Win, Lose, or Draw?
Some people think about problems and conflicts that occur at work in the same way they think about a basketball game or tennis match: someone has to win and someone has to lose. There are some problems with this sports comparison. First, the
3663_Chapter 8_0121-0132.indd 123
3663_Chapter 8_0121-0132.indd 123 9/15/2014 4:37:27 PM9/15/2014 4:37:27 PM
Process Cyan
Process CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black
aim of conflict resolution is to work together more effectively, not to win. Second, if people really do lose they are likely to feel bad about it. As a result, they may spend their time gearing up to win the next round rather than concentrating on their work.
A win-win result in which both sides gain some benefit is the best resolution (Haslan, 2001). Some- times people cannot reach agreement (consensus) but can recognize and accept their differences and get on with their work (McDonald, 2008).
Other Conflict Resolution Myths
Many people think of what can be “won” as a fixed amount: “I get half, and you get half.” This is the fixed pie myth of conflict resolution (Thompson &
Fox, 2001). Another erroneous assumption is called the devaluation reaction: “If the other side is getting what they want, then it has to be bad for us.” These erroneous beliefs can be serious barriers to achieve- ment of a mutually beneficial conflict resolution.
When disagreements first arise, problem solving may be sufficient. If the situation has already devel- oped into a full-blown conflict, however, negotia- tion, either informal or formal, of a settlement may be necessary.
Problem Resolution
The use of the problem-solving process in patient care should be familiar. The same approach can be used when staff problems occur. The goal is to find a solution that satisfies everyone involved. The process illustrated in Figure 8.1 includes iden- tifying the issue, generating solutions, evaluating the suggested solutions, choosing what appears to be the best solution, implementing that solution, evaluating the extent to which the problem has been resolved, and, finally, concluding either that the problem has been resolved or that it will be
necessary to repeat the process to find a better solution.
Identify the Problem or Issue
First, ask participants in the conflict what they want (Sportsman, 2005). If the issue is not highly charged, they may be able to give a direct answer.
Other times, however, some discussion and explo- ration of the issues will be necessary before the real problem emerges. “It would be nice,” wrote Browne and Keeley, “if what other people were really saying was always obvious, if all their essential thoughts were clearly labeled for us . . . and if all knowledge- able people agreed about answers to important questions” (Browne & Keeley, 1994, p. 5). Of course, this is not what usually happens. People are often vague about what their real concern is; sometimes they are genuinely uncertain about what the real problem is. Strong emotions may further cloud the issue. All this needs to be sorted out so that the problem is clearly identified and a solution can be sought.
Generate Possible Solutions
Here, creativity is especially important. Try to dis- courage people from using old solutions for new problems. It is natural for people to try a solution that has already worked well, but previously suc- cessful solutions may not work in the future.
Problem resolved If yes, end
Begin here
If not, repeat process
Implement solution
chosen
Generate possible solutions
Choose best solution
Evaluate suggested
solutions Identify
the problem
Figure 8.1 The process of resolving a problem.
• You feel very uncomfortable in a situation.
• Members of your team are having trouble working together.
• Team members stop talking with each other.
• Team members begin “losing their cool,” attacking each other verbally.
box 8-1
Signs That Conflict Resolution Is Needed
Adapted from Patterson, K., Grenny, J., McMillan, R., & Surtzler, A.
(18 March 2003). Crucial conversations: Making a difference between being healed and being seriously hurt. Vital Signs, 13(5), 14–15.
3663_Chapter 8_0121-0132.indd 124
3663_Chapter 8_0121-0132.indd 124 9/15/2014 4:37:27 PM9/15/2014 4:37:27 PM
Process Cyan
Process CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black
When an innovative solution is needed, suggest that the group take some time to brainstorm. Ask everyone to write down (or call out as you write on a board, screen, or flip chart) as many solutions as they can come up with (Rees, 2005). Then give everyone a chance to consider each suggestion on its own merits.
Review Suggested Solutions and Choose the Best Solution
An open-minded evaluation of each suggestion is needed, but accomplishing this is not always easy.
Some groups get “stuck in a rut,” unable to “think outside the box.” Other times, groups find it diffi- cult to separate the suggestion from its source. On an interdisciplinary team, for example, the status of the person who made the suggestion may influence whether the suggestion is judged to be useful. Yet the best suggestions often come from those closest to the problem (McChrystal, 2012). This may be the care assistants who spend the most time with their patients. Whose solution is most likely to be the best one, the physician’s or the unlicensed assis- tant’s? A suggestion should be judged on its merits, not its source. Which of the suggested solutions is most likely to work? A combination of suggestions is often the best solution.
