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This series of self-study lessons on Central Service topics was developed by the International Association of Healthcare Central Service Materiel Management (IAHCSMM). The lessons are administered by Purdue University’s Continuing Education Division.

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Lesson Plan CRCST 104
Managing Conflict
[Reprinted from Communiqué: January/February 2009]

Conflict is disagreement or opposition between persons or groups. Its results can be minor (example: a difference of opinion) or more serious (example: persons are incompatible). At the extreme, outright opposition can hinder the attainment of healthcare facility and/or departmental goals. In a labor-intensive healthcare facility with many departments employing numerous people conflict is almost inevitable. Reasons include:

• Increasingly limited resources
• Differing goals
• Role ambiguity (“Whose job is it?” “Who is responsible?”)
• Stressful working relationships
• Individual differences (diversity)
• Organizational issues
• Communication problems

A Central Service Manager’s ability to address conflict impacts the work environment and creates employee cooperation (and goal attainment) or conflict (and goal blockage).

Objective 1: Explain organizational benefits of conflict.

There are potential organizational benefits to conflict. Managers may more thoroughly analyze goals and the strategies to attain them to establish priorities. Differences of opinion and perspectives about work processes can lead to performance improvements as work tasks are discussed, reviewed, revised, and implemented. Another benefit: managers can practice and improve upon their decision-making and problem resolution skills as they manage conflict within their areas of responsibility.

As Figure 1 indicates, some observers believe conflict can actually contribute to optimal organizational performance.

When reviewing Figure 1, note the level of conflict is graphed on a line from “low” to “high.” As well, an organization’s level of performance can be graphed from “low” to “high.” A low level of conflict and performance yields stagnation, and when there is a high level of conflict and a high level of performance, chaos is likely. Figure 1 suggests that optimal organizational results occur at the intermediate point where the levels of conflict and performance cross.

Objective 2: Review five basic strategies to manage conflict.

A manager’s assertiveness (desire to meet departmental needs) and willingness to cooperate (desire to meet the other party’s needs) are factors that influence the selection of conflict management strategies. This relationship is illustrated in Figure 2.

When reviewing Figure 2, note the degree of cooperation ranges from “not cooperative” to “very cooperative” and the degree of assertiveness ranges from “not assertive” to “very assertive.” Five conflict management strategies become possible:

1. Strategy One: Avoidance (not cooperative; not assertive)
   
   The manager exerts little effort to satisfy either his/her own or the other person’s or department’s goals. Tactics include withdrawing from the situation, avoiding contacts with the other person, and refusing to discuss the situation creating the conflict. Problems with conflict avoidance include concerns that critical issues may go unaddressed, and issues can continue or even worsen.
   
   When might a conflict avoidance strategy be used? Examples include:
   
   • For unimportant issues.
   • When the manager knows he/she can’t “win” the conflict.
   • When other persons are judged able to more effectively resolve the conflict.
   • When there is an interest in reducing tension and stress.
   • When the issue is a symptom of rather than a problem itself.


2. Strategy Two: Accommodation (very cooperative; not assertive)
   
   Managers using this strategy attempt to achieve the other person’s or department’s goal rather than their own. This may be a useful approach when the other party is stronger, when the issue is judged unimportant by one party, or when the relationship with the other person or department is unimportant. Problems include limited creativity and a reduced interest in the search for solutions.
   
   Conflict accommodation can be useful when:
   
   • The manager knows he/she is wrong, wants to learn, and/or wants to be seen as reasonable.
   • Issues are more important to the other party, and use of the strategy will be viewed as cooperation.
   • The manager wants to help others learn from mistakes.


3. Strategy Three: Competition (not cooperative; very assertive)
   
   This strategy focuses only on attaining one’s goals. Tactics include the use of authority (power) and a reliance on rules and policies. It is useful when quick and decisive action is needed. Problems include affected relationships, limits to creativity, and a reduced search for solutions.
   
   Conflict competition might be useful:
   
   • When quick action is needed.
   • On important issues where unpopular actions must be implemented.
   • On vital issues when the manager knows he/she is right.
   • When a manager wants to use non-competitive behavior to gain benefit for his/her department.


4. Strategy Four: Collaboration (very cooperative; very assertive)
   
   This focuses on discovering a solution in the best interests of both parties. No assumption is made that both parties must give up something to gain something else. This strategy is typically time-consuming, and it may not be useful when issues involve the values of the parties attempting to resolve the conflict.
   
   Conflict collaboration can be useful:
   
   • To find a mutually beneficial solution when concerns of both parties cannot be compromised.
   • When the manager wants to learn.
   • To merge inputs from persons with different views.
   • To gain commitment.
   • To improve feelings which have previously affected relationships.
   
   
5. Strategy Five: Mutual Problem-Solving (multi-strategy method)
   
   This strategy, like collaboration, focuses on solutions in the best interests of both parties. It is often accomplished through “fixed sum” negotiation: each party gains and loses something. This creates a problem as
   managers realize they must give up something to gain something.
   
   Mutual problem-solving may be useful:
   
   • When goals are important but not worth the potential disruption of more assertive tactics.
   • When the other party has equal power and is committed to mutually beneficial goals.
   • To attain temporary settlement of a complex issue.
   • To generate a useful solution when time is critical.
   • As a back-up when collaboration or competition is not successful.
   • When alternative conflict resolution strategies are planned.

