Dr Tim Porter-O'Grady is a medical mediator and consultant who works with health systems throughout the world, assisting them with major cultural change and systemwide conflict resolution. He can be contacted at [email protected]
A more extensive version of this article was originally published in Healthcare Management Review
All conflict is normative. Conflict is fundamental to the human experience and is a requisite of all human interaction. Conflict is simply the recognition and subsequent expression of differences in human relationships. Once the leaders understand how to use conflict management skills in their roles, they must clearly articulate the essential structural characteristics of conflict management as a day-to-day imperative of the organisation.
Development of Conflict-Based Educational Processes
Organised and structured conflict resolution processes within an organisation should be directed to address conflicts and disputes on issues related to productivity, absentee policies and practices, quality of work life, sexual harassment, work rules, discrimination and employee discipline and termination processes. Bringing conflict resolution processes to the workplace, especially the healthcare workplace, provides a significant opportunity to anticipate and to address issues that would otherwise require other, sometimes more costly, approaches to their resolution. Researchers have identified various implications and positive outcomes of effective and well-organised conflict management programmes: improved and positive atmosphere that supports the discussion of conflict and reduces stress, reduced conflict-related health problems, increased perceptions of fairness and job satisfaction, increased pro-social behaviours, and fewer incidents of aggressive behaviours (employee theft and litigation).
Conflict resolution must be available to all staff in the healthcare facility regardless of place, position or shift. This means that skilled mediation must be available at a convenient place and time for the user. It is essential to have sufficiently trained individuals on staff at all times to create a viable programme. In the conflict resolution process, time is of the essence. Conflict is a dynamic; it does not remain static and therefore continues to deepen and expand the longer it remains unresolved. Timeliness requires sufficient resources to address the conflict as quickly as possible, so that the stages of resolution can be activated as soon as possible.
Because 90% of conflict will emerge at the point of service, the leadership will have to focus on identifying and carefully selecting and preparing staff-based mediators in as many locations in the organisation as possible according to an equitable distribution across the system. The programme should ensure that staff-based problems are mediated by staff mediators and leadership problems are mediated by those leaders at the same level of the individuals experiencing the conflict situation. Therefore, carefully structuring the number of staff and role positions sufficient to address the various levels of conflict resolution will be an important strategic concern for the human resource office. As the programme becomes the framework for resolving conflict, addressing disputes, and ameliorating differences, the expectation will quickly arise that the programme will be available for everyone.
Furthermore, managers must seek out opportunities for the conflict management process to be used as a way to resolve differences at their point of origin. Indeed, managers must use the conflict resolution programme as a leadership tool capable of advancing employee involvement and empowering workers in owning and expressing accountability for issues that belong to them and should be addressed at the right place in the organisation. Leaders themselves must also be willing to embrace employee-derived solutions to longstanding operational, organisational, or relational problems. Leaders must be willing to actively support resolution by facilitating and assuring that resolution decisions and actions be clearly undertaken in response to the conflict resolution process.
Mediators must be deeply inculcated and highly skilled in the application of the specific process, documentation and procedural activities. The mediation conflict resolution process has eight general stages that must be engaged in throughout for it to effectively impact the conflict and the parties seeking resolution. At a minimum, the following elements are included in the mediation process:
CHART of Stages of Conflict Resolution Process
'Welcoming the participants, explaining the mediation process, identifying issues of confidentiality, and laying the ground rules for the process.
'Participants’ description of their situation, which includes outlining their issues and giving word to their feelings and to the processes associated with their part in the conflict.
'Identifying the issues and re-ordering the identified main concerns.
'Participants seeking solutions, including restatement of ideas, brainstorming, exploration and aggregation of possibilities.
'Evaluation and selection of participant ideas for resolution, including discussion of liability and identification of the emerging confluence of solutions.
'Enumeration of solutions and specification of impact, response, role, and individual commitments to actions related to the solutions.
'Documentation of resolution, performance expectations, follow-up actions, and evidencebased performance follow-up.
'Evaluation of mediation process including participant evaluation of the process, mediator, and evaluation of the dynamics and the process and submission of evaluation for programme review.
Confidentiality is Critical
The design of the programme should ensure that the participants remain confident that the issues and elements discussed in the processes associated with the conflict resolution programme remain confidential and within the context of the specific resolution events. Breaches of conflict and generation of information by mediators or participants to others virtually eliminate the viability of the programme and universally reduce trust in its application. Both mediators and participants should be fully sensitised to the issue of confidentiality.
Constant Evaluation of the Programme
Adjustments and adaptation are periodically required to continue to make the programme relevant. Furthermore, evaluation of mediators and their skills is critical to ensuring that the level of talent in the mediation process remains consistently high. Solid mediation is evidenced by indicators of satisfaction of the participants. A programme such as this has huge potential for human error and mediator-associated problems. Reducing the risk of such problems depends entirely on the developmental tools of the programme, the continuing and growing skill level of the mediators, the successful resolution of conflicts, and the ongoing viability and utility of the programme to all employees in the organisation. Evaluation must occur in all of these places.
Although conflict resolution programmes are relatively new to the healthcare system, they have existed in service and industry for several years now. Healthcare is a particularly humanistic environment, requiring high levels of relationship and functional interaction between and among the members of the work community. The opportunity for conflict is accelerated by increased intensity of interaction and human communication. Leaders must recognise the need to approach conflict by building a format for learning, creating and managing an effective conflict management programme. Ownership in resolving human conflict can further ensure the highestpossible quality of service, human interaction, and problem resolution.