Summary of Provider, Patient, and Family Member Conflict
Based on the preceding review of research, we surmise that conflict occurs within various health care contexts (e.g., hospital, residential care), across various patient populations (e.g., children, adults, elderly) and health concerns (e.g., cancer, heart disease, depression), and within a wide range of provider-patient relationships (e.g., doctor-patient, nursefamily, social worker-family).
Studies conducted through case study, discourse analytic, ethnographic, and survey research approaches contribute to our understanding of both the contributing factors and consequences of conflict within this context. Table 16.1 illustrates that sources of conflict are diverse—from communication style and power relations to the nature of the patient’s illness. Improving communication, and minimizing conflict, between patients, family members, and health care providers is critically important in several regards. Poor communication has been associated with greater dissatisfaction with care (Grau, Teresi, Burton, & Chandler, 1995), less frequent visiting (Port, 2004), poor patient outcomes (Anderson, Issel, & McDaniel, 2003), higher instances of aggressive behavior (Vinton & Mazza, 1994), lower provider job satisfaction and performance (Cohen-Mansfield, 1995), higher staff turnover (Anderson, Corazzini, & McDaniel, 2004), and higher staff burnout (Abrahamson, Suitor, & Pillemer, 2009). As Roter and Larson (2002) argued, the designation of effective communication practices as “patient centered” fails to take into account the reciprocal relationship between providers and patients, and hence, should be recast as “relationship-centered” communication.Research that examines various conflict prevention and management interventions will be discussed in the third section. The overview provided in this section also suggested that the structure and processes of health care organizations create opportunities for conflict.
Hence, we turn our attention to conflict within health care organizations, spanning all three circles in Figure 16.1: (1) organizational, (2) group, and (3) dyadic contexts.Conflict Within
Health Care Organizations
While health care settings face conflicts similar to any organization, the structure and complexity of the health care system presents several unique challenges. Among the causes of conflict to be described in this section include issues of power and status, ambiguity, role conflict and role strain, and cross-disciplinary communication. These structural and relational causes of conflict may be exacerbated by more concrete, task-related concerns based on economics, threats of litigation, different opinions about patient care, and organizational practices.
This section starts at the most macrolevel in Figure 16.1, conflict within health care groups
Status inequities
Organizational/professional culture
Competing discourses
Communication structure
Tensions of autonomy and connection
Role ambiguity
and teams and culminates with an overview of research at the most micro, dyadic level: conflict between and among doctors, nurses, and residents. The main causes of conflict within health care institutions and medical personnel are summarized in Table 16.2.