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Dr. Krupesh Thacker
“Conflict is a process that begins when
     an individual or group perceives
   differences and opposition between
  him- or herself and another individual
or group about interests, beliefs, or values
        that matter to him or her.”
     (De Dreu, Harinck, & Van, 1999; Wall & Callister, 1995)
occurs in routine life
Conflicts

Different person different personality

Changing health care system – increased
interaction- more chances of conflicts
Effects-positive& negative
education of nurses
Increased

More rights/responsibilities in patient’s treatment

Difficult for physicians to accept such autonomy

May find difficulties to trust diagnosis by nurses

Nurses feel stress and job dissatisfaction

Affect the nurse-physician relationship

Conflict may occur
Framework for the assessment of conflict
      The components are PEPRS:
    Parties involved
    Events/issues (goals, behavior)
    Power
    Regulation of conflict(limiting factors,
   solution used)
    Style of management
FORTE (1997)          JEHN (1995)

    Interpersonal        Task content
                    



    Intrapersonal        Emotional
                    



    Inter group          Administrative
                    



    Intra group

Latent  conflict : conditions present; but not
recognized
Perceived conflict : perceive the occurrence
 Felt conflict : take matter seriously, but will not
react openly
Manifest conflict : reflects emotions in the behavior
Conflict aftermath : solved and a new working
relationship is established
 Individual characteristics
    values, education, age, demography
 Interpersonal factors
    trust, respect, communication
 Organizational factors
    interdependence
stress
Job

Negative Emotions

Absenteeism

       to leave
Intent

Medical Errors

Reduced productivity

Patient’s safety

Avoidance

       dissatisfaction
Job
“Conflicts are cracks in a broken system, but they
        can also be source of creativity”

    Strong relationships


    New better ways


    Decrease stress


    Increase work capacity


    Increase productivity

Avoidance
   Frequently used by nurse & physician
      Positive               Negative

Postpone the matter   Delayed decision

Save time             Patient’s safety

To withdraw           Interpersonal
                      relations
Diplomatic            Communication lack
Emotional type of conflict


    Save time and let both of them (physician-

    nurse) handle the problem
    Should judge the exact time to interfere in the

    matter, if required
Pressing

         difference
Power

 Overestimate self/other’s power

 Underestimate self/other’s power

Nurses feel insulted, mental stress, job
dissatisfaction, negative emotions
To deal with emotional type of conflict


    Keep a close watch , so whenever required

    he/she can settle the issue
Accommodation
       importance to other’s wish
More

To avoid unpleasant disputes

In past nurses used more frequently

Study on 354 professional nurses in

    Thailand in 2000
    41.2% used accommodation
    29.2% used compromising approach
Often uses this method


    Give physicians what they want


    Maintain good relations


    May become avoidance or pressing for the

    nurses due to accommodation between
    manager and physicians
Compromising
 Both should compromise
 Good interpersonal relations


According to the study on 126 nursing
 students, undergraduate and
 graduate students used
 compromising approach followed
 by avoidance
Collaboration


“Nurses  and physician working
together cooperatively to achieve
shared problem solving, conflict
resolution, decision making,
communication and coordination”
Collaboration

     better way
New

No compromise

Mutual respect

Satisfaction

              attitude
Co-operative

Increase work capacity

Improve patient’s safety
Study : in 5 hospitals on 75 physician & 54
head nurses; collaborating method is chosen
more frequently by nurses & least frequently
                by physicians

 Improving collaborative communication has
   benefits of increasing patient survival,
shortening length of hospital stay, enhancing
 professional relationships, staff satisfaction.
safety is directly proportional
Patient’s

  to the physician-nurse communication
  that decreases medical errors

       understand the severity of the
Must

  effect of their conflict on patient’s
  life as well as hospital’s productivity
Collaborative approach is beneficial for

    physicians, nurses as well as patients
    Manager should try to use this approach to

    deal with physician-nurse conflict
approach is the best
Collaborative

Physician should understand

  & accept the change
Attain conflict resolution training program

Training improves conflict management skills

  in professional as well as personal life

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Nurse-Physician Conflict Management

