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Managing Through Conflict Harnessing the Energy and Power of Change
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Mary Henrikson, MN, RNC
Managing Through Conflict Harnessing the Energy and Power of Change anet was fuming. This was the third time in a row she’d gotten up to answer a patient’s call light while Betty, her colleague, just sat there, not even bothering to look up from her charting to see which patient was calling. As Janet marched down the hall she thought about how she would, again, probably end up working overtime because she needed to finish charting. It seemed like Betty was always leaving right at the end of the shift because she focused only on getting her own work done versus pitching in and helping everyone so they all could leave on time. By the time Janet got to the patient’s room she was even angrier. “What do you want?,” she sputtered as she threw open the door. The patient’s eyes grew wide and she timidly stated, “Uh, I think the bleeding is worse. I just wanted someone to check it.”
Conflict Management Conflict. Even the word can make us cringe. Conflict itself is not a bad thing. Any time a group of people work, or play, together, conflict is bound to happen. How we manage conflict determines whether we have a positive or negative working environment. Unmanaged conflict will fester and permeate every aspect of the work environment, including interactions with colleagues, other health care professionals, and our customers, particularly our patients. For example, if you’re finding that patient satisfaction scores in your unit are lower than they were previously, you may have unresolved conflict within your unit. In the scenario above, Janet’s anger over her belief that she will now have to work overtime because of Betty’s unwillingness to help spilled over to her interaction with the patient. It’s Mary Henrikson, MN, RNC is the Director of the Prentice Women’s Hospital, Northwestern Memorial Hospital, Chicago, IL. August 1998
naive to think that the patient won’t remember this situation when she fills out the patient satisfaction survey or when she describes her hospitalization to her friends. Long-term conflict can wear on those involved or close to it. Going to work becomes a chore instead of the pleasure it should be. Symptoms of units in conflict may include an increase in sick calls, lack of teamwork in patient care and unit projects, decreased productivity, decreased communication between staff, and increased aggressive confrontation, avoidance behavior, or both. As the conflict continues and word of the poor working environment spreads through the institution, an increased turnover of staff and inability to recruit transfers to the unit are real possibilities.
Energy 81Creativity Conversely, conflict that is dealt with can be turned to the advantage of the unit team. When conflict is managed, cohesiveness and effectiveness are increased. Because conflict stimulates interest and energy, it often fosters creativity, which can result in better ideas and more innovative solutions. Better decisions are reached when people share their points of view and bring them together through consensus. When involved in conflict management, team members will develop their articulation and argument
skills and learn to extract precise meanings from the information they receive, leading to better communication and outcomes.
Responding to Conflict Janet and Betty are obviously experiencing conflict (even if Betty is oblivious to it). What should happen next? Response to conflict can take different forms. The most common, and destructive, is avoidance: repressing our feelings or physically removing ourselves from the situation. Janet has been avoiding dealing with her conflict with Betty. The obvious outcome is that the conflict grows and festers. A second response is diffusion or “cooling off.” Diffusion is different from avoidance because the intent is to return to the conflict after one has had time to bring emotions under control. It’s a postponement. Problems occur when the postponement turns into avoidance. In addition, if the intent is to remove all the emotion from the conflict, it can backfire, because emotion is what makes the conflict real and important. A third response is aggressive confrontation. This is a “take it on, solve the problem!” approach in which the parties involved go head to head in a struggle to resolve their differences. If at least one of the parties is not exceptionally skilled in communication techniques, the outcome may be increased anger and escalating conflict. The fourth response is to engage in collaborative negotiation in which a problem-solving process is used. This is a learned approach that takes time, with the emphasis on a “win-win” result for all. In other words, a solution is derived that is acceptable to everyone. To be successful in collaborative negotiation, follow these guidelines: Include only those people involved directly in the conflict Set aside a time when interruptions won’t occur AWHONN Lifelines
Working Through Conflict I ..............................................
6enerate stternate solutions. Ask the person for possible sobtions to the defined problem. Use this as a brainstorming session. In other words, don’t evaluate any solution until all possible options are on the table. Try to generate a number of solutions.
few minutes generating a list of solutions. They decide to irnplement changes and create a plan of action. They agreed to implement the plan, and when they met for lunch again two weeks later, they both agreed that their solutions, with minor changes, had worked. They had enlisted the help and support of others, they perceived a greater sense of teamwork on everyone’s part, and, on most days, they were all getting out on time. Betty and Janet agreed their problem-solving session was well worth the time and effort.
