Conflict Management Skills

1. Conflict, and its precipitating events in the health sector.

2. Measures for preventing, mitigating and handling conflicts.
3. Prevention of Workplace violence

Conflicts in the workplace are natural and bound to occur when you have people
of different backgrounds and perspectives working side-by-side. Workplace
conflict occurs when there's a disagreement amongst employees due to opposing
interests, personalities, beliefs, or ideas. Given the sheer amount of workplace
conflicts that arise every day in healthcare, conflict management is quickly
becoming one of the most sought-after skills. Conflict can begin when one person
or group believes that another person or group has harmed or taken anything of
value to the first group or has not dealt with me in a fair manner. Conflicts are an
inevitable part of every system and healthcare is no exception.
Conflicts can be placed under two major labels: Functional and Dysfunctional
conflicts. A conflict that promotes individual and group goals and improves
performance is classified as a functional conflict, whereas conflict that harms
individual or group performance is defined as a dysfunctional conflict.
Dysfunctional conflicts can sometimes assume a destructive form. It is hard to
define which conflict comes under which category and hence, when evaluating
the influence of conflict on goal achievement, individual perspective and the
effect of group performance should be taken into account. Depending on whether
the disagreement helps to higher performance, it should be categorized as
functional or dysfunctional.

Conflicts must be resolved as soon as possible due to their negative consequences

on the teams’ performance. If not managed promptly, conflicts can exacerbate a
hostile work environment, increasing absenteeism and employee disengagement.
There have been instances where conflicts have become so severe that a
department's operations have come to stand still. Another school of thought
believes that conflicts can help people come up with new ideas, stimulate friendly
rivalry, and foster a sense of brotherhood. However, this is only achievable in the
rarest of circumstances, where ideas are communicated effectively and authority
and responsibilities are delegated well within the organization.
Conflict can cause a breakdown in the regular functioning of a facility, and
interfere with decision-making procedures, making it harder for an individual or
group to choose an action option. Competing demands on an individual or group
rivalry and competitiveness may be the cause of the collapse. Hostility, negative
attitude, violence, and gross misunderstanding are all examples of conflict. It
occurs as a result of individuals' or groups' differing interests.
The common sources of conflicts between individuals are-
● Personal goals of conflicting individuals ( for eg. conflict in your goals
and your colleague's goals)
● Difference in likes, dislikes, values and interests
● Competition (professional/personal)
● Rivalry
● Shared resources
● Scarcity of resources like- power, position, opportunities, influence,
materials, space etc.
● Task Interdependence
● Difference in perception and values
● Personal style of the conflicting individuals
● Poor communication
● Role conflict / Role expectation (usually at the personal front)
● Conflict in the Job demands & personal demands or values

Conflict and its precipitating events in the health sector:

If we look into the conflicts present in the healthcare setup, conflicts can occur
between doctors, doctors and staff, staff or the health care team, and the patient
or patient's family. Conflicts can range from minor skirmishes to huge disputes
that could result in litigation or violence. Productivity, morale, and patient care
are all harmed by conflicts. This may result in limiting team contributions,
obstructing efficiency and ultimately, affecting the quality of care provided to
patients.

In healthcare, you may experience conflict with the following-

1. With your fellow colleagues, who enjoy the same rank as yours and have
rights much similar to yours. A lot of time you will experience conflict with
your fellow professionals over disagreements on day to day functioning of
the department, and division of responsibility. There may be conflict due to
the drastic unequal distribution of rights and opportunities. Conflicts can
also arise when issues needing attention are not addressed timely and are
either brushed under the carpet or are just parked as unimportant.

2. With your team members, who are not of the same rank but expect you to
treat them fairly. When your team is not satisfied with the way they are
treated, they are likely to get into a passive or passive-aggressive way of
handling issues and tasks. Such conflicts lead to sabotaging and delayed
progress and should be managed at the earliest.

