Managing Conflict: A Key Leadership Skill

A key attribute of a successful physician leader is his or her ability to manage and resolve conflict, particularly among members of the medical care team. Conflict can be unpleasant and most people try to avoid it. What generally is not appreciated is that all human interaction is foundationally based on conflict.(1)

Conflict is part of the human experience because it allows individuals to express their differences and to recognize diversity within human interaction.(2) Successful leaders recognize that effective decision-making in their organizations will always involve conflict, conflict in ideas, conflict in approaches and conflict in how ideas are deployed.(2)

Successful leaders embrace and manage conflict in their organizations, recognizing that conflict is a dynamic and important function of innovation and value creation. The key for any physician leader is to manage the conflict in a positive manner that moves the discussion among the conflicting parties to a productive ending.(3)

Conflict, by definition, is an interactive process which is expressed in disagreement or dissonance between individuals, among groups of individuals or even organizations.(4) Scholars have debated whether organizations and their leaders should approach conflict by trying to resolve it or by trying to manage it.(4) The structural difference between management of conflict and the resolution of conflict is that, in the minds of the individuals involved, resolution means achieving a permanent outcome. Think of conflict management as an overarching organizational strategic approach to conflict, while conflict resolution is the process of reaching a mutually agreed-upon solution.

Although some would suggest that there are only minor differences between resolution and management of conflict, managing conflict is an important modern management tool that, if done effectively, will enhance learning in an organization.(4) To become a learning organization is not a choice in today’s business world, but a necessity for survival.(5)

What appears to be essential components of successful learning organizations are the presence of tension and conflict used as tools by the senior leaders to question and challenge the status quo.(4) It must be recognized that tension and conflict need to be managed to encourage learning and to strengthen the decision-making and strategic direction of the organization, otherwise chaos can ensue.

We all have been in meetings in which there is a “devil’s advocate” in the room. An individual who is constantly challenging the groupthink.(6) As a physician leader, consider this individual to be a detractor from the good work of the team or one who is enhancing the flow of ideas and stimulating innovative thinking. Research into team dynamics suggests that teams that have creative tension have better outcomes. The critical decision of an organizational leader is to arrive at the optimal level of conflict. Not enough conflict will lead to stagnant ideas and processes while too much conflict will lead to organizational upheaval, resulting in reduced productivity and a breakup in individual relationships.

As more organizations embrace team-based workgroups, conflict is to be expected. There are three general types of team-based conflicts.(7,8) Understanding which type of conflict is occurring will help a physician leader approach the conflict in an efficient manner.

• Relationship conflict is common between two individuals or groups and involves emotional issues resulting in tension or friction. Although there are no reliable data on this, we suspect that relationship conflict is probably the most frequent conflict that a physician leader must confront among members of the medical staff.

• Task conflict occurs when there is disagreement on how to perform a given task. Team-based interactions usually experience task conflicts.

• Process conflict involves around disagreements about how a given process or activity will proceed. Teams that experience greater levels of process conflict will generally have a low level of performance.(7) Research suggests task conflicts represent the least destructive form of conflict compared to process or relationship conflicts.(8,9)

Physician leaders might want to consider proactively developing an organizational strategy for managing conflict — if not for the entire organization, then at least for the physicians they lead. There are three basic strategies to consider.(10)

• A strategy for dealing with conflicts that can have negative effects on individuals and, potentially, the organization. These conflicts might include sexual harassment, racial issues or personal attacks. This type of conflict generally cannot be managed, but must be resolved.

• A strategy for dealing with conflicts that have the potential to be positive for the individuals or the organization in the long run. Examples include disagreements on policy, type of process, or deployment of processes.

• Specific strategies to teach members of the organization how to deal with disagreements that will occur during the course of the normal workday.

When Ambiguity Reigns

One of the greatest barriers to group and organizational harmony is ambiguity.(2) From an organizational perspective, ambiguity can be devastating in that it allows individuals and “microwork” units to interpret work direction and strategy in ways that are not consistent with the desires of senior leaders. Ambiguity creates misunderstanding and inconsistency, a potent threat to patient safety.(2)

Physician leaders must be aware of the circumstances that can lead to the rise of ambiguity in their organizations. Ambiguity can arise from five specific circumstances.(2)

• Information that is incorrect or misleading is a major cause of ambiguity in organizations. Physician leaders must always ensure that the information they provide to their organization is clear and accurate.

• Information that is accurate but is not interpreted in the same way by stakeholders in the organization. Multiple efforts at communication using different communication formats should reduce this cause of ambiguity. Physician leaders need to be aware, however, that too much information can lead to information overload.

• Information overload can result in lack of certainty and misinterpretation by the workforce.

• Misperception because of senior leaders’ lack of understanding of the needs and expectations of the affected stakeholders.

• Frequent changes in direction can create confusion and in some circumstances distrust in the workforce.

