Managing team conflict assertively and responsibly
2. Identify four categories of conflict
3. Identify the steps of win–win conflict resolution
4. Contrast win–win, lose–win, and win–lose methods of handling team conflict
5. Identify the characteristics of multigenerational team members and their impact on the team
6. Participate in selected exercises to build assertive conflict-resolution skills
Definition of conflict
Conflict can be a source of personal and organizational stress by the very nature of nurses’ work (Vivar, 2006). Conflict, often seen as “bad,” is a natural part of interactions and, when effectively addressed, improves interpersonal relationships and can promote organizational growth (Chadwick, 2010). A longitudinal study of 53 college student teams indicated that conflict management “has a direct, positive effect on team cohesion and moderates the relationship between relationship conflict and team cohesion as well as that between task conflict and team cohesion” (Tekleab et al, 2009, p. 170). Conflict may be viewed as a feeling, a disagreement, a real or perceived incompatibility of interests, inconsistent worldviews, or a set of behaviors (Mayer, 2000). Conflict arises when interdependency exists, and conflict resolution is necessary to build positive relationships with others as well as to meet our own needs. Whenever two people come together, there is the potential for conflict. Conflict can occupy 30% of a manager’s time (Marick and Albright, 2002). Although conflict is inevitable, it can have advantageous outcomes when it is handled in assertive and responsible ways. Conflict resolution can build interdependence and professional collaboration and help team members better address the big-picture issues.
Building positive co-worker relationships, teamwork, and collaboration supports clear communication, which has a direct impact on patient safety. The integration of communication skills and teamwork training in schools of nursing and in the workplace supports this effort (Beckett and Kipnis, 2009; Chapman, 2009; Clark, 2009; Corless et al, 2009; McKeon et al, 2009; Thomas, 2009). The Institute of Medicine’s report on medical errors concluded that “as many as 98,000 people die yearly in the United States because of preventable medical errors . . . a startling 70% of these preventable medical errors result from poor communication between healthcare providers” (Kohn et al, 2000, as cited in Lamontagne, 2010, p. 54). The Joint Center for Transforming Healthcare (Zhani, 2010) reports an “estimated 80% of serious medical errors involve miscommunication between caregivers when responsibility for patients is transferred or handed-off.” In their Hand-off Communication Project participating hospitals found that more than 37% of hand-offs were defective, preventing the receiver of the information from safely caring for the patient. After implementing targeted solutions to the hand-off communication, the result was a 52% reduction in defective hand-offs.
Cushnie (1988) identifies four categories of conflict intensifying in degree of difficulty from first to last: facts, methods, goals, and values.
Methods
Conflicts about methods are differences about how something is done. A conflict about methods occurs when there is no absolute standard shared by all parties affected by the issue. Resolving conflicts of this kind includes acknowledging that there is more than one way to accomplish the same goal or task. A way to minimize this type of conflict is to establish criteria for method selection.
Values
Differences in belief systems are the most complex type of conflict, and a high level of motivation is required from involved parties to understand each other’s beliefs. If the parties can avoid the divisiveness of allocating others’ viewpoints to rigid categories of “right” or “wrong” and find compatible goals, they are on their way to conflict management (Cushnie, 1988).
Several forms of conflict are seen (Kinder, 1981):
• Intrapersonal conflict occurs within an individual.
• Interpersonal conflict occurs between two individuals or among members of a group.
• Intragroup conflict occurs within an established group.
This chapter focuses on interpersonal conflict in a workplace or school setting.
Healthcare teams are composed of people with many different backgrounds. A variety of professional outlooks are found in a team of nurses, physicians, clergy, nutritionists, occupational and physical therapists, social workers, and others. In addition to the differences in socialization of these professionals, they carry personal views based on sex, age, cultural origin, socioeconomic situation, and life experience. This potpourri is a potential source of conflict in any healthcare team.
