of policies and leaving work early can lead to disruptive conflict in workplace. Dr. Jones issue of leaving work early and not attending to patients’ needs should be brought to attention earlier and discussed by Cindy. The process of the compliment will determine the succeeding steps that will be taken to resolve the complaint and start proper conflict management. Cindy realized enough is enough when Dr. Jones decided to leave work and asked to reschedule afternoon appointments of patients waiting to see him more than three months. She called her manager and informed her about the situation. The process of compliant would be better if Cindy and Dr. Jones talked and discussed. Cindy didn’t say no to him and didn’t share her concerns and insist to inform him about the necessity of attending to patients’ needs. Both didn’t have clear communication and understanding that led to the stated conflict. Poor communication usually occurs when there is ineffective interactions and challenging behaviors from individuals participating in the communication process (Pérez, 2010).

Causes of Conflict

Effective communication is essential to prevent conflict from happening and poor communication often creates conflict (Emmarex & Owuze, 2015). The conflict between Dr. Jones and Cindy could be resolved in early stage but poor communication was the main issue. Cindy didn’t share her concerns and didn’t say anything to Dr. Jones when he said “I’m sure you will be able to smooth things over. Just tell them that I got called to an emergency.” Dr. Jones expect Cindy to control the situation while she was not accepting it and called her manger to report him. Professional communication and discussion should be established to clarify priorities and work duties.

Another cause of conflict is the stress that Cindy is experiencing. Stress, tension and anger all can simply feed the conflict process (Fisher, 2000). Unhealthy response to conflict is anger. She was upset and angry about Dr. Jones leaving work early several times until she decided to call her manger and complain. The high tension she was experiencing led her to have emotional outburst. It was a stressful situation when she had to inform the patients that their appointments will be rescheduled. Cindy could use her problem-solving skills and assert her views rather than escalating this issue while being angry. According to Nelson (2000), avoiding confronting physicians will lead to high level of stress. This could lead Cindy to be reluctant due to his position. Stress management would help Cindy to overcome her stress at work and encourage her to use her problem-solving skills.

Unawareness of professional code of ethics, clinical practice guidelines and healthcare policies can have negative effect on patients’ outcomes and quality of care. Physicians’ adherence to clinical practice guidelines have a common barrier that is lack of awareness which affect their behaviors, attitudes and knowledge (Cabana et al., 1999). Dr. Jones informed Cindy to tell them that he was called to an emergency. Dr. Jones behavior could be understood here as a barrier to adhere to clinical practice guidelines and professional code of ethics. Health ethics are standard roles of clinical practice to provide safe and high quality of care to patients. Awareness and proper education about ethical principles need to be applied in healthcare settings for better implementation and effective clinical practice. According to Yaghobian, Kaheni, Danesh & Abhari (2014), it is important for physicians and healthcare providers to improve their knowledge about patients’ rights and to attend classes about ethics to gain the required knowledge for future situations.

The process of compliant taken by Cindy is another cause for worsening conflict between Dr. Jones and Cindy. This issue should be addressed appropriately with Dr. Jones but it was escalated from Cindy’s manager to the chief medical officer, the executive director of the clinic, the director of HR and the union representative before Jones was ever made aware of it. It is quite easy to identify that the conflict is not necessarily problematic, but the way in which individuals or organizations deal with it may be (Garmel, 2008). Conflict has a certain tendency to be escalated that it becomes more intense and has involved some unresolved issues (Fisher, 2000). Even though, they continued to work together but their relationship was irreparable. He was labeled as disruptive physician and she was unwelcomed in any department because physicians were afraid of her targeting them. Temporary solutions to their conflict were possibly implemented by the high authorities in the hospital for a while but the conflict was not solved. Intensity of the conflict may be moderate for periods of time but the issues remained and triggering events induce their behaviors and beliefs with negative consequences. Consequently, Cindy resigned and Dr. Jones believed he was betrayed and unappreciated.

Conflict Management. Conflict resolution skills are important for a successful patient care (Garmel, 2008). Conflict management depends on effective communication between Dr. Jones and Cindy. Robert Bolton (1979), proposes a simple process for conflict resolution which consist of three levels: respect the other person, listen until you experience the other side and state your needs. A manager who knows how to manage the conflict between Dr. Jones and Cindy would ensure effective conflict resolution by mutual respect, effective listening and open communication with each other.

Thomas and Kilmann (1974), presented a matrix showing five different responses to conflict based on assertiveness and cooperativeness which include: avoiding, accommodating, compromising, competing and collaboration. The best response to the conflict between Dr. Jones and Cindy is collaborating. It is a win-win strategy which is characterized by high assertiveness and high cooperativeness. It helps in learning, finding solutions and integrating perspectives to conflict (Garmel, 2008).