Physician leaders must also understand their own emotional and internal response to conflict. If individuals, teams or even the organization are looking to the physician leader for solutions to a given conflict, the perception of the physician leader by the parties involved ultimately will shape the framework of how the conflict will be resolved.

A physician leader should be emotionally above the conflict and focus on guiding the parties to address the conflict in a way that does not interpose the physician leader’s opinion into the solution.(2) A physician leader who does not inject his or her conflict of interest into the resolution of the conflict will enhance the potential for long-term harmony.

Developing Strategies

So, how do you develop your conflict management strategies? There are three general pillars upon which every conflict management strategy should rest.(4) Strategies should be developed with the primary purpose of enhancing organizational learning and effectiveness.

• Individual personal growth and development should be considered. Enhancing your physician workforce’s critical and innovative thinking is what a learning organization is all about.

• Strategy should be directed at the needs and expectations of the stakeholders.(4) When conflict occurs, all of the involved parties should be included in the solution of the conflict. This process leads to collective organizational learning and effectiveness over time.

• Organizational ethics are essential.(4) An organization cannot effectively solve a conflict unless it operates within a strong ethical framework. Physician leaders should role model and insist upon the process of conflict management based on ethical behavior and ethics-based processes that have oversight of individual and organizational behavior.

A physician leader’s role in conflict management is to create an environment in which individuals will come forward and openly discuss the conflict.(10) An accommodating organizational culture in which there is trust and open communication will allow for the free flow of ideas and provide the framework for the development of solutions without the fear of retribution.

The building of trust does not simply occur but requires ongoing efforts of active listening and a demonstration of respect for the views of all parties. In addition, physician leaders must have the ability to treat individuals fairly during the process of conflict resolution. A hierarchal management approach emphasizing a top-down approach and solutions to a given conflict does not work in the long run.

What are some specific actions that a physician leader can take during a specific conflict resolution process that will facilitate a positive outcome.(6) Conflict resolution is most likely to succeed if the strategy is built on ethical leadership principles, effective communication skills and individual and organizational flexibility.(11) The most effective form of leadership style is one of a democratic approach where the leader is open and has effective communication skills. Communication should be open, unemotional and honest.(11)

A physician leader might want to assume the role of the facilitator during a conflict resolution process, although in many circumstances a trained individual in conflict resolution, who does not have a conflict of interest, might be preferable. The first task is to clarify the issues in dispute. This process of clarifying the issues will focus the attention of the participants and help direct the discussion. In addition, a physician leader should make sure that, before any discussion, everyone involved understands the process of resolution that will be used.

Also, it is important to understand, early in the process, the key expectations of the individuals involved. Understanding the perspectives of each participant will help guide the discussion and hopefully the resolution of the conflict. During the resolution process, physician leaders should be extremely sensitive to the feelings, interests and attitudes of the individuals involved in the discussion. Training in good listening techniques and an understanding and interpretation of body language will go a long way in helping the physician leader protect the potentially fragile egos and feelings of the participants.

The foundation of any conflict resolution process is for a leader to use accurate and timely data to allow the participants to effectively agree on a solution. Finally, physician leaders should outline follow-up actions to ensure that the agreed upon process of resolution is working and that the organization will commit its resources to sustain the process going forward.

References

1. Tessier C, Chaudron L, Muller H. Conflicting Agents Conflict Management in Multi-agent Systems. Kluwer Academic, New York, NY: Kluwer Academic, 2002.

2. Porter-O’Grady. Embracing conflict: building a healthy community. Health Care Manage Rev. Vol. 2004;29(3):181-7.

3. Moore C. The Mediation Process: Practical Strategies for Resolving Conflict, 3rd ed. San Francisco, CA: Jossey-Bass, 2003.

4. Rahim MA. Toward a theory of managing organizational conflict. The International Journal of Conflict Management. 2002;13(3):206-35.

5. Senge PM. The Fifth Discipline: The Art and Practice of the Learning Organization. 1st ed. New York, NY: Doubleday, 1990.

6. O’Connor EJ, Fiol CM. Making conflict work for you: its value, sources, and opportunities. Chapter 14. In: Essentials of Medical Management. Eds: Curry W, Linney BJ. Tampa, FL: American College of Physician Executives, 2003.

7. Jehn KA, Mannix EA. The dynamic nature of conflict: a longitudinal study of intragroup conflict and group performance. Academy of Management Journal. 2001;44 (2):238-51.

8. Greer LL, Saygi O, Aaldering H, deDreu CKW. Conflict in medical teams: opportunity or danger. Medical Education. 2012;46(10):935-42.

9. de Wit FRC, Greer LL, Jehn KA. The paradox of intragroup conflict: a meta-analysis. J Appl Psychol, 2012;97(2):360-90.

10. Rahim MA. Managing Conflict in Organizations. 3rd Ed. Westport, CT: Quorum Books, 2001.

11. Lee L, Berger DH, Awad SS, et al. Conflict resolution: practical principles for surgeons. World J Surg. 2008;32(11):2331-5.