Implement the Solution Chosen
The true test of any suggested solution is how well it actually works. Once a solution has been imple-
mented, it is important to give it time to work.
Impatience sometimes leads to premature aban- donment of a good solution.
Evaluate: Is the Problem Resolved?
Not every problem is resolved successfully on the first attempt. If the problem has not been resolved, then the process needs to be resumed with even greater attention to what the real problem is and how it can be resolved successfully.
Consider the following situation in which problem-solving was helpful (Case 2)
The nurse manager asked Ms. Deloitte to meet with her to discuss the problem. The following is a summary of their problem-solving:
■ The Issue. Ms. Deloitte wanted to take her vacation from the end of December through early January. Making the assumption that she was going to be permitted to go, she had purchased nonrefundable tickets. The policy forbids vacations from December 20 to January 5. The former nurse manager had not enforced this policy with Ms. Deloitte, but the new nurse manager thought it fair to enforce the policy with everyone, including Ms. Deloitte.
■ Possible Solutions 1. Ms. Deloitte resigns.
2. Ms. Deloitte is fired.
3. Allow Ms. Deloitte to take her vacation as planned.
Case 2
The Vacation
Francine Deloitte has been a unit secretary for 10 years. She is prompt, efficient, accurate, courteous, flexible, and productive—everything a nurse manager could ask for in a unit secretary. When nursing staff members are very busy, she distributes afternoon snacks or sits with a family for a few minutes until a nurse is available. There is only one issue on which Ms. Deloitte is insistent and stubborn: taking her 2-week vacation over the Christmas and New Year holidays. This is forbidden by hospital policy, but every nurse manager has allowed her to do this because it is the only special request she ever makes and because it is the only time she visits her family during the year.
A recent reorganization of the administrative structure had eliminated several layers of nursing manag- ers and supervisors. Each remaining nurse manager was given responsibility for two or three units. The new nurse manager for Ms. Deloitte’s unit refused to grant her request for vacation time at the end of December. “I can’t show favoritism,” she explained. “No one else is allowed to take vacation time at the end of December.” Assuming that she could have the time off as usual, Francine had already purchased a nonrefundable ticket for her visit home. When her request was denied, she threatened to quit. On hearing this, one of the nurses on Francine’s unit confronted the new nurse manager saying, “You can’t do this. We are going to lose the best unit secretary we’ve ever had if you do.”
3663_Chapter 8_0121-0132.indd 125
3663_Chapter 8_0121-0132.indd 125 9/15/2014 4:37:28 PM9/15/2014 4:37:28 PM
Process Cyan
Process CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black
4. Allow everyone to take vacations between December 20 and January 5 as requested.
5. Allow no one to take a vacation between December 20 and January 5.
■ Evaluate Suggested Solutions. Ms. Deloitte preferred solutions 3 and 4. The new nurse manager preferred 5. Neither wanted 1 or 2.
They could agree only that none of the solutions satisfied both of them, so they decided to try again.
■ Second List of Possible Solutions
1. Reimburse Ms. Deloitte for the cost of the tickets.
2. Allow Ms. Deloitte to take one last vacation between December 20 and January 5.
3. Allow Ms. Deloitte to take her vacation during Thanksgiving instead.
4. Allow Ms. Deloitte to begin her vacation on December 26 so that she would work on Christmas Day but not on New Year’s Day.
5. Allow Ms. Deloitte to begin her vacation earlier in December so that she could return in time to work on New Year’s Day.
■ Choose the Best Solution. As they discussed the alternatives, Ms. Deloitte said she could change the day of her flight without a penalty.
The nurse manager said she would allow solution 5 on the second list if Ms. Deloitte understood that she could not take vacation time between December 20 and January 5 in the future. Ms. Deloitte agreed to this.
■ Implement the Solution. Ms. Deloitte returned on December 30 and worked both New Year’s Eve and New Year’s Day.
■ Evaluate the Solution. The rest of the staff members had been watching the situation very closely. Most believed that the solution had been fair to them as well as to Ms. Deloitte.
Ms. Deloitte thought she had been treated fairly. The nurse manager believed both parties had found a solution that was fair to Ms.
Deloitte but still reinforced the manager’s determination to enforce the vacation policy.
■ Resolved, or Resume Problem Solving? Ms.
Deloitte, staff members, and the nurse manager all thought the problem had been solved satisfactorily.