Step 3
Lasting Change
Here are the steps to take the next time you engage in d i e t IMIUI-~~ ...o......................o.o
step 1
Identify and define the problem. The problem should be expressed in a way that does not communicate judgment or blame. Use ‘I” messagesto do this. Have the other person verbalize their side and remember that the initial response may be anger or defensiveness. Use an active listening approach. Don’t be in a hurty to move out ofthis s t e w s important that you both accept the definition of the problem. Be careful not to define the problem as a conflict between competing solutions but rather in terms of conflicting needs.
Step 2
Evaluate eacb solution. This is the step in which you must take special care to be honest If you don‘t like a solution or a part of a solution, say so. Otherwise, you might end up agreeing to something that will continue or even escalate the conflict Use a criiical thinking approach. Are there flaws in any of the solutions? Any reasons why a particular solution will not work? How hard will it be to implementthe solution? Make a decision. Determinewhich solution will work best and commit to making it work. Implement the solution. Agree on who will do what by when. The most constructive attitude at this time is complete trust that each person will do her or his part
Step 4 Step 5 Step 6
Follow-up and evaluate the solution. Agree on a time when the two of you will get back together to evaluate how things are going. Remember to keep the door open for revision if needed.
Have a pencil and paper to jot down notes on points and emotions that must be addressed Keep an open mind Commit to making it work
Applying the Guidelines Let’s look at how this problem-solving process might work for Janet and Betty. Janet is appalled at her interaction with the patient. She quickly apologizes to the patient and makes a decision to talk with Betty. She spends the evening preparing what she is going to say and the next day asks Betty to have lunch with her. They go to a quiet comer of the cafeteria and Janet says, “Betty, the reason I wanted to meet with you today is to talk about a problem I am having. Yesterday I snapped at a patient because I was angry when I got up to answer the third call light in a row while you were sitting next to me charting and weren’t pitching in to help. I ended up having to work 15 minutes of overtime so I could finish charting. But you left on time, as it seems you do every day. It feels like you’re not part of the team; pitching in so we all can get out on time.” 54
AWHONN Lifelines
Betty is surprised. She says, “Oh Janet, I had no idea you were feeling that way! I hurry to get out on time because my little girl is in a day care and I have to pay $5.00 for every minute I am late picking her up. If I don’t leave right at 3:30, I get caught at the train track waiting for the 3:45 train to go by, and then I am about ten minutes late to pick up Kelsey. I can’t afford that extra $50 every day. I thought about changing day care, but Kelsey is really happy there and I can’t find anything for the same cost.” Janet responds, “Wow Betty, I can see where that would be a problem for you. I would still like to see what we could do so we feel like were working together and everyone is sharing the load.’Would you agree that our problem is that we all want to get out on time and that there isn’t a sense of teamwork to make that happen?” Betty replies, “Yes, I would, but I have to leave on time. I don’t have a choice.” Janet says, “I understand, let’s brainstorm on what solutions there might be to this problem.” Janet and Betty spend the next
The best conflict management technique is collaborative negotiation that leads to a “win-win” solution for all. The tools that help facilitate this technique are: Engage in active listening Send clear, honest messages Have respect for the needs of the other person(s) Trust they will be honest with you and carry out their part of the solution Be open to new ideas Be persistent Be firm in your unwillingness to have your efforts fail If all of these efforts fail, or if you have someone on your team who refuses to engage in conflict management, enlist the help of a mediator such as your nurse manager or supervisor. Excellence in any organization depends on conflict and its effective management. Working through the process produces a satisfaction and depth in the solution achievable in no other way. The process itself produces a closeness, a connectedness, and a new working relationship that are invaluable. The overall benefit is a positive working environment that facilitates excellence in patient care.
