[Introduce concept of conflict as being neither “good” nor “bad.”]
Conflict is generally understood to be defined by various authors as:
A clash in individuals’ or groups’ values, differences in beliefs, attitudes, and expectations (Conerly and Tripathi, 2004)
More than simple disagreements: Conflict arises from a strong sense, a feeling of incompatibility. It represents an escalation of everyday competition and discussion into an arena of emotional or even hostile encounters that puts a strain on personal or interpersonal tranquility, or both (Scott, 1990).
Conflict can be a strategic tool when addressed appropriately, and it can actually serve to deepen and develop human relationships (Porter-O’Grady, 2003).
Some of the first authors on organizational conflict (Blake & Mouton, 1964), for example, claimed that a complete resolution of conflict might not even be desirable and may in fact thwart the stimulation of growth and change for the better.
Why study conflict?
To maximize strengths within groups
To learn more about why individuals within groups choose/need conflict at some times more than others
To produce better outcomes, including patient-care related goals
Increasing our knowledge of the role stress plays within conflict is critical. Our society is known for being particularly stressful and stress-producing. We already know that stress leads to fatigue, which can lead to an increase in medical errors. Our culture within health care, furthermore, has been built upon a tradition of secrecy, shame, and blame when it comes to our failure to prevent medical errors.
Gender differences exist and may explain at least in part why women are known for either avoiding or using compromise and why men may be known for aggressive techniques…none of which may completely solve a conflict.
Finally, our knowledge of the aeronautic, military, and submarine industries and the recent SBAR communication tools they have spawned (see IHI website for additional information on SBAR) have focused on toolkits characterized by clear, succinct exchanges of information. Their widespread use is based on the premise that a stressful situation is more likely to lend itself to conflict and negative patient outcomes. Think about the last time you tried to convey information to a physician about a patient’s status: How did you feel? Were you anxious/nervous? Did you forget some critical details that you remembered too late? Was the physician hearing/acting upon what you were saying? Why or why not?
Frustration: Remember, when people or groups perceive that their goals may be blocked, they feel frustrated. This frustration may escalate into a stronger emotion, such as when people become angry or just give up. Have you ever seen someone get angry over nothing? If you have, then you have seen a misunderstanding, based on someone’s inability to gauge the situation accurately. Suppose you did not discuss the patient’s treatment plan/care plan with him or her and (this happens frequently, unfortunately) when the patient does not carry out his or her part of the plan, you label this patient as “noncompliant” and feel frustrated that the patient is uncooperative, when in all likelihood, the patient had a completely different set of priorities at the start from those of the nurse. At the same time, the patient may view the nurse as controlling and insensitive. When such frustrations occur, it is a cue to stop and clarify the nature of major differences and make sure everyone is “on the same page.”
Conceptualization: I like the idea of the “snapshot” image; for example, when we see or are confronted with something, our mind forms a mental judgment about what actually happened. Everyone involved has an individual interpretation of what the conflict is and why it is occurring. Most often, these interpretations are different and involve the person’s own perspective, which is based on personal values, beliefs, and culture.
Regardless, conceptualization forms the basis for everyone’s reactions to the frustration. The way the individuals perceive and define the conflict has a great deal of influence on how creative those involved may be in trying to resolve the problem and what type of outcomes can come about.
For example, within the same conflict situation, some individuals may see the conflict itself as very threatening and may label everyone involved as “insubordinate” and become so angry at the threat to their role that they fall back on rigid adherence to policy and procedure.
Others may view conflict as trivial bickering and become critical of everyone involved, as in, "We've been over this subject already. Why can't you just drop it?" and complain or withdraw.
One can think about and consider many things when selecting an approach to resolving conflict: nature of the differences, underlying reasons, importance of the issue, strength of feelings, commitment, and goals involved. Preferred and previously effective approaches can be considered, but they need to match the situation. Not everyone has the same experiences nor the memory of the same conflict!
Sometimes, a third party may be introduced into a conflict so that mediation can occur. Mediation is a learned skill for which advanced training and/or certification is available. The mediator is usually an impartial helper who assists each party in the conflict to better hear and understand the other. Mediation is not so easy. In our American society, for example, much focus is placed on who can control whom with a lot of emphasis on winning. The successful individual involved in conflict resolution and negotiation often moves beyond winning, and even beyond avoidance, accommodation, and compromise, which are more about trying not to disturb the status quo.
In the nursing practice arena, often an added difficulty occurs in negotiating conflicts when at least one of the parties, which has historically been the physician when it comes to quality of care issues, is viewed to be (or views himself or herself) on an unequal or uneven playing field.
