Andrea M. Landis, PhD, RN
UW LEAH
November 30th, 2012
Conflict: Introduction
 Definition
 Fight, battle, war
 Antagonistic state or action (as of divergent ideas,
interest, or persons)
 Mental struggle resulting from incompatible or
opposing needs, drives, wishes, or external or internal
demands
 Within or between
 Where can conflict occur?
Conflict
 Conflict can arises from:
 Different goals
 Differing sets of information
 Differing perceptions
 Horizontal violence
 Perception that levels of appreciation are not equal
Conflict
 GOAL: Advance collaborative practice and conflict
competence among health professionals and industry
leaders who are responsible for the following:
 Improving patient safety
 Achieving accountable care
 Developing healthy work environments
 Creating a resilient workforce
Part 1: Perspectives in Conflict
A “Nobody’s in Charge” World
 Shared responsibility for the same programs & goals
 UW – Shared Governance
 Integrated and networked organizations require
“power sharing”
 Interdependence required to “get things done” places
limits on individual authority
 Disagreements & conflicts are not uncommon
How do you view conflict?
 A battle to be won?
 A problem to be solved?
 A danger?
 An opportunity?
 Something to be avoided at all costs?
Perspectives of Conflict
Traditional
Destructive
Eliminate
Behavioral
Inevitable
Control
Interaction
Inevitable
Manage
Common Reactions to Conflict
FIGHT
FLIGHT
 Confronting
 Bypassing
 Sabotaging
 Avoiding
 Over-reacting
 Under-reacting
Consider your Shadow Side
 What are your behavioral tendencies when you are…
 Angry?
 Exasperated?
 Tired?
 Stressed?
 In a bad mood?
 Can you recognize when you are…
Dealing with your Emotions
 Take your emotional temperature
 Resist your first negative reaction
 Consider a time-out
 Get the facts
 Get another perspective
 Vent to someone else
 If time permits, plan your approach
Dealing with their emotions
 Allow them to vent
 Use restatement; don’t raise your voice
 Accept their feelings as legitimate
 Help them “save-face” – work towards a win-win
 Don’t refute their statements – yet!
 Don’t be afraid of silence
 Don’t be afraid to say “You might be right”
Reduce Tension Through Listening
 Listen to understand
 Listen actively (in an involved way)
 Listen with your eyes
 Don’t tune out messages you think you’ve heard before
 Listen first – THEN plan your next comment
Part 2: Strategies for Navigating &
Resolving Conflict
Conflict Management
 Comprehensive term indicating the range of attitudes
and behaviors individuals, groups, and organizations
manifest in dealing with conflict.
 Always present
 Range from denial, suppression, and retaliation to
creative proactive programs
Alternative Dispute Resolution
(ADR) (Gerardi, 2010)
 Provides an array of processes designed to achieve that
goal, negotiation, mediation, and arbitration for health
care providers
 Developed body of literature documenting best practices
and empirical findings to guide both students and
practitioners of ADR
ADR continued
 Came to age in the 1990’s
 Restructuring of health care organizations
 Reductions in the number of acute care nurses; shortened
length of stay that increased patient acuity concurrent with
increased emphasis on patient safety.
 IOM report (1999) “To Err is Human: Building a Safer Health
Care System”
 Documenting the magnitude and severity of preventable
medical errors (adverse events)
 Further catalyzed the patient safety movement
 Creation of patient safety organizations that generated
substantial data sets
 Documented that problematic relationships among
providers was a primary causal factor in adverse events.
ADR continued
 ADR practitioners considered health care the “last frontier”
persistently resistant to self-examination and action that
might enhance existing conflict management practices.
 Reasons for resistance:
 Health care environments are complex adaptive systems;
 Widespread inequalities and imbalances in power;
 Includes numerous subcultures with significant variance;
 Difficulty determining who should be “at the table”
 History of litigation – pattern of conflict aversiveness,
avoidance, suppression, and blame.
Thomas-Kilmann Conflict Mode
Instrument
 5 potential responses to conflict:
 Avoidance
 Compromise
 Accommodation
 Competition
 Collaboration*
* Both high cooperativeness and assertiveness and
provides long-term solution to a conflict
Conflict Engagement
 Part of ADR
 De-emphasizes conflict resolution and shifts the focus
to competent engagement
 Blueprint for collaboration
“Silence Kills”
 AACN (2005) sponsored a landmark study (1,700 nurses,
physicians, clinical-care staff, and administrators) identifying
conversations especially difficult for health care professionals, at
the same time essential for people in healthcare to master –
including:







1. Broken rules
2. Mistakes
3. Lack of support
4. Incompetence
5. Poor teamwork
6. Disrespect
7. Micromanagement
 Concurrently developed related standards for health work
environments
“Silent Kills”
 Majority of healthcare workers regularly see some of their
colleagues break rules, make mistakes, fail to offer support,
or appear critically incompetent; < 10% say anything
 This study explored the frequency with which people
experience these kinds of concerns and the consequences
of their failure to speak up when they do
 Online survey of nurses – 53% respondents reported that
conflict while on the job was “common”
 This study suggests that creating a culture where
healthcare workers speak up before problems occur is a
vital part of the solution.
