The following are basic rules on how to mediate a conflict between two or more parties:
1. Protect each party’s self-respect. Deal with a conflict of issues, not personalities.
2. Do not put blame or responsibility for the problem on the participants. The participants are responsible for developing a solution to the problem.
3. Allow open and complete discussion of the problem from each participant.
4. Maintain equity in the frequency and duration of each party’s presentation. A person of higher status tends to speak more frequently and longer than a person of lower status. If this occurs, the mediator should intervene and ask the person of lower status for response and opinion.
5. Encourage full expression of positive and negative feelings in an accepting atmosphere. The novice mediator tends to discourage expressions of disagreement.
6. Make sure both parties listen actively to each other’s words. One way to do this is to ask one person to summarize the other person’s comments before stating her or his own.
7. Identify key themes in the discussion and restate them at frequent intervals.
8. Encourage the parties to provide frequent feedback to each other’s comments; each must truly understand the other’s position.
9. Help the participants develop alternative solutions, select a mutually agreeable one, and develop a plan to carry it out. All parties must agree to the solution for successful resolu- tion to occur.
10. At an agreed-upon interval, follow up on the progress of the plan.
11. Give positive feedback to participants regarding their cooperation in solving the conflict.
Conflict management is a difficult process, consuming both time and energy. Management and staff must be concerned and committed to resolving conflict by being willing to listen to others’ positions and to find agreeable solutions.
Conflict Responses Confrontation is considered the most effective means for resolving conflicts. This is a problem- oriented technique in which the conflict is brought out into the open and attempts are made to resolve it through knowledge and reason. The goal of this technique is to achieve win–win solutions. Facts should be used to identify the problem. The desired outcome should be ex- plicit. “This is the third time this week that you have not been here for report. According to
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hospital policy, you are expected to be changed, scrubbed, and ready for report in the lounge at 7:00 a.m.” is an example.
Confrontation is most effective when delivered in private as soon as possible after the inci- dent occurs. Employee respect and manager credibility are two important considerations when a situation warrants confrontation. A more immediate confrontation also helps both the employee and manager sort out pertinent facts. In an emotionally charged situation, however, it may be best for the parties to wait. Regardless of timing, the message is usually more effective if the manager listens and is empathetic.
Negotiation involves give-and-take on various issues among the parties. Its purpose is to achieve agreement even though consensus will never be reached. Therefore, the best solution is not often achieved. Negotiation often becomes a structured, formal procedure, as in collec- tive bargaining (see Chapter 24). However, negotiation skills are important in arriving at an agreeable solution between any two parties. Staff learn to negotiate schedules, advanced prac- tice nurses negotiate with third-party payers for reimbursement, insurance companies negotiate with vendors and hospitals for discounts, and clinic managers negotiate employment contracts with physicians. Although negotiation involves adept communication skills, its usefulness re- volves around issues of conflict. Without differences in opinion, there would be no need for negotiation.
Collaboration implies mutual attention to the problem, in which the talents of all parties are used. In collaboration, the focus is on solving the problem, not defeating the opponent. The goal is to satisfy both parties’ concerns. Collaboration is useful in situations in which the goals of both parties are too important to be compromised.
Compromise is used to divide the rewards between both parties. Neither gets what she or he wants. Compromise can serve as a backup to resolve conflict when collaboration is ineffective. It is sometimes the only choice when opponents of equal power are in conflict over two or more mutually exclusive goals. Compromising is also expedient when a solution is needed rapidly.
Competing is an all-out effort to win, regardless of the cost. Competing may be needed in situations involving unpopular or critical decisions. Competing is also used in situations in which time does not allow for more cooperative techniques.
Accommodating is an unassertive, cooperative tactic used when individuals neglect their own concerns in favor of others’ concerns. Accommodating frequently is used to preserve har- mony when one person has a vested interest in an issue that is unimportant to the other party. You may recall that Morrison (2008) found that nurses with higher emotional intelligence scores seldom used accommodating as a conflict response.
In situations where conflict is discouraged, suppression is often used. Suppression could even include the elimination of one of the conflicting parties through transfer or termination. Other, less effective techniques for managing conflict include withdrawing, smoothing, and forc- ing, although each mode of response is useful in given situations.
In avoiding, the participants never acknowledge that a conflict exists. Avoidance is the con- flict resolution technique often used in highly cohesive groups. The group avoids disagreement because its members do not want to do anything that may interfere with the good feelings they have for each other.
Withdrawal from the conflict simply removes at least one party, thereby making it impos- sible to resolve the situation. The issue remains unresolved, and feelings about the issue may resurface inappropriately. If the conflict escalates into a dangerous situation, avoiding and with- drawing are appropriate strategies.
Smoothing is accomplished by complimenting one’s opponent, downplaying differences, and focusing on minor areas of agreement, as though little disagreement existed. Smoothing may be appropriate in dealing with minor problems, but in response to major problems, it pro- duces the same results as withdrawing.
Forcing is a method that yields an immediate end to the conflict but leaves the cause of the conflict unresolved. A superior can resort to issuing orders, but the subordinate will lack
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commitment to the demanded action. Forcing may be appropriate in life-or-death situations but is otherwise inappropriate.
Resistance can be positive or negative. It may mean a resistance to change or disobedience, or it may be an effective approach to handling power differences, especially verbal abuse.
Filley’s Strategies Filley (1975) identified three basic strategies for dealing with conflict according to the outcome: win–lose, lose–lose, and win–win. In the win–lose strategy, one party exerts dominance, usu- ally by power of authority, and the other party submits and loses. Forcing, competing, and nego- tiating are techniques likely to lead to win–lose competition.