+
References Fisher, R., & Ury, W. (1981). Getting to Yes. Penguin Books. Jamison, K. (1985).Straight talk: A norm changing intervention. O D Practitioner, June:l-S. Kushell, E., & Ruh, S. (1996). Dealing with conflict: The Margaret Chapman case. Journal of Nursing Administration, 26(2):34-40. Volume 2, Issue 4
$ d L‘i QU
Q P ~
Mary Henrikson, MN, RNC
Managing Through Conflict Harnessing the Energy and Power of Change anet was fuming. This was the third time in a row she’d gotten up to answer a patient’s call light while Betty, her colleague, just sat there, not even bothering to look up from her charting to see which patient was calling. As Janet marched down the hall she thought about how she would, again, probably end up working overtime because she needed to finish charting. It seemed like Betty was always leaving right at the end of the shift because she focused only on getting her own work done versus pitching in and helping everyone so they all could leave on time. By the time Janet got to the patient’s room she was even angrier. “What do you want?,” she sputtered as she threw open the door. The patient’s eyes grew wide and she timidly stated, “Uh, I think the bleeding is worse. I just wanted someone to check it.”
Conflict Management Conflict. Even the word can make us cringe. Conflict itself is not a bad thing. Any time a group of people work, or play, together, conflict is bound to happen. How we manage conflict determines whether we have a positive or negative working environment. Unmanaged conflict will fester and permeate every aspect of the work environment, including interactions with colleagues, other health care professionals, and our customers, particularly our patients. For example, if you’re finding that patient satisfaction scores in your unit are lower than they were previously, you may have unresolved conflict within your unit. In the scenario above, Janet’s anger over her belief that she will now have to work overtime because of Betty’s unwillingness to help spilled over to her interaction with the patient. It’s Mary Henrikson, MN, RNC is the Director of the Prentice Women’s Hospital, Northwestern Memorial Hospital, Chicago, IL. August 1998
naive to think that the patient won’t remember this situation when she fills out the patient satisfaction survey or when she describes her hospitalization to her friends. Long-term conflict can wear on those involved or close to it. Going to work becomes a chore instead of the pleasure it should be. Symptoms of units in conflict may include an increase in sick calls, lack of teamwork in patient care and unit projects, decreased productivity, decreased communication between staff, and increased aggressive confrontation, avoidance behavior, or both. As the conflict continues and word of the poor working environment spreads through the institution, an increased turnover of staff and inability to recruit transfers to the unit are real possibilities.
Energy 81Creativity Conversely, conflict that is dealt with can be turned to the advantage of the unit team. When conflict is managed, cohesiveness and effectiveness are increased. Because conflict stimulates interest and energy, it often fosters creativity, which can result in better ideas and more innovative solutions. Better decisions are reached when people share their points of view and bring them together through consensus. When involved in conflict management, team members will develop their articulation and argument
skills and learn to extract precise meanings from the information they receive, leading to better communication and outcomes.
Responding to Conflict Janet and Betty are obviously experiencing conflict (even if Betty is oblivious to it). What should happen next? Response to conflict can take different forms. The most common, and destructive, is avoidance: repressing our feelings or physically removing ourselves from the situation. Janet has been avoiding dealing with her conflict with Betty. The obvious outcome is that the conflict grows and festers. A second response is diffusion or “cooling off.” Diffusion is different from avoidance because the intent is to return to the conflict after one has had time to bring emotions under control. It’s a postponement. Problems occur when the postponement turns into avoidance. In addition, if the intent is to remove all the emotion from the conflict, it can backfire, because emotion is what makes the conflict real and important. A third response is aggressive confrontation. This is a “take it on, solve the problem!” approach in which the parties involved go head to head in a struggle to resolve their differences. If at least one of the parties is not exceptionally skilled in communication techniques, the outcome may be increased anger and escalating conflict. The fourth response is to engage in collaborative negotiation in which a problem-solving process is used. This is a learned approach that takes time, with the emphasis on a “win-win” result for all. In other words, a solution is derived that is acceptable to everyone. To be successful in collaborative negotiation, follow these guidelines: Include only those people involved directly in the conflict Set aside a time when interruptions won’t occur AWHONN Lifelines
Working Through Conflict I ..............................................
6enerate stternate solutions. Ask the person for possible sobtions to the defined problem. Use this as a brainstorming session. In other words, don’t evaluate any solution until all possible options are on the table. Try to generate a number of solutions.
few minutes generating a list of solutions. They decide to irnplement changes and create a plan of action. They agreed to implement the plan, and when they met for lunch again two weeks later, they both agreed that their solutions, with minor changes, had worked. They had enlisted the help and support of others, they perceived a greater sense of teamwork on everyone’s part, and, on most days, they were all getting out on time. Betty and Janet agreed their problem-solving session was well worth the time and effort.
