David Thompson, DNSc, MS, RN
Jill Marsteller, PhD, MPP
Conflict Resolution
What is Conflict?
• Perception of mutual interference
• A process that begins when goals of one
party are frustrated by another
• Requires interdependence/interaction
Views of Conflict
• Conflict Good (interactionist view)
• Conflict Natural (human relations view)
• Conflict Bad (traditional view)
• Conflict must be managed
Sources of Conflict
• Conflict arises from resource scarcity
• Goals of parties are incompatible
• Other structural factors (size, routinization,
specialization, reward systems)
• Conflicting perceptions, ideas, or beliefs
• Differences between people
• Conflicting thoughts/needs within an
individual
• Lack of communication (maybe)
Types of Conflict
– Task Content conflict (differing opinions related
to the task) G
– Emotional or Relationship conflict (interpersonal
conflict--dislike, negative emotions) B
– Administrative or Process conflict (disagreement
on how to get the task completed—e.g., duties,
decision-making technique) B to N
Goal of Conflict Resolution
• Confront problems, communicate openly
and respectfully with someone of opposing
opinion to provide optimal patient care.
Why address Conflict Resolution?
• Inevitable in dynamic environments
• Conflict can lead to feelings of
powerlessness
• Conflict can cause anyone especially
subordinates to view administrators,
attending physicians as adversaries and
creates conflict and divided loyalties in the
workplace
Assertion IS
Being appropriately assertive means:
• Organized in thought and communication
• Technically and socially competent
• Disavowing perfection while looking for
clarification / common understanding
• Being owned by the entire team (this is not
just a “subordinate” skill-set, and it must be
valued by the receiver to work)
Assertion –Is NOT
• NOT
• Aggressive
• Hostile
• Confrontational
• Ambiguous
• Demeaning
• Condescending
The Assertion Model
• Model to guide and improve assertion in the
interest of patient safety
Helpful Hints in Applying
The Assertion Model
• Focus on the common goal: quality care, the
welfare of the patient, safety – it’s hard to
disagree with safe, high quality care
• Avoid the issue of who’s right and who’s wrong
“Patient Centered care – concentrate on doing
the right thing”
• De-personalize the conversation
• Actively avoid being perceived as judgmental
• Be hard on the problem, not the people
Strategies for Conflict Resolution
1. Withdrawal—little or no significance to either
party (lose-lose)
2. Forcing—force outcome regardless of the
desire of one party (win-lose)
3. Conciliation—giving in to preserve relationship
with other party (lose-win)
4. Compromise—concerned with both outcome
and relationship (?-?)
5. CONFRONTATION—meet the problem head
on (win-win)
Confrontation is an Assertive means of
Conflict Resolution
• Respectful negotiation
• Effective Conflict resolution is what is right
not who is right.
• Never Aggressive. Use to explain
perspectives. If handled appropriately may
be an opportunity to educate the other
party involved.
Two Attempt Rule:
• Using the elements of assertion make 2
attempts to reach a common goal.
• If your viewpoint is disregarded, Traditionally
continue up the chain of command or “escalate”
to achieve resolution.
• Charge nurse
• Nurse Manager
• Fellow
• Attending
Conservative Response
• Non-confrontational method to gain
agreement among 2 or more team
members
• Used to ensure disagreement does not
escalate to confrontation by seeking input
and advice from another team member or
outside consultant
DESC Script
What is it?
A structured, assertive, communication approach for managing and resolving
conflict.
D
Describe the specific situation
E
Express your concerns about the action
S
Suggest other alternatives
C
Consequences should be stated
Ultimately, consensus shall be reached.
When to use it?
Whenever you have a personal conflict with another health team member that
threatens your ability to perform your job well
Key Points
Have timely discussion
DESC Example
• D- When you scream at me in front of my co-workers
about the delay in care, you’re making it personal.
• E- This reduces my credibility with the patients and
undermines my authority with staff. I feel you don’t
respect me.
• S- If you are upset about delays or other patient care
issues, pull me aside and I will address your
concerns.
• C- If your outbursts continue we won’t have a working
relationship, and patient care will suffer.
LEEN--A Model for Conflict
Resolution
L- Listen
E- Empathize
E- Explain
N- Negotiate
Conflict with Patients/Families
L- Can you help me understand
why you are upset.
E- That is understandable, I can
see why you are upset.
E- The reason we wanted to do
this was because—
N- Let’s agree on a path forward.
Conflict with Clinicians
• L- Can you help me understand how you
see the situation, how you are weighing
the risks and benefits.
• E- I can see how you see it that way.
• E- Let me explain how I see things.
• N- Let’s put the patient first and agree on a
plan.