Every utterance functions on two
levels
 Level 1: Communicates ideas
 Level 2: Negotiates relationships
Develop a Negotiation Mindset
 What is your personal goal in managing conflict more
effectively?
Two Primary Concerns for Every
Negotiator
 Achieving the best
outcome and agreement
 Maintaining and
building the relationship
Diagnosing Disagreement
What is the nature of the difference?
1.
1.
2.
3.
4.
Facts
Goals
Methods
Values
2. What factors may underlie these differences?
1. Information: differences based on different set of facts
2. Perceptual: parties bring different sets of biases and
beliefs
3. Role: position and status of parties can place
constraints on the discussion
Underlying Causal Factors
 Information Factors
 Disagreement is based on different facts
 Do the disagreeing parties have access to the same info?
 Perceptual Factors
 Different set of biases and beliefs
 Do the disagreeing parties perceive the shared information
differently?
 Role Factors
 Disagreement is influenced by the position or status of the
parties in the organization and/or society
 How much are the disagreeing parties influenced by their
position or role in the organization?
Plan Your Approach
 Know your goal for resolving the disagreement: what
do you want?
 Define the problem/issue for yourself
 Consider how the other party defines the
problem/issue
Execute Your Approach
 State the problem/issue
 Set a positive tone for the conversation
 Explore each other’s needs
 Start with, “How can we….”
 Ask open-ended questions
 Don’t include solutions in your questions
 Watch your listen/talk radio
 Observe non-verbal cues
 Avoid interpreting motives
 Identify possible options
 Select the best one
 Reach agreement
Handling Disagreements Without
Resolving Them
 Listen but don’t argue
 Agree to disagree
 Accept their feelings, not points
 Focus on something else
Dealing effectively with differences
depends on….
 Desire to resolve the differences
 Ability to diagnose and understand the differences
 Awareness and ability to use the appropriate
behavioral responses
 Ability to deal with your own feelings – especially
those that might limit your effectiveness
Carefronting (Kupperschmidt,2008)
 How to manage conflict when individuals have
divergent values, beliefs, and attitudes
 Goal is to guide individuals and/or teams to get past
their day to day problems, conflicts, and
communication issues
 Augsburger (1981) – refers to the skill of caring enough
about oneself, others, and desired goals to confront
inappropriate behavior responsibly while offering the
opportunity for change.
Carefronting
 Act of inviting, not demanding, another to change and a
creative way through conflict, a way to unite caring and
candor in relationships
 Key tenets:
 Truthing it: A simplified speech style
 Owning anger: Let both your faces show
 Inviting change: Careful confrontation
 Giving trust: A two-way venture
 Ending blame: Forget whose fault the conflict is
 Getting unstuck: The freedom to change
 Peacemaking: Getting together again
Tenet
Definition
Examples
Truthing it Willingness and ability to listen deeply,
empathetically, and accurately to assure
understanding of others’ point of view
“I want to hear you
accurately; I want to share
my feelings and attitudes
with you; I want to be
heard”
Owning
Anger
Anger is both a positive, self-affirming
emotion and a demand; When one feels
ignored/rejected the normal response is
anger
“I am a person of worth, I
demand that you
recognize and respect
me”; Each person is
responsible for choosing
how they respond and
react to others when
conflict occurs
Inviting
change
Focus on feedback on the behavior, not
Think caringly, gently,
the person; on observations, not
constructively, and clearly
conclusions; on descriptions, not
judgments; on ideas and alternatives, not
on advice and answers.
Tenet
Definition
Example
Giving
Trust
Trust grounded in authentic selfdisclosure; Trust confronts openly,
frankly, respectfully, and responsibly,
trusting that the other person will
assume his/her responsibility to be
equally honest and frank
Release demands and accepts
apologies
Ending
Blame
Confrontation that endeavors to place
blame inevitably evokes resistance and
resentment. Ends the blame game,
leading to real questions
“Where do we go from here?
When do we discuss the
conflict? If not now, when?”
Getting
unstuck
Owning responsibility for one’s part in
the conflict and refusing to waste time
in assigning blame
Accepting accountability for
behavioral changes that accept
responsibility for the present
conflict and focusing on what
can be shared.
Peacemaking
Truly present in conflict situations,
listening, and caring for all
stakeholders; care enough to confront
and drop the demands of the past
Value others; those who have
rediscovered that the values that
shape their decisions must be
lasting values consistent with the
values of the profession
Carefronting
 Alternative to traditional conflict resolution
 Useful in healthcare environments where team
synergy and interdependence are required for high
quality and safe patient care (think interdisciplinary)
 Development of trust among team members on teams
begins with communication in relationships,
especially, when there is disagreements
 Relationships live within the context of conversations
that individuals have or do not have with one another
Peace cannot be kept by force; it can only be achieved
through understanding.
~ Albert Einstein
Whenever you are confronted with an opponent, conquer
him with love."
~ Mohandas Gandhi
We have to face the fact that either all of us are going to die
together or we are going to learn to live together and if we
are to live together we have to talk.
~ Eleanor Roosevelt