Blake, Shepard & Mouton (1964), offered three approaches to deal with conflict which include: win-lose, lose-lose, and win-win approaches. The win-win approach is a sensible and regular attempt to achieve the goals of both parties through cooperative problem-solving techniques (Fisher, 2000). This approach would help Dr. Jones and Cindy to resolve their conflict. This approach emphases on the needs of both parties, problem definition, analysis and development of consensus decisions and agreeable solutions (Fisher, 2000). Dr. Jones and Cindy can work together toward common goals which will emphasize on the quality of their long-term relationship in workplace. By implementing win- win approach, their communication will be open and direct toward safe patient care delivery. Their attitudes and behaviors will be directed positively toward cooperation, trust and acceptance rather than complaints, suspicions and anger.

Counseling sessions with Dr. Jones are required to address the issue of not working as mandated by the hospital. The counseling sessions will be opportunities to provide an explanation of his behaviors. Open communication and discussion will allow Dr. Jones to express his thoughts freely to the manager. Counselling sessions with Cindy is also required to understand her needs and express her feelings and thoughts freely. Any opportunity for communication and sharing thoughts is an important step to solve problems related to conflict (Garmel, 2008). Effective communication is extremely needed to the process of conflict resolution (Garmel, 2008).

Creating medical forums for honest discussions in healthcare settings would help in identifying any similar issues that physicians are practicing. Honest discussions with physicians and healthcare providers is important in conflict resolution (Skochelak et al., 2016). Medical forums should be intended for physicians, healthcare workers and receptionists. Agenda of medical forums should include open communication about reasons of leaving work early or arriving late and the cancellation of appointments. Managers need to investigate similar issues and need to put action plans to be implemented. Supervision strategies of working hours could be implemented to track healthcare workers’ attendance. Healthcare organizations can implement fingerprint technologies to ensure proper employee attendance (Shahnewaz , 2015). Implementing fingerprint technologies would resolve the conflict between Dr. Jones and Cindy earlier and would prevent any similar issues from happening.

Dr. Jones’s lack of motivation to adhere to full working hours need to be considered. Effective motivation leads to effective high quality of patient care. A motivational plan is need for Dr. Jones to encourage him to realize his goals for better performance (Plunkett, Allen, & Attner, 2013). Herzberg’s Two-Factor Theory would be a good motivational theory which assess factors of Dr. Jones’ job dissatisfaction. Herzberg’s theory is based on a two-dimensional model of factors which are hygiene factors and motivational factors. Motivational factors that can cause job satisfaction are achievements and recognition (Herzberg, Mausner, & Snyderman, 1959). Motivation and job satisfaction will be achieved by recognizing Dr. Jones’ achievements, contributions and prior accomplishments.

Improving communication will promote patient safety and quality of healthcare services (Zakari, Al Khamis & Hamadi, 2010). For effective conflict resolution, healthcare organizations must create a positive environment that encourages open communication (Verma, 1998). Open communication should be encouraged to help Dr. Jones and Cindy to be more neutral for better conflict resolution. Verma (1998), stated that “Being clear about expectations about what is wanted, as well as why and when it is needed, ensures that communication is successful.” (p.10).

Awareness of hospital policies, clinical practice regulations and health ethics are needed to provide safe and high quality of healthcare services to patients. Proper education about patients’ rights and ethical principles need to be applied in healthcare settings for better implementation and effective clinical practice. Dr. Jones need to adhere the hospital’s policies and to be aware of professional code of ethics. It is important for physicians to improve their knowledge about patients’ rights and obtain education about ethics to gain the required knowledge for future situations (Yaghobian, Kaheni, Danesh & Abhari, 2014).

Conclusion

Working in healthcare organizations revolve around different healthcare workers in which conflicts could happen. This script is describing a conflict between a receptionist named Cindy and Dr. Jones. The conflict between them is analyzed based on given factors. Their conflict is described as relationship interpersonal conflict. Causes of their conflict are poor communication, unawareness of professional code of ethics, nonadherence to hospital policies, improper complaint process, stress and anger. Healthcare organizations must encourage proactive conflict management approaches (Zakari, Al Khamis & Hamadi, 2010). An effective conflict resolution should be applied by manager. Approaches of conflict resolution are applying collaborating conflict response, win-wing strategy, counselling sessions with Dr. Jones and Cindy. Also, establishing medical forums to discuss similar incidents to Dr. Jones. In addition to, creating motivational plan to Dr. Jones based on Herzberg’s theory. Moreover, improving communication skills and awareness of patients’ rights and code of ethics. Applying proper conflict resolution is a skill to be obtained. Fisher (2000), stated “The conflict is seen as a problem to be solved rather than a war to be won”. (p.5).