Majority rule is another example of the win–lose outcome, especially within groups. It may be a satisfactory method of resolving conflict, however, if various factions vote differently on different issues and the group functions over time so that members win some and lose some. Win–lose outcomes often occur between groups. Frequent losing, however, can lead to the loss of cohesiveness within groups and diminish the authority of the group leader.
In the lose–lose strategy, neither side wins. The settlement reached is unsatisfactory to both sides. Avoiding, withdrawing, smoothing, and compromising may lead to lose–lose outcomes. One compromising strategy is to use a bribe to influence another’s cooperation in doing some- thing he or she dislikes. For example, the nurse manager may promise a future raise in an at- tempt to coerce a staff member to work an extra weekend.
Using a third party as arbitrator can also lead to a lose–lose outcome. Because an outsider may want to give something to each side, neither gets exactly what he or she desires, resulting in a lose–lose outcome. This is a common strategy in arbitration of labor-management disputes. Another strategy that may result in a lose–lose or win–lose outcome is resorting to rules. The outcome is determined by whatever the rules say, and confrontation is avoided.
The win–lose and lose–lose methods share some common characteristics:
1. The conflict is person-centered (we–they) rather than problem-centered. This is likely to occur when two cohesive groups that do not share common values or goals are in conflict.
2. Parties direct their energy toward total victory for themselves and total defeat for the other. This can cause long-term problems for the organization.
3. Each side sees the issue from her or his own point of view rather than as a problem in need of a solution.
4. The emphasis is on outcomes rather than definition of goals, values, or objectives.
5. Conflicts are personalized.
6. Conflict-resolving activities are not differentiated from other group processes.
7. There is a short-run view of the conflict; the goal is to settle the immediate problem rather than resolve differences.
The win–win strategy focuses on goals and attempt to meet the needs of both parties. Two specific win–win strategies are consensus and integrative decision making. Consensus involves attention to the facts and to the position of the other parties and avoidance of trading, voting, or averaging, where everyone loses something. The consensus decision is often superior to even the best individual one. This technique is most useful in a group setting because it is sensitive to the negative characteristics of win–lose and lose–lose outcomes. True consensus occurs when the problem is fully explored, the needs and goals of the involved parties are understood, and a solution that meets these needs is agreed upon.
Integrative decision making focuses on the means of solving a problem rather than the ends. This strategy is most useful when the needs of the parties are polarized. Integrative deci- sion making is a constructive process in which the parties jointly identify the problem and their needs. They explore a number of alternative solutions and come to consensus on a solution. The
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focus of this group activity is to solve the problem, not to force, dominate, suppress, or com- promise. The group works toward a common goal in an atmosphere that encourages the free exchange of ideas and feelings. Using integrative decision-making methods, the parties jointly identify the value needs of each, conduct an exhaustive search for alternatives that could meet the needs of each, and then select the best alternative. Like the consensus methods, integrative decision making focuses on defeating the problem, not each other.
Alternative Dispute Strategies Conflicts that have the potential to lead to legal action are often negotiated using alternative dispute resolution (ADR) (Sander, 2009). Mediation is a form of ADR that involves a third- party mediator to help settle disputes. Mediation agreements can satisfy all parties, cost less and take less time than legal remedies, and lead to improved interprofessional relationships (Gardner, 2010). Mediation has been used successfully in settling disputes in long-term care facilities (Rosenblatt, 2008).
ADR efforts have resulted in the creation of the International Institute of Conflict Prevention and Resolution, expanded state and federal legislation encouraging mediation, a dispute resolu- tion division in the American Bar Association, and development of ADR courses in law schools. The use of ADR in public policy promises to increase in the coming years (Susskind, 2009).
See how one nurse manager handled a conflict between two members of her staff in Case Study 12-1.
CONFLICT MANAGEMENT Mai Tran is the nurse manager of a 20-bed medical- surgical unit in a large university hospital. Her nursing staff is diverse in experience and educational back- ground. Working in a teaching hospital, Mai believes that nurses should be open to new methods and work processes, with an emphasis on evidence-based practice.
Ken Robertson, RN, has worked for two years on the unit and is in his final semester of a master’s program fo- cusing on geriatric care. Eileen Holcomb, RN, has worked on the same unit for the past 28 years and was a gradu- ate of the hospital’s former diploma program. Ken re- cently completed a clinical rotation in dermatology and has worked with the skin care team at the hospital to develop new protocols for preventing skin breakdown. During a recent staff meeting, Ken presents the new protocols to the staff. Eileen makes several comments during the presentation that simply getting patients out of bed and making sure they have adequate nutrition is easier and less time-consuming than the new proto- col. “All these new protocols are just a way to justify all those credentials behind a name,” Eileen says, gathering a chorus of chuckles from some of the older nurses on the staff. Ken frowns at Eileen and responds, “As nurses become educated, we need to reflect a professional practice.” Mai notices that several staff members are un- comfortable as the meeting ends.
Ken and Eileen continue to exchange sarcastic com- ments and glares over the next two shifts they work together. The obvious disagreement is affecting their coworkers, and gossiping is decreasing productivity on
the unit. Mai schedules individual meetings with Ken and Eileen to discuss their perspective. After reviewing the situation and determining that the issue is simply one of personality conflict, Mai brings Ken and Eileen to- gether for a meeting in her office. Mai reviews the facts of the situation with them and shares her opinion that both have acted inappropriately. She states that their actions have affected not only their work, but that of the unit as a whole. She informs Ken and Eileen that they must act in a professional and respectful manner with each other or disciplinary action will be taken. She encourages them to work out any future problems in a cooperative manner and not to bring personal conflicts into the work environment.