This variety results in different perceptions about an issue and the role and obligations each should fulfill. When team members do not agree about a situation or their respective roles, then the potential for conflict is great.
Team members often have different (or opposing) ideological views about a given situation. Their views may come from having different objectives or from endorsing different priorities among the objectives. Conflict results when team members do not agree on what to do, how to do it, and when to do it. Review Chapter 5 for the stages of group behavior. Remember that group conflict is healthy and expected in the storming stage.
Conflict-resolution approaches
You know you cannot avoid conflict. What you can avoid is feeling impotent or uncomfortable when you encounter situations involving conflict. By now you are familiar with assertive and responsible communication. These approaches can help you resolve conflicts in constructive ways.
Resolving a conflict means acting in such a way that an agreement is reached that is acceptable, and even pleasing, to both parties. If both parties cannot agree on a resolution, the conflict will continue. When conflict drags out and team members do not see a hopeful resolution, then helplessness prevails. Any healthcare team that is stuck in this hopeless situation is not working at its full capacity. Harrington-Mackin (1994) advises dealing with conflicts in a timely way and suggests that most people find it difficult to openly discuss and work through conflicts. Instead, they accumulate grudges and use techniques such as procrastination and sniping to “get even.” Client care and morale suffer when conflicts remain unresolved.
The win–win approach to conflict resolution requires you to be assertive and responsible. This approach results in a solution with which you and your colleagues are happy. Not only is the outcome satisfactory, but adopting a win–win approach uses your full creativity and often results in a unique and innovative resolution.
The lose–win approach is one in which you allow your colleagues to resolve the conflict at your expense. Either you are not happy with the outcome or you permit your colleagues to walk all over you. This approach is nonassertive and irresponsible.
The win–lose approach is the opposite of the lose–win approach. You may resolve the conflict in a way that is satisfying to you, but in the process you bulldoze over the rights of your colleagues. This approach is aggressive and irresponsible.
Any win–lose/lose–win approach creates forces that aggravate the struggle and do little to discover constructive solutions acceptable to all involved. A conflict is more constructive when the outcome is satisfying to all the participants than when it is satisfying to only some. Conflict at some point is inevitable, so it helps to know how to use it as an opportunity to be constructive—because the alternatives have unpleasant consequences.
A win–win conflict management strategy covers each of the following steps (Flanagan, 1995):
1. View the problem in terms of needs (what is required) instead of solutions (what should be done) to facilitate a mutual problem-solving approach; detach yourself from biases and stay focused on the actual data.
2. Consider the problem as a mutual one to be solved, requiring the active involvement of all affected persons.
3. Describe the conflict as specifically as possible, using undistorted data.
4. Identify the differences between concerned parties before attempting to resolve the conflict.
5. See the conflict from another point of view.
6. Use brainstorming to arrive at possible solutions instead of adopting the first or most convenient idea.
7. Select the solution that best meets both parties’ needs and considers all possible consequences.
8. Reach an agreement about how the conflict is to end and not recur.
9. Plan who will do what and where and when it will be done.
10. After the plan has been implemented, evaluate the problem-solving process and review how well the solution turned out.
Table 28-1 summarizes three different approaches to conflict. The assertive, responsible attitude toward conflict and approach to conflict resolution is contrasted with the nonassertive, irresponsible approaches.
