Institutional Conflict Interventions and Dispute System Design
All of the aforementioned models of education and training emphasize the value of addressing conflict management on a systemic level and focusing on prevention through improved training and procedures that minimize harmful conflict interaction.
Just as a preventive health system does not eradicate disease, however, conflict management systems do not prevent the occurrence of conflict. Institutionalization of conflict practices may, however, facilitate systemic changes that help participants interact in more productive, constructive ways. This section summarizes systemic interventions, including mentoring, third-party intervention, and conflict management systems in health care.Mentoring Programs. Interviews with health care leaders by Dellve and Wikstrom (2009) demonstrated a paradox in attempts to balance administrative and occupational roles. Specifically, providers may privilege their clinical work to be seen as loyal to their colleagues, thus downplaying their administrative or managerial role. While this strategy may improve relationships with peers, it creates stress and conflict when they need to put on their “administrator hat” and make decisions in the organization’s best interests. Faced with this situation, leaders are torn between denying their role as administrators and losing the trust of colleagues. Dellve and Wikstrom suggested that leadership development, mentoring, and social support are needed to help health care leaders achieve transparency and open communication.
Third-Party Intervention. Health care organizations often have informal or formal third parties available to assist with conflict management. Lum and Fitzgerald’s (2007) study of surgical teams found that anesthetists often acted as informal third parties in emergency room conflicts between surgeons and nurses. This dynamic was successful because the anesthetists were seen as neutral to the individual interests of the surgeons and nurses.
Kressel et al. (2002) devoted significant attention to the question of how informal conflict managers intervened in an urban hospital. Interviews with 17 staff members who had a reputation among employees for being effective conflict managers found that the managers enacted the roles of neutral mediator, mediators with power (i.e., nursing supervisors), problem solvers, consultants, or direct advocates for their constituents. While these were not formally appointed roles, the work of these third parties prevented conflicts from going to the formal grievance process. These studies suggest that health care delivery could benefit from a more formalized system of third-party conflict management.Dispute System Design in Health Care. PorterO’Grady (2004) recommended building a programmatic structure for conflict management that is accessible at every level of the organization. More specifically, he suggested that conflict resolution skills training should be offered to all health care personnel, that leaders should implement a staff mediation program, and that conflict management processes should be routinely evaluated. Knowing that there is someone to go to for assistance may reduce the tendency toward silence and conflict avoidance discussed above.
In a study of internal dispute resolution (IDR), Rabinovich-Einy (2007) used the term internal transformative resolution to describe a process of conflict management that promotes ongoing dialogue with stakeholders and proactive measures for addressing problems in an Israeli hospital setting. Based on the transformative model of mediation (Bush & Folger, 2005), internal transformative resolution is presented as part of a comprehensive IDR system. The advantages of such systems include cost savings, enhanced employee morale, productivity, stability, and preventing the public airing of disputes. IDR is also frequently more efficient and more flexible in terms of remedies than legal proceedings (disputes may often be transformed with an apology, for example). Perhaps most important is the potential of such systems to change the conflict environment by contributing to organizational learning. More issues may be openly discussed, and participants in the process may feel empowered to manage future conflicts in more productive ways. While Rabinovich-Einy (2007) acknowledged the potential dark side of mediation—keeping issues such as discrimination private when they may need to be made more public to set precedent for future behavior—the author contended that transforming conflict management was necessary to change the culture of communication in health care.