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and implications
Laurie McKibben
C
defined role expectations or lack of communication (Ellis and
onflict, or at least the propensity for it, is considered Abbott, 2011; Marquis and Huston, 2014).
inherent to the human condition, therefore, it Johansen (2012) provided a different perspective on
is destined to be inevitable, particularly in the conflict in healthcare, citing such is borne from a disparity
dynamic arena of healthcare with its hierarchical in an individual’s perceptions, in relation to patient care.
organisation and complex care issues and Prerequisites such as autocracy, hostility, disrespect, inequities,
dilemmas. The aim of this article is to highlight that positive hierarchy, low morale and absence of shared goals have been
conflict management, with favourable team leadership, can be suggested as precipitating factors (Barr and Dowding, 2012). In
beneficial. Positive management fosters mutual role respect, presenting several definitions a wider perspective is provided
improves working relationships, recovers staff retention and upon how we define the larger, abstract concept of conflict in
sickness, and especially benefits new members of staff who may its complexity.The focus of positive resolution therefore lies in
find it difficult coming into long-established teams (Marquis addressing these root causes, for example, mending relationships,
and Huston, 2014; Stanton, 2014). Moreover, if conflict is not improving communication, accepting change, all of which may
managed effectively, it will have direct implications for the level be facilitated via effective leadership and team management.
and quality of care that is delivered to patients. Poor delivery of
patient care threatens the integrity of the nurse, the profession, Organisational conflict and dynamics
and the health service as a whole. In relation to understanding organisational conflict, it can
The Nursing and Midwifery Council (2015) Code highlights be beneficial to apply a model or framework that may act
a nurses’ professional responsibility to work cooperatively and as explanatory or predictive. The Pondy (1992) framework
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is discomfort experienced. The final two phases are manifest, situations such as those mentioned above compromise patient
when conflict is expressed, and the aftermath, and how this care and safety, one’s professional registration, and overall
affects the individuals and the team. Pondy viewed conflict as reputation of the healthcare organisation.
dynamic, and despite how or why conflict arises, it can still be
inspected and managed using this framework. Resolution
Thomas’s (1992) model agreed that conflict is dynamic Effective resolution and conflict management can be beneficial
in that it is continuous, with the outcome of one episode if managed practically. However, this is dependent on transparent
of conflict leading to another. The model involves awareness, communication, listening, and understanding the perceived
thoughts and emotions, intentions, behaviour and outcomes. focus of disagreement (Ellis and Abbott, 2011; Stanton, 2014).
Thomas suggests conflict is a rolling issue that requires ongoing Pondy (1992) stated that recognising the signs of conflict
management within organisations. Using the knowledge from and sourcing the origins will determine the best means for
such frameworks and models as a predictor, and also as a tool to preventing it. Escalation can be prevented by recognising early
manage, can be beneficial in resolving such conflict, whether signs and acting on them (Stanton, 2014).
it is new or ongoing. Ellis and Abbott (2011) recommended avoiding seven Cs
Organisational conflict is classically considered to have as ground rules before approaching conflict: commanding,
a negative impact on team functioning, weakening stability, comparing, condemning, challenging, condescending,
disrupting the status quo and impeding productivity (Barr contradicting and confusing. Commanding by way of telling
and Dowding, 2012). This compounds the earlier discussed people how to behave will induce resistance and comparing
definitions of conflict.To expand, types of specific team conflict the person or situation to other people and situations should
have been shown to include tasks, relationships, and the processes be avoided as each case is individual. Conflict resolution seeks
that enable tasks to be carried out.These conflicts directly impact to solve a problem, not the person, therefore condemning
on performance, however, the influence of each varies (Jehn, individuals is not the solution. Challenging behaviour and
1997). Nevertheless, reduced performance will have a direct condescension may cause distress by reducing morale and
impact on patient care and so these factors must be considered creating bad feeling, likewise, contradictory or confusing actions
to be precipitating for poor care. may lead to uncertainty and frustration, all of which create bad
Bradley et al (2013) agree the focus of conflict in teams is feeling and demonstrate lack of respect.
in terms of task and relationships, however acknowledge other The Tuckman (1965) model has been used for decades in
predisposing conditions such as the characteristics of the conflict health care in understanding conflict. This model suggests
or indeed the individuals. Barr and Dowding (2012) offer three that groups work though sequential stages of evolution before
types of relationship-based conflict; intrapersonal, interpersonal performing in a cultivated and efficient manner. The forming
and inter-group. Intrapersonal conflict is internal discord and stage incorporates group efforts to come together, storming
conflict occurring within the individual, which can manifest exposes conflict and hostility, norming involves group settling,
from role confusion for example. Interpersonal conflict arises and performing concludes in optimum performance.The fifth
between two or more people with differing views or goals, stage, adjourning, occurs if the team demobilises and members
which may lead to harassment and stress, and intergroup conflict move on to other duties.The model provides insight into team
involves two or more teams who, for example, do not share dynamics, however, an unhealthy level of conflict still exists in
the same organisational goals. Common interpersonal conflict many healthcare teams.
is relationship based with interpersonal frictions, tensions and In order to minimise conflict or manage it effectively, it is
resentment occurring between two or more team members. useful to understand the person, or people at the centre of it.
It is essential that this is identified and managed as it can have Thomas and Kilmann’s (1974) theory provides an alternative
a negative impact on team performance (Bradley et al, 2013). method of conflict management, identifying five varying
Hierarchy may result in team members feeling dominated or styles of management in relation to scope of assertiveness
not having a voice, furthermore, process conflict arising from and cooperativeness.The theory argues that individuals favour
incompatible views on how work should be done, for example a particular style and acknowledge certain styles were more
distribution of the workload and task ordering, can also affect useful.The Thomas-Kilmann Conflict Mode Instrument (TKI)
individual job performance and overall team functioning (Jehn, was developed to identify conflict style. The five styles were:
1997). It is therefore important that the conflict is managed collaborating, compromising, accommodating, competing
carefully by the team manager, for example, through group and avoidance.
supervision or a forum for team communication, to allow for Collaborators meet everyone’s needs, compromising
shared discussion and problem solving. individuals implement problem solving to find a solution that
Clinical team conflict can equal growth or destruction satisfies the greatest number of people, while accommodators
depending on how it is managed, importantly it is how a meet the needs of other team members while sacrificing
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team manages this that determines the end result (Marquis and their own. A competing style is operated from a position
Huston, 2014). Dysfunctional outcomes of conflict include stress, of authority, and avoiders simply do not solve the problem,
sickness, reduced job satisfaction, poor communications, distrust, which can make problems worse in the long term (Ellis and
suspicion, damaged inter-group relations, resistance and reduced Abbott, 2011).
function (Marquis and Huston, 2014). Counterproductive In understanding what kind of style a person adopts in
(National Health Service Improving Quality (NHSIQ), 2013). in preventing escalation (McConnon and McConnon, 2010).
Thomas (1992) supports this with his model that proposed
Change that conflict status needs reassessed regularly, with ongoing
Change and conflict are intertwined as one can precipitate management taking into account factors such as emotions,
the other. For example, unplanned change with poor behaviours and outcomes.
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Improve Team Performance? A Review of Evidence and Framework for Weber M (1947) The theory of social and economic organization (Henderson
Future Research. Acad Manage Proc January 2013. doi: https://dx.doi. AM, Persons T, trans. from German). Oxford University Press, New York.
org/10.5465/AMBPP.2013.17093abstract [originally published 1929]