References

Apipalakul, C., & Kummoon, D. (2017). The Effects of Organizational Climate to Conflict

Management amongst Organizational Health Personnel. Procedia-Social and Behavioral

Sciences, 237, 1216-1222.

Bercovitch, J. (1983). Conflict and conflict management in organizations: A framework for

analysis. Hong Kong Journal of Public Administration, 5(2), 104-123.

Bolton, R. (1979). People Skills: how to assert yourself, listen to others, and resolve conflict.

New York: Touchstone.

Burnett, R. E. (1993). Conflict in collaborative decision-making. Professional communication:

The social perspective, 144-162.

Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P. C., & Rubin,

H. R. (1999). Why don’t physicians follow clinical practice guidelines? The Journal of the

American Medical Association, 282(15), 1458–1465. doi: 10.1001/jama.282.15.1458.

Emmarex, O. E., & Owuze, C. A. (2015). Managing Organizational Conflicts: A

Phenomenological Study of Nurse/Physician Conflicts in Nigerian Hospitals and their

Impact on Managed Care Delivery. Journal of Educational Research in Natural and

Social Sciences, 1(1), 170-181.

Fisher, R. (2000). Sources of conflict and methods of conflict resolution. International Peace

and Conflict Resolution, 1-6.

Garmel, G. M. (2008). Conflict Resolution in Emergency Medicine. Philadelphia: Saunders.

Herzberg, F., Mausner, B., & Snyderman, BB (1959). The Motivation to Work (2nd ed.). New

York: John Wiley & Sons.

Mckay, K., & Narasimhan, S. (2012). Bridging the gap between doctors and nurses. Journal of

Nursing Education and Practice, 2(4), 52.

Myers, S. A., & Anderson, C. M. (2008). The fundamentals of small group communication.

London: Sage Publications.

Nelson, H. W. (2012). Dysfunctional health service conflict: causes and accelerants. The health

care manager, 31(2), 178-191.

Pérez, M. T. (2010). Interprofessional Conflict: A Preventive Health Approach to Ineffective

Communication in Nurse-Physician Relationships. Retrieved from:

https://dlib.bc.edu/islandora/object/bc-ir:102170/datastream/PDF/view

Plunkett, W. R., Allen, G. S., & Attner, R. F. (2013). Management: Meeting and exceeding

customer expectations (10th ed.). Mason: South Western Cengage Learning.

Rahim, M. A. (2010). Managing conflict in organizations. (4th ed.). London: Transaction

Publishers.

Ramsay, M. A. (2001). Conflict in the health care workplace. Baylor University Medical Center.

Proceedings,14(2), 138 – 139.

Shahnewaz, M. (2015). How does a Fingerprint Time Clock Eliminate Time and Attendance

Fraud? Retrieved from: http://www.m2sys.com/blog/workforce-management/how-does-

a-fingerprint-time-clock-eliminate-time-and-attendance-fraud/

Skochelak, S. E., Hawkins, R. E., Lawson, L. E., Starr, S. R., Borkan, J., & Gonzalo, J. D.

(2016). Health Systems Science. Philadelphia: Elsevier Health Sciences.                  

Thomas, K. W. (1974). Thomas-Kilmann conflict mode instrument. New York: Xicom.

Turkalj, Ž., Fosić, I., & Dujak, D. (2008). Conflict management in organization.

Interdisciplinary management research, 505-515.

Wilmot, W. W., & Hocker, J. L. (2001). Interpersonal conflict. New York: McGraw-Hill.

Yaghobian, M., Kaheni, S., Danesh, M., & Abhari, F. R. (2014). Association between Awareness

of Patient Rights and Patient’s Education, Seeing Bill, and Age: A Cross-Sectional study.

Global journal of health science, 6(3), 55.

Zakari, N. M., Al Khamis, N. I., & Hamadi, H. Y. (2010). Conflict and professionalism:

perceptions among nurses in Saudi Arabia. International nursing review, 57(3), 297-304.

Zhang, Q., & Zhang, J. (2012). Conflict types, resolution, and relational satisfaction: A US-

China investigation. Journal of Intercultural Communication Studies, 21(3), 41-52.

Zwarenstein, M., & Reeves, S. (2002). Working together but apart: Barriers and routes to nurse–

physician collaboration. The Joint Commission journal on quality improvement, 28(5),

242-247.