  • 2. “Conflict is a process that begins when an individual or group perceives differences and opposition between him- or herself and another individual or group about interests, beliefs, or values that matter to him or her.” (De Dreu, Harinck, & Van, 1999; Wall & Callister, 1995)
  • 3. occurs in routine life Conflicts Different person different personality Changing health care system – increased interaction- more chances of conflicts Effects-positive& negative
  • 4. education of nurses Increased More rights/responsibilities in patient’s treatment Difficult for physicians to accept such autonomy May find difficulties to trust diagnosis by nurses Nurses feel stress and job dissatisfaction Affect the nurse-physician relationship Conflict may occur
  • 5. Framework for the assessment of conflict The components are PEPRS:  Parties involved  Events/issues (goals, behavior)  Power  Regulation of conflict(limiting factors, solution used)  Style of management
  • 6. FORTE (1997) JEHN (1995) Interpersonal Task content   Intrapersonal Emotional   Inter group Administrative   Intra group 
  • 7. Latent conflict : conditions present; but not recognized Perceived conflict : perceive the occurrence  Felt conflict : take matter seriously, but will not react openly Manifest conflict : reflects emotions in the behavior Conflict aftermath : solved and a new working relationship is established
  • 8.  Individual characteristics values, education, age, demography  Interpersonal factors trust, respect, communication  Organizational factors interdependence
  • 9. stress Job Negative Emotions Absenteeism to leave Intent Medical Errors Reduced productivity Patient’s safety Avoidance dissatisfaction Job
  • 10. “Conflicts are cracks in a broken system, but they can also be source of creativity” Strong relationships  New better ways  Decrease stress  Increase work capacity  Increase productivity 
  • 11. Avoidance Frequently used by nurse & physician Positive Negative Postpone the matter Delayed decision Save time Patient’s safety To withdraw Interpersonal relations Diplomatic Communication lack
  • 12. Emotional type of conflict  Save time and let both of them (physician-  nurse) handle the problem Should judge the exact time to interfere in the  matter, if required
  • 13. Pressing difference Power  Overestimate self/other’s power  Underestimate self/other’s power Nurses feel insulted, mental stress, job dissatisfaction, negative emotions
  • 14. To deal with emotional type of conflict  Keep a close watch , so whenever required  he/she can settle the issue
  • 15. Accommodation importance to other’s wish More To avoid unpleasant disputes In past nurses used more frequently Study on 354 professional nurses in Thailand in 2000 41.2% used accommodation 29.2% used compromising approach
  • 16. Often uses this method  Give physicians what they want  Maintain good relations  May become avoidance or pressing for the  nurses due to accommodation between manager and physicians
  • 17. Compromising  Both should compromise  Good interpersonal relations According to the study on 126 nursing students, undergraduate and graduate students used compromising approach followed by avoidance
  • 18. Collaboration “Nurses and physician working together cooperatively to achieve shared problem solving, conflict resolution, decision making, communication and coordination”
  • 19. Collaboration better way New No compromise Mutual respect Satisfaction attitude Co-operative Increase work capacity Improve patient’s safety
  • 20. Study : in 5 hospitals on 75 physician & 54 head nurses; collaborating method is chosen more frequently by nurses & least frequently by physicians Improving collaborative communication has benefits of increasing patient survival, shortening length of hospital stay, enhancing professional relationships, staff satisfaction.
  • 21. safety is directly proportional Patient’s to the physician-nurse communication that decreases medical errors understand the severity of the Must effect of their conflict on patient’s life as well as hospital’s productivity
  • 22. Collaborative approach is beneficial for  physicians, nurses as well as patients Manager should try to use this approach to  deal with physician-nurse conflict
  • 23. approach is the best Collaborative Physician should understand & accept the change Attain conflict resolution training program Training improves conflict management skills in professional as well as personal life