Step 3
Lasting Change
Here are the steps to take the next time you engage in d i e t IMIUI-~~ ...o......................o.o
step 1
Identify and define the problem. The problem should be expressed in a way that does not communicate judgment or blame. Use ‘I” messagesto do this. Have the other person verbalize their side and remember that the initial response may be anger or defensiveness. Use an active listening approach. Don’t be in a hurty to move out ofthis s t e w s important that you both accept the definition of the problem. Be careful not to define the problem as a conflict between competing solutions but rather in terms of conflicting needs.
Step 2
Evaluate eacb solution. This is the step in which you must take special care to be honest If you don‘t like a solution or a part of a solution, say so. Otherwise, you might end up agreeing to something that will continue or even escalate the conflict Use a criiical thinking approach. Are there flaws in any of the solutions? Any reasons why a particular solution will not work? How hard will it be to implementthe solution? Make a decision. Determinewhich solution will work best and commit to making it work. Implement the solution. Agree on who will do what by when. The most constructive attitude at this time is complete trust that each person will do her or his part
Step 4 Step 5 Step 6
Follow-up and evaluate the solution. Agree on a time when the two of you will get back together to evaluate how things are going. Remember to keep the door open for revision if needed.
Have a pencil and paper to jot down notes on points and emotions that must be addressed Keep an open mind Commit to making it work
Applying the Guidelines Let’s look at how this problem-solving process might work for Janet and Betty. Janet is appalled at her interaction with the patient. She quickly apologizes to the patient and makes a decision to talk with Betty. She spends the evening preparing what she is going to say and the next day asks Betty to have lunch with her. They go to a quiet comer of the cafeteria and Janet says, “Betty, the reason I wanted to meet with you today is to talk about a problem I am having. Yesterday I snapped at a patient because I was angry when I got up to answer the third call light in a row while you were sitting next to me charting and weren’t pitching in to help. I ended up having to work 15 minutes of overtime so I could finish charting. But you left on time, as it seems you do every day. It feels like you’re not part of the team; pitching in so we all can get out on time.” 54
AWHONN Lifelines
Betty is surprised. She says, “Oh Janet, I had no idea you were feeling that way! I hurry to get out on time because my little girl is in a day care and I have to pay $5.00 for every minute I am late picking her up. If I don’t leave right at 3:30, I get caught at the train track waiting for the 3:45 train to go by, and then I am about ten minutes late to pick up Kelsey. I can’t afford that extra $50 every day. I thought about changing day care, but Kelsey is really happy there and I can’t find anything for the same cost.” Janet responds, “Wow Betty, I can see where that would be a problem for you. I would still like to see what we could do so we feel like were working together and everyone is sharing the load.’Would you agree that our problem is that we all want to get out on time and that there isn’t a sense of teamwork to make that happen?” Betty replies, “Yes, I would, but I have to leave on time. I don’t have a choice.” Janet says, “I understand, let’s brainstorm on what solutions there might be to this problem.” Janet and Betty spend the next
The best conflict management technique is collaborative negotiation that leads to a “win-win” solution for all. The tools that help facilitate this technique are: Engage in active listening Send clear, honest messages Have respect for the needs of the other person(s) Trust they will be honest with you and carry out their part of the solution Be open to new ideas Be persistent Be firm in your unwillingness to have your efforts fail If all of these efforts fail, or if you have someone on your team who refuses to engage in conflict management, enlist the help of a mediator such as your nurse manager or supervisor. Excellence in any organization depends on conflict and its effective management. Working through the process produces a satisfaction and depth in the solution achievable in no other way. The process itself produces a closeness, a connectedness, and a new working relationship that are invaluable. The overall benefit is a positive working environment that facilitates excellence in patient care.
+
References Fisher, R., & Ury, W. (1981). Getting to Yes. Penguin Books. Jamison, K. (1985).Straight talk: A norm changing intervention. O D Practitioner, June:l-S. Kushell, E., & Ruh, S. (1996). Dealing with conflict: The Margaret Chapman case. Journal of Nursing Administration, 26(2):34-40. Volume 2, Issue 4