Negotiating Conflict in Healthcare Organizations: Theory and Practice

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Negotiating Conflict in Healthcare
OrganizationsTheory and Practice

• Dr. Vicky Gunn
• Learning and Teaching Centre

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• Why do we need to consider how conflict is
  negotiated in healthcare settings?
• Should we divide conflict situations into
  interprofessional and intraprofessional ones?
• Is conflict more likely in an environment of
  increasing complexity (in terms of
  specialization) and the consequential awareness
  that this has an impact on healthcare outcomes?
  (Interprofessional)
• Are conflict situations just part of ordinary
  interpersonal relationships occurring within an
  organization setting? (Interprofessinal/
  intraprofessional)
• What do psycho-dynamic theories offer to our
  understanding of conflict in healthcare?

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Why do we need to consider how conflict is
negotiated in healthcare settings?
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• Does leadership responsibility require us to
  reflect on what cause conflict and how we
  negotiate it?

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Is conflict more likely in an environment of
increasing complexity (in terms of
specialization) and the consequential awareness
that this has an impact on healthcare outcomes?
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Irvine et als Useful Framework for
Interprofessional Conflict (2002)

• Professional divisions
• Authority and the division of labour
• Subverting medical dominance
• Professional organization
• Different value systems (cf Irvine, et al, 2004)
• Legal effects

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• Rather than promoting more egalitarian and
  collaborative social formations, healthcare teams
  tend to reflect, reproduce and perpetuate the
  traditional divisions of labour, status systems
  and systems of authority.
• (Irvine, et al., 2002, p. 204)

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Irvine et al continued

• Cultural barriers
• Intellectual baggage
• Language (eg in shock)
• Intra-professional variation
• Identity
• Training

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• Are conflict situations just part of ordinary
  interpersonal relationships occurring within an
  organization setting? (Interprofessional/
  intraprofessional

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Optional interpersonal responses to conflict (or,
how do we respond to one another?)
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(No Transcript)
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Intractability

• Threats to the identity often lurk behind
  intractable conflict

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Simple de-escalation strategy(person-centred
approach)

1. Slow the situation down
2. Check for self-oriented distortions / selective
   interpretation / self-belief in fixed picture of
   an existing truth
3. Move away from power-based strategies
4. Identify areas of genuine mutuality for
   collaboration.

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What do psycho-dynamic theories offer to our
understanding of conflict in healthcare?
(understanding why conflict occurs)
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Lets try this assumption

• Experiences of conflict within healthcare
  settings are primarily the embodiment of
  interpersonal emotionality and psychodynamics
  within an institutional context.

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• We view organizations as processes of human
  behaviour that are experienced as experiential
  and perceptual systems governed by unconscious
  processes, whereby much thought and activity
  takes place outside of conscious awareness
• (Diamond Allcorn, 2003, p. 492)

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Key reflective questions(from Diamond and
Allcorn, 2003)

• What are the underlying motives, desires, wishes,
  and fantasies that energize the thoughts,
  feelings and actions of organizational members?
• What is the personal experience of organizational
  reality and what does it seem to mean to each and
  all organization members?

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Case Study to Illustrate Theory

• Power of passive aggression within an organization

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Theory summarized!

• Projective-identification
• Transference
• Paranoia and regression
• Activities that occur on a continuum from benign
  to malignant, and seem to relate to the
  management of anxieties.

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Closing questions for reflection

• Is healthcare an intrinsically anxiety-provoking
  work?
• If we can mitigate anxiety and fear can we
  decrease conflict within healthcare teams?
• Is this possible to do within contemporary
  organizational structures and external pressures?
• How can external policies be designed to mitigate
  the impact of their implementation?