Objective 3: List steps to mediate conflict between employees

Central Service Managers who effectively manage conflict contribute to departmental efficiency.

Sometimes talking with affected employees individually is useful, especially when the conflict is complicated or serious. Avoid “jumping to conclusions” and keep an open mind as conversations and meetings about the conflict evolve.

Six steps to manage a discussion of employees involved in conflict can be followed:

Step 1 – Set the tone. Establish an open and non-threatening atmosphere for the meeting. A statement, “I’ve noticed something seems to be different between you two lately, and I hope it’s something we can discuss” is better than “I know there is a problem, and we must address it now.”

Step2 – Focus on discovering the employees’ feelings. This can help staff members release their emotions and clear the way for an effective solution. Allow employees to “talk out” their feelings and then summarize and re-state them for re-clarification. Avoid any indication of approval or disapproval about what is said, and do not question, criticize, interpret, or sympathize. Employees asked to express themselves frequently become encouraged to start talking, and it becomes easier to move from emotions and feelings to reasons and solutions. Effective managers know they must first deal with emotions.

Step 3 – Obtain the Facts. Fact-finding involves patient listening, careful review and clarification, and listening for “what is not said.” Depersonalize the conflict by addressing it as if it could occur with anyone. Ask affected employees to pretend they are managers trying to discover what has contributed to the conflict, and ask each employee to think about how the other person may have seen the situation.

Step 4 – Ask for help. Conflicting parties should be asked to help resolve the conflict. This tactic is typically much better than “telling employees what they should do” to resolve it. Employees will be more willing to resolve the conflict because their self-esteem needs will be addressed. Lead the employees toward future actions. It is each employee’s responsibility to resolve the conflict; a manager can only facilitate discussion, add suggestions, and secure commitment for conflict resolution.

Step 5 – Obtain a commitment. After agreement, ask the employees to commit to performing their part of the solution. This can typically be accomplished with an oral statement about the “who,” “what,” “when,” and “how” of the resolution plan.

Step 6 – Follow-up. Schedule a follow-up meeting to assure that the solution has been implemented and is working. If the conflict continues, determine possible reasons and address them. Sometimes managers must have their own plan ready, review it with the employees, and inform them that this alternative will be necessary if conflict resolution is not possible.

Objective 4: Present eight best practices to manage conflict.

A best practice is a way of performing an organizational function or process that is better than all other methods. The term typically applies to procedures used by organizations, but it can also be applied to suggested behavior for individuals. Best practices to resolve conflicts must recognize that resolution strategies should confront the conflict itself rather than the other person. Remember that the problem—not the other person—is the “enemy.” All parties work for the same organization, are concerned about it, and want their employer to improve. They cannot add value to the organization when they are in conflict with another team member.

Effective Central Service managers use the following best practices to manage organization conflict:

• They are aware of how they typically handle conflict.
• They determine whether subconscious, procedural, or psychological needs are impacted by the conflict. Note: thinking about what will happen if the conflict is not addressed may help to clarify one’s needs.
• They assess the “mechanics” for conflict resolution efforts including “who,” “what,” “where,” “why,” and “when,” and the ground rules for effectively managing the situation.
• They know it is critical to understand the other person before they are “understood” by the other person. In other words, they listen carefully to understand the other person’s point of view.
• They clearly assert their needs. They are specific, respect the needs of the other party, build on what they learn, and continue listening.
• They are flexible as they identify the issues, generate alternatives, and determine how challenges will be addressed.
• They recognize that impasses may occur that must be managed. Tactics include breaking a resolution process into manageable parts, restating or considering new options, reaffirming the “ground rules” for the conflict resolution process and, sometimes, taking a break and returning to the issue at another time.
• They build workable agreements. This most frequently occurs when all affected parties assist with implementation, when realistic action steps are taken, and when the agreement is future-oriented.

Objective 5: Discuss how trust impacts conflict management.

Trust relates to the beliefs and expectations about another person based upon one’s experience. Staff members who trust their superiors are more self-assured, open, willing to take risks and accept change, and they are more aligned with the facility and the department in which they work.

Trust encourages collaboration (win/win conflict resolution) and creativity. The best Central Service Managers build and maintain trust. They are ethical, dependable (consistent and reliable), fair, loyal, and competent. They admit mistakes, acknowledge, as necessary, the need for their own personal improvement, and request feedback (and consider it!) in efforts to improve. They share information useful to others and openly acknowledge the help of their associates. They also change their position when confronted with a “better” idea, and they are considerate of how others will react to their recommendations.

When genuine trust is ingrained into an organizational culture, there is typically an increased willingness to resolve conflict in a manner beneficial to both parties and, in the process, to the organization and the departments within it. Healthcare organizations most effective in building and maintaining trust are ethical and socially responsible, and they provide high-quality and on-going training and development opportunities for their staff members. The best facilities also provide job security, and they promote open communication up, down, and across the organization.

In Conclusion

Conflict in healthcare organizations can yield positive outcomes especially when Central Service Managers utilize “best practices” of conflict resolution. As well, an organizational culture that emphasizes trust of and respect for staff members at all levels is important to assure that conflict benefits rather than hinders the attainment of organizational goals.

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