Conflict in Health Care: A Literature Review

Direct patient contact health care employees such as physicians, nurses, and technologists work in complex, stressful environments that are prone to conflict. Though some of this conflict may result in positive outcomes, much will have the opposite effect. Dysfunctional conflict has the potential to negatively affect the health care workplace on a variety of levels, including impacting the quality of patient care, employee job satisfaction, and employee wellbeing. Therefore, it would behoove hospital managers to learn to recognize the precursors to conflict in order to prevent any ill effects. The purpose of this literature review is to offer an overview of the antecedents and effects of conflict among health care workers. Both positive and negative effects of conflict are addressed. Also explored in this review are methods in which negative conflict can be adequately managed and resolved. Although there is no universal definition of conflict (Cox, 2001; Katielidou et al., 2012; Kelly, 2006), it can be described as “a process in which one party perceives that its interests are being opposed or negatively affected by another party” (Kreitner & Kinicki, 2010, p. 373). As pleasant as it may seem at first glance, the total avoidance of conflict is more a fairytale than a realistic expectation. In fact, though there are multiple negative effects of conflict, there do also exist some benefits. This positive effect is often overlooked. Society tends to lend the term conflict a negative connotation. For example, the word war is synonymous with conflict. Wars are often viewed as events to be avoided at all costs, yet organizational conflict will occur more frequently and is expected by wise leaders. Repeated avoidance of conflict leads to dysfunction and is often based on various fears such as rejection, anger, failing, loss of relationships, and hurting others (Kreitner & Kinicki, 2010). Without conflict, problems develop. With chronic conflict, problems develop. Maintaining a delicate balance is the responsibility of organizational leaders. Leaders of companies must inevitably face the issue of conflict in their workplaces. Health care leaders are certainly not immune. Hospital employees experience conflict quite frequently in the workplace (Berman-Kishony, 2011; Forte, 1997; Guidroz, Wang, & Perez, 2011) due to its high-stress environment (Chipps, Stelmaschuk, Albert, Bernhard, & Holloman, 2013) and the variety of stakeholders involved (Shin, 2009). This literature review will seek to answer key questions regarding conflict among direct patient contact health care workers, namely the following. (1) How are Kreitner and Kinicki’s (2010) antecedents of conflict relevant to health care personnel? (2) What are the potential effects of conflict in the health care workplace? (3) What are some strategies that can be utilized in order to manage and resolve unhealthy conflict within the health care system? The implications for further research and the future of the health care workplace regarding conflict will also be discussed. DYNAMICS OF CONFLICT Conflict is a complex behavior. It can occur on various levels – intrapersonal, interpersonal, intragroup, or intergroup. Intrapersonal conflicts occur within the person, whereas interpersonal conflict takes place between people. Likewise, intragroup conflict happens within one group of people and intergroup conflict occurs between two or more groups of people (Forte, 1997). According to the definition of conflict, “one party perceives that its interests are being opposed or negatively affected by another party,” perception plays an important role in conflict. The issues that arise to cause conflict may be genuine or illusory (Kreitner & Kinicki, 2010, p. 373). The subsequent conflict is real, nonetheless. Dysfunctional conflict refers to the negative types of conflict that “hinder organizational performance” (Kreitner & Kinicki, 2010, p. 375). However, not all conflict results in Conflict in Health Care: A