Table 28-1
Assertive/Responsible versus Nonassertive/Irresponsible Ways of Handling Team Conflict
CHARACTERISTIC WIN | WIN–WIN LOSE | LOSE WIN–WIN | WIN–LOSE |
Attitude toward conflict | Assumes conflict is inevitable and occurs whenever people work together | Assumes conflicts are sent to try us | Sees conflict as a challenge to be won |
Assumes that conflict can be managed so that creative solutions are achieved | Assumes that in a conflict the other person always wins | Considers that manipulation is needed to win conflicts and that it is never ceasing and thinks fighting is required to get what you want | |
Assumes that controversy involves everything in the issue and increases members’ commitment | Assume that it is a foregone conclusion that the plan to resolve the conflict will satisfy only others | Believes the other person is trying hard to win | |
Assumes that conflict can be resolved in ways that are satisfying to all team members | Wonders why there must be conflict in the workplace | ||
Approach to conflict resolution | Employs a systematic problem-solving approach | Decides in advance that the other person will win and gives up | Keeps fighting with biased information that supports his or her own viewpoint |
Data collection | Examines his or her own thoughts and feelings objectively | Prematurely closes data collection | Seeks, examines, and submits only data that support his or her own desired resolution |
Listen emphatically to colleagues’ points of view | Assumes it is hopeless to collect data because of an irrational belief that others will win regardless | ||
Seeks relevant information from appropriate resources (literature, consultants) | Dwells on how bad things will be if the conflict is not resolved | ||
Shares knowledge of the conflict with all others involved | Passively participates in information sharing | ||
Remains objective | |||
Assessment | Formulates an accurate definition of the conflict | Defines the conflict in terms of how it affects colleagues | Does not seek out colleagues’ assessments of the conflict |
Shares assessment with colleagues | Defines conflict from his or her own point of view | Overwhelmingly argues for his or her own assessment of the conflict | |
Acknowledges colleagues’ perceptions of the conflict | |||
Resolution generation | Considers resolutions that satisfy all involved | Contributes little to this planning because of the assumption that the winner will tell the loser what to do | Only considers or supports plans that agree with his or her own interpretation of the conflict |
Chooses resolutions that maximize the benefits and minimize the drawbacks | Sabotages plans that oppose his or her own view | ||
Evaluation | Maintains vigilance to ensure that resolution continues to satisfy self and colleagues on the team | Complains that resolution could never be successful; disgruntled | Ignores the fact that others are not satisfied with the resolution |
Assertive and responsible ways to overcome conflict
On healthcare teams, conflict can involve all members or only a few. How to manage conflict using a win–win approach in both these instances is explored.
Conflict situation involving the whole healthcare team
1. Before you can do anything to resolve a conflict, you need to fully understand the conflict, including your own thoughts and feelings about the situation as well as the thoughts of your colleagues. If you try to resolve a conflict without completing an assessment, you will probably overlook an important factor that could result in an unsatisfactory resolution.
Example: You believe that clients have the right to be informed about any untoward side effects they might experience when taking a prescribed medication. On your unit, few clients are told in advance of the potential side effects. This omission is incompatible with your beliefs about good nursing care and client rights. You discover that many of your colleagues, including the other nurses and physicians on your team, prefer to keep knowledge of side effects from clients so that they will be more likely to take the medication. Here the conflict is incompatible activities (informing versus not informing) and incompatible beliefs about clients’ rights (autonomy versus dependency).
2. To fully understand your side of the conflict, you need to examine your own thoughts and feelings. You cannot complete this step in a hurry. You need to sit down (with paper and pencil if necessary) and discover your answers to the following questions:
What is it about this conflict that bothers me?
In considering the conflict you might have some of the following thoughts:
• “It bothers me that clients are not warned about side effects that might result from the medications.”
• “It’s not right that they don’t have full knowledge of the treatment and that they are taking the pills without fully understanding the implications.”
• “I believe that it is dishonest to withhold information about side effects from clients.”
• “I believe that people have the responsibility to decide what they should do about their health. By withholding information, we are keeping the control of clients’ health in our hands.”
Answering this question makes it clearer what the conflict means to you. You have a strong belief that clients should be given the information they need to make the best decision about what health behavior to adopt.
Our initial reaction to a conflict situation is often influenced more by emotion than by intellect. The tension or anxiety creates a fight-or-flight stress response, and the intensity of the stress response varies in relation to the degree of threat perceived (Cushnie, 1988). Taking time to sort out your emotional reactions as you just did helps you control your emotions and increases your effectiveness in conflict management.

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