Corporate Conflict
Understanding disagreement versus conflict
Written by: Andrew Vincent, Medicology Ltd. Published: 3rd June 2010
The combination of increased expectations,reducing resources, shorter waiting timesand explicit service targets, conflict is notsurprisingly on the increase. The teamenvironment in healthcare is much akin toa witch’s cauldron, containing a culturally,intellectually and socially diverse collectionof ingredients stirred together. The more youturn up the heat, the greater the reactionsthat bubble away inside and the more toiland trouble you get on the outside (it’sclose to Halloween, what did you expect!).This article though, seeks to deal with agrowing issue that need not be a growingissue at all – the inadvertent classification ofdisagreement as conflict.
Understanding our case exampleBob and Peter are attempting to decidewhether their outpatient clinic is best servedby 12 x 15-minute appointments, with 2 x15-minute emergency slots at the end (Bob’sview) or 17 x 12 minute appointment and noemergency slots (Peter’s view). Each presentstheir arguments:
Bob believes that:
- You need 15 minutes to be thorough
- The emergency slots allow bettermanagement of patients close to targetbreaching
- Patients struggle to cope in 12 minutes,naturally delaying the consultations to 15minutes anyway and forcing clinic to run over
Peter believes that:
- 12 minutes is just about enough if youare organised and efficient
- With more 12 minute slots, they’ll seemore patients leading to greater income
- By seeing 17 patients per clinic, theywon’t have so many breach issues anyway
Currently appointment times are scheduledevery 20 minutes with no emergency slotsand there have been instances of targetbreaches. The current appointment timingis simply based on historical practice, whichboth believe needs to change, especiallyas the Trust is naturally pushing for evergreater throughput. However, in Europe, theaverage consultation in this scenario remainsat 20 minutes, based on anecdotal opinionsthat this is the right time for the correctlevel of thoroughness and quality, despitetheir being no audit or research evidence toconfirm it.
Differing opinions
The reorganisation of the clinic is behindtarget, arising largely out of Bob & Peter’sfailure to reach consensus on the correctstructure. Each has systematically presentedtheir arguments and sought to providesnippets of evidence and justification thattheir opinion is the correct one. Sadly, bothare now at impasse, with Bob saying it is acompromise to his professional standingand an unacceptable risk to see patientsin 12 minutes and Peter accusing Bob ofundermining their financial security andability to meet national waiting time targets.Both are clearly passionate about theirpositions and there appears to be no middleground. Recently Bob and Peter have takento avoiding each other.
The Trust has had enough. It has called inconflict resolution experts (Medicology,naturally...) to repair the situation to helpBob and Peter with conflict management.The big question is whether this is indeedconflict or simply a difference of opinion?Undoubtedly it is affecting performance andtherefore we can probably all agree that itneeds resolving.
Understanding conflict
Conflict is usually categorised as eitherwarranted or unwarranted. Unwarrantedconflict arises when one party effectivelycalls into question the validity of theother party i.e. it is personally directed.For instance, a theatre nurse says to anorthopaedic surgeon “you are rude and abully”. His response is to suggest that he hasto be strong to get the right level of actionunder pressured circumstances, especiallyfrom nurses with a lack of focus! This typeof conflict is more a reflection of underlyinginterpersonal difference where the nurseneeds to be treated more sensitively orhumanely than she currently is (which sheexperiences as bullying) and the surgeonwants to run a tight ship in the interests ofproductivity and control.
Warranted conflict (we don’t like to term) iswhere two persons have a natural differenceof opinion about the solutions to a problem.In fact, we don’t see this as conflict at all,although it does have the potential to eruptinto unwarranted conflict if not managedeffectively. In our scenario, this is clearly thecase and we are starting to see the earlysigns of the eruption with disengagement ofboth parties. Fortunately, the issue is mucheasier to resolve than unwarranted conflict,although without the correct methodology,neither Bob nor Peter may feel so.
Needs versus positions
Both parties are currently working atthe level of positions. My opinion is (theposition)... because (the justification)... Infact, both positions are simply each person’sattempt at a solution but we need to knowwhat drivers are underpinning the positionif we are to help Bob and Peter through this.In order to do this, we need to examine theneeds underlying the position. With somecareful questioning and a little reflection, itturns out as follows:
If conflict is to be avoided, all needs shouldbe satisfied in whatever solution is produced.However, whilst working at the level ofpositions, what Bob & Peter are doing isexcluding other potential solutions that maymeet all needs or represent innovation inpractise.
Need-based problem solving
Now that we have ascertained needs, weneed to form a common problem platformthat addresses all aspects. That may looksomething like:
GOAL
To create improved service delivery byimproving income without compromisingsafety and support, whilst ensuring that allnational targets are met.
As a goal, we’d add a timescale too but theabove is sufficient to illustrate the process.Once the problem statement is agreed,you can see that all solutions must deliveragainst both person’s needs, as well asthose of the Trust. This gives rise to manyquestions that can help Bob and Peterresolve their challenge:
- How else can we improve income?
- What can we do to reduce wasted time?
- What can we do to improve patientreadiness?
- Can we have mixed appointment times?
- What other support can we providepatients that lessens the burden in clinic?
- How can we best utilise staff and facilitiesto enhance throughput?
- What are our key ‘musts’ to ensure safetyis always paramount?
Although Bob and Peter have still gotwork to do, they now have the mechanismto work through present and alternativesolutions without arriving in conflict. Bycommitting to a common goal, they maytest each and every solution to see how itmatches, rejecting the ones that don’t serve allaspects of the goal. Conflict> What conflict?