3. With patients and their attendants who look up to you and your team for a
level of care and attention. When dissatisfied, they may get in conflict with
you or your team. Patients today are far more aware of their rights and are
quite vocal about it. They expect to be treated respectfully and cordially.
Any aggressive or disrespectful behavior towards them can precipitate
conflict and aggressive reaction. They expect prompt availability of services,
medicines and timely reporting of staff on duty. Any delay or
mismanagement can end up in conflict.

4. With your higher-ups, who are not satisfied with you or your team’s
performance or if there is a conflict of interest or approach. One of the
common reasons for conflict with the higher-up is when you are not able to
develop a good rapport with them and are not able to align your
functioning to their expectations.

5. In public health, you may experience conflict with the community leaders, if
you don’t enjoy a good rapport with them or if there is a conflict of interest.
Working in a community setup requires collaboration with community
leaders and resources. It is helpful to take the community leaders on board
and ask them to promote the objectives of your healthcare facility
Miscommunications and clashes of viewpoints are common in these interactions,
which eventually lead to disputes. In a worst-case scenario, conflicts can result in
violent outbreaks which could be hidden or open in nature.

There can be the following associated factors aggravating conflict: 

1. Preceding conditions of conflictual behavior, such as resource scarcity,

workload, and uncomfortable working conditions.
2. Individuals' emotional states, such as stress, tension, aggression, anxiety, and
so on.
3. Individuals' cognitive state, which includes faulty perceptions, awareness, and
conflictual circumstances.
4. Aggressive behavior, which can range from passive resistance to outright
aggression. Aggressive behavior of the doctor can affect the morale and team
spirit of the team and create a stressful environment, for example, in an operating
room a berating physician behavior can result in higher staff turnover and a
dysfunctional team. Staff may hide information for fear of an outburst, and
communication is weak. The information suppressed could be critical to the
patient's health. The physician may become isolated as a result of a lack of
support from his or her colleagues. Retaliation may occur if the problem is severe,
and it can take various forms: failure to appropriately assist, or even purposeful
sabotage. There is a need for intervention before conflict enters this phase.

Measures for preventing, mitigating, and handling conflicts:

There is a saying - a stitch in time saves the nine. Preventing, mitigating and
handling conflicts at the earliest can help minimise the damage. Creating and
maintaining a healthy work environment with the opportunity to come and speak
to you directly will give you an idea of the real-time situation.

Policies and Practices that can prevent conflicts:

1. Open door policy- encourging everyone to come and openly express their concern
2. Quick address of complaints and requests
3. Fair and transparent way of functioning
4. Fair handling of disciplinary cases
5. Valuing everyone’s contribution
6. Healthy and respectful workplace environment
7. Patient-centric functioning
 8. Valuing employees' safety and welfare
9. Creating cooperative synergy
10. Creating an environment of approach and problem solving than avoidance

Different approaches that can prevent and mitigate conflict in any workplace-
Collaborating: Collaboration strategy entails one party attempting to work with
the other cooperatively to solve a problem for mutual gain. The technique entails
identifying areas of dispute, digging further into the problem, and coming up with
a practical solution that benefits both parties. When two sets of solutions are
required for both parties to be compromised, this technique is used. As a result,
finding an integrated solution has become critical. This strategy denotes
collaborative work, mutual benefit, and integrated solutions reached by mutual
agreement. Collaboration takes a lot of time and effort. The strategy aims to find
win-win solutions to its objectives.
Accommodating: In accommodating mode, a person sacrifices his interests to
serve the interests of others. It is a sort of selfless charity in which one submits to
the viewpoint of another. When the other person's point of view is stronger, you
want to gain goodwill and demonstrate that you are reasonable. This conflict
resolution approach is helpful if you want the other person to provide at a later
time when it is more convenient for you. Those who score high on
accommodating may diverge too much from the preferences of others and pay
little attention to their thoughts and concerns, despite the fact that they may
understand they are not getting the attention they deserve. Individuals low on
accommodating should consider whether they lack others' goodwill and whether
others regard them as unreasonable, inflexible, dogmatic, and demanding.
Compromising: Compromise is a mode in which both sides endeavour to find an
expedient, mutually acceptable solution that partially sacrifices both parties in a
conflict situation. There is no clear winner or loser when it comes to
compromising. None of the parties is completely satisfied since they ration the
aim of the conflict and accept a compromise that neither of them finds
satisfactory. When people compromise, there's a risk of creating a
'gamesmanship' attitude at work. There's also the risk of compromising on certain
ethical values, which isn't ideal. While compromising, the organization's values,
ethics, ideals, and long-term goals must be protected. When people are unwilling
 to compromise, it is difficult for them to make compromises and a power struggle
ensues, which must be avoided.
When a collaborative plan fails, compromise policies are easy to implement.
According to research, people are born with a predisposition to deal with conflict
in specific ways. Individuals, in particular, have preferences among the five
conflict resolution strategies. Their preferences are fairly stable, and a person's
intentions may be fairly accurately predicted using a mix of intellectual and
personality qualities. When confronted with a conflict situation, some people
want to win at all costs, while others want to find the best solution, others want
to flee, and yet others want to "split the differences."
Prevention of Workplace Violence:

1. Train the staff in effective communication- Violence in healthcare is another

safety hazard both for the patient and the staff. In most cases, the reason for the
violence is communication failure or misunderstanding due to communication
failure. When the hospitals fail to communicate effectively with the patients and
their families, patients are unhappy and frustrated. The patient party expects care
providers to answer their questions and explain to them about the illness,
treatment, prognosis, duration of treatment etc. They want someone to clarify
their doubts and reassure them of the outcome.

Their concerns need to be addressed and questions need to be answered. All this
requires time, effort and arrangement from the healthcare team. We need to
keep additional time to counsel and explain to the patient’s family. When the
hospital staffs are not able to understand the communication need of the patient
party, it leads to disappointment and aggressive reaction. It also affects the
mental health of the patient and adds to their stress.

It becomes difficult to work in a stressful environment. Patient healing gets

affected. It interferes with the recovery and outcome of the treatment by directly
influencing the efficacy of the treatment. The likelihood of errors in patient care
could increase with an environment of distrust and disrespect for each other. All
efforts should be made to avoid a situation where the patient and staff are not
happy working with each other. It is helpful to train and sensitize the staff to
 effective communication with the patient party. In general, courteous and
respectful behavior is helpful in creating an image of a good healthcare facility
and sends a message to behave well with hospital staff.

2. Create robust security protocol: Security personnel should be trained to deal

effectively with incidents involving workplace violence. Conflicts between hospital
employees and patients/patients' relatives can be handled by security personnel.
Violence against doctors has become increasingly common in India recently, and
there is an urgent need to address this issue. Security personnel are the first line
of defence for your employees' safety, and they must respond quickly to regain
control of the situation before it worsens.

3. Set up a no-tolerance policy: The first step in preventing workplace violence is to

stand firm and denounce any instances of workplace violence. It is the
responsibility of management to ensure that employees' safety comes first.
Establish policies and practices for dealing with such disputes and ensure that
they are enforced. Any assault on the hospital staff should be taken seriously and
reported to the police for appropriate and timely action.

4. Train staff: Staff training on how to respond to any type of workplace violence can
help to improve communication channels. Creating a plan of action, in case of
violence and educating the staff about the same can help mitigate the situation.
Training programs to educate employees on their rights and responsibilities
provide a platform for them to voice their grievances and can help prevent
violence amongst the staff. This also promotes a healthier workplace
environment in which your employees realize that their rights will not be violated
and know how to respond when such situations do occur.

5. Setup security cameras and other preventive technologies in prone areas: For a
variety of reasons, any organization should invest in a good closed-circuit video
system. Installing cameras and providing metal detectors and crowd control devices
to security personnel can assist diffuse any issue before it becomes out of hand.
While investigating a workplace violence incident, CCTV camera footage can also be
used as evidence. Ensuring proper light and safety all across the hospital is helpful
in preventing assault and violence in isolated areas.

Being aware of the possibility of conflict and being able to mitigate it at the
earliest is what keeps the ball rolling. As a team leader, you need to keep an eye
on the issues and people that can precipitate conflict and manage it promptly.