Negotiating Conflict in Healthcare Organizations: Theory and Practice

1. Negotiating Conflict in Healthcare Organizations:Theory and Practice Dr. Vicky Gunn Learning and Teaching Centre

2. 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?

3. Why do we need to consider how conflict is negotiated in healthcare settings?

4. Does leadership responsibility require us to reflect on what cause conflict and how we negotiate it?

5. 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?

6. Irvine et al’s 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

7. “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)

8. Irvine et al continued • Cultural barriers: • ‘Intellectual baggage’ • Language (eg ‘in shock’) • Intra-professional variation • Identity • Training

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

10. Optional interpersonal responses to conflict (or, how do we respond to one another?)

12. Intractability • Threats to the identity often lurk behind intractable conflict

13. Simple de-escalation strategy(person-centred approach) • Slow the situation down; • Check for self-oriented distortions / selective interpretation / self-belief in fixed picture of an existing truth; • Move away from power-based strategies; • Identify areas of genuine mutuality for collaboration.

14. What do psycho-dynamic theories offer to our understanding of conflict in healthcare?(understanding why conflict occurs)

15. Let’s try this assumption: “Experiences of conflict within healthcare settings are primarily the embodiment of interpersonal emotionality and psychodynamics within an institutional context.”

16. “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)

17. 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?

18. Case Study to Illustrate Theory • Power of passive aggression within an organization

19. 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.

20. 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?