Negotiating an Agreement Informally
When a disagreement has become too big, too complex, or too heated for problem resolution to be successful, a more elaborate process may be required
to resolve it. On evaluating Case 1, the nurse manager decided that the tensions between Team A and Team B had become so great that negotia- tion would be necessary.
The process of negotiation is a complex one that requires much careful thought beforehand and con- siderable skill in its implementation. Box 8-2 is an outline of the most essential aspects of negotiation.
Case 1 is used to illustrate how it can be done.
Scope the Situation
For a strategy to be successful, it is important that the entire situation be understood thoroughly.
Walker and Harris (1995) suggested asking three questions:
1. What am I trying to achieve? The nurse manager in Case 1 is very concerned about the tensions between Team A and Team B. She wants the members of these two teams to be able to work together in a cooperative manner, which they are not doing at the present time.
2. What is the environment in which I am operating? The members of Teams A and B were openly hostile to each other. The overall climate of the organization, however, was benign. The nurse manager knew that
teamwork was encouraged and that her actions to resolve the conflict would be supported by administration.
3. What problems am I likely to encounter? The nurse manager knew that she had allowed the problem to go on too long. Even physicians, social workers, and visitors to the unit were getting caught up in the conflict. Team members were actively encouraging other staff to take sides, making clear that “if you’re not with us, you’re against us.” This made people
• Scope the situation. Ask yourself:
What am I trying to achieve?
What is the environment in which I am operating?
What problems am I likely to encounter?
What does the other side want?
• Set the stage.
• Conduct the negotiation.
• Set the ground rules.
• Clarify the problem.
• Make your opening move.
• Continue with offers and counteroffers.
• Agree on the resolution of the conflict.
box 8-2
The Informal Negotiation Process
3663_Chapter 8_0121-0132.indd 126
3663_Chapter 8_0121-0132.indd 126 9/15/2014 4:37:28 PM9/15/2014 4:37:28 PM
Process Cyan
Process CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black
from other departments very uncomfortable because they had to work with both teams. The nurse manager knew that resolution of the conflict would be a relief to many people.
It is important to ask one additional question in preparation for negotiations.
4. What does the other side want? In this situation, the nurse manager was not certain what either team really wanted. She realized that she needed this information before she could begin to negotiate.
Set the Stage
When a conflict such as the one between Teams A and B has gone on for some time, the opposing sides are often unwilling to meet to discuss the problem. This avoidance prevents an exchange of information between the two groups (Sun, 2011).
If this occurs, it may be necessary to confront them with direct statements designed to open communi- cations between the two sides, challenging them to seek resolution of the situation. At the same time, it is important to avoid any suggestion of blame because this provokes defensiveness.
To confront Teams A and B with their behavior toward one another, the nurse manager called them together at the end of the day shift. “I am very concerned about what I have been observing,” she told them. “It appears to me that instead of working together, our two teams are working against each other.” She continued with some examples of what she had observed, taking care not to mention names or blame anyone for the problem. She was also prepared to take responsibility for having allowed the situation to deteriorate before taking this much-needed action.
Conduct the Negotiation
As indicated earlier, conducting a negotiation requires a great deal of skill.
1. Manage the emotions. When people are very emotional, they have trouble thinking clearly.
Acknowledging these emotions is essential to negotiating effectively (Fiumano, 2005). When faced with a highly charged situation, do not respond with added emotion. Take time out if you need to get your own feelings under control. Then find out why emotions are high (watch both verbal and nonverbal cues
carefully) and refocus the discussion on the issues. Allow disagreements to be expressed.
Those who are willing to voice their differences play an important role in helping the group move toward resolution of the problem. The leader’s role is to encourage group members to listen to and consider these differences, the first step in moving toward resolution of the conflict (Sarkar, 2009). Without effective leadership to prevent disagreements, emotional outbursts, and personal attacks, a mishandled negotiation can worsen a situation. With effective
leadership, the conflict may be resolved (Box 8-3).
2. Set ground rules. Members of Teams A and B began throwing accusations at each other as soon as the nurse manager made her statement.
The nurse manager stopped this quickly and said, “First, we need to set some ground rules for this discussion. Everyone will get a chance to speak but not all at once. Please speak for yourself, not for others. And please do not make personal remarks or criticize your coworkers. We are here to resolve this problem, not to make it worse.” She had to remind the group of these ground rules several times during the meeting.
3. Clarification of the problem. The nurse manager wrote a list of problems raised by team members on a chalkboard. As the list grew longer, she asked the group, “What do you see here? What is the real problem?” The group remained silent. Finally, someone said,
• Create a climate of comfort.
• Let others know the purpose is to resolve a problem or conflict.
• Freely admit your own contribution to the problem.
• Begin with the presentation of facts.
• Recognize your own emotional response to the situation.
• Set ground rules.
• Do not make personal remarks.
• Avoid placing blame.
• Allow each person an opportunity to speak.
• Do speak for yourself but not for others.
• Focus on solutions.
• Keep an open mind.
box 8-3
Tips for Leading the Discussion
Adapted from Patterson, K., Grenny, J., McMillan, R., & Surtzler, A.
(18 March 2003). Crucial conversations: Making a difference between being healed and being seriously hurt. Vital Signs, 13(5), 14–15.
3663_Chapter 8_0121-0132.indd 127
3663_Chapter 8_0121-0132.indd 127 9/15/2014 4:37:28 PM9/15/2014 4:37:28 PM
Process Cyan
Process CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black
“We don’t have enough people, equipment, or supplies to get the work done.” The rest of the group nodded in agreement.
4. Opening move. Once the problem is clarified, it is time to obtain everyone’s agreement to seek a way to resolve the conflict. In a more formal negotiation, you may make a statement about what you wish to achieve. This first statement sets the stage for the rest of the negotiation (Suddath, 2012). For example, if you are negotiating a salary increase, you might begin by saying, “I am requesting a 10%
increase for the following reasons: . . .” Of course, your employer will probably make a counteroffer, such as, “The best I can do is 3%.”
These are the opening moves of a negotiation.
5. Continue the negotiations. The discussion should continue in an open, nonhostile manner.
Each side’s concerns may be further explained and elaborated. Additional offers and
counteroffers are common. As the discussion continues, it is helpful to emphasize areas of agreement as well as disagreement so that both parties are encouraged to continue the
negotiations (Tappen, 2001).
Agree on a Resolution of the Conflict
After much testing for agreement, elaborating each side’s positions and concerns, and making offers and counteroffers, the people involved should finally reach an agreement.
The nurse manager of Teams A and B led them through a discussion of their concerns related to working with severely limited resources. The teams soon realized that they had a common concern and that they might be able to help each other rather than compete with each other. The nurse manager agreed to become more proactive in seeking resources for the unit. “We can simultaneously seek new resources and develop creative ways to use the resources we already have,” she told the teams.
Relationships between members of Team A and Team B improved remarkably after this meeting.
They learned that they could accomplish more by working together than they had ever achieved separately.
Formal Negotiation: Collective Bargaining There are many varieties of formal negotiations, from real estate transactions to international peace treaty negotiations. A formal negotiation process of
special interest to nurses is collective bargaining, which is highly formalized because it is governed by laws and contracts called collective bargaining agreements.
Collective bargaining involves a formal proce- dure governed by labor laws, such as the National Labor Relations Act in the United States. Non- profit health-care organizations were added to the organizations covered by these laws in 1974. Once a union or professional organization has been designated as the official bargaining agent for a group of nurses, a contract defining such impor- tant matters as salary increases, benefits, time off, unfair treatment, safety issues, and promotion of pro fessional practice is drawn up. This contract governs employee-management relations within the organization.
A collective bargaining contract is a legal docu- ment that governs the relationship between man- agement and staff, who are represented by the union (for nurses, it may be the nurses’ association or another health-care workers’ union). The con- tract may cover some or all of the following:
■ Economic issues: Salaries, shift differentials, length of the workday, overtime, holidays, sick leave, breaks, health insurance, pensions, severance pay
■ Management issues: Promotions, layoffs, transfers, reprimands, grievance procedures, hiring and firing procedures
■ Practice issues: Adequate staffing, standards of care, code of ethics, safe working
environment, other quality-of-care issues, staff development opportunities
Better patient-nurse staffing ratios, more reason- able workloads, opportunities for professional development, and better relationships with man- agement are among the most important issues for practicing nurses (Budd, Warino, & Patton, 2004).
Case 3 is an example of how collective bargain- ing agreements can influence the outcome of a conflict between management and staff in a health- care organization.
The Pros and Cons of Collective Bargaining Some nurses believe it is unprofessional to belong to a union. Others point out that physicians and teachers are union members and that the protec- tions offered by a union outweigh the downside.
There is no easy answer to this question.
3663_Chapter 8_0121-0132.indd 128
3663_Chapter 8_0121-0132.indd 128 9/15/2014 4:37:28 PM9/15/2014 4:37:28 PM
Process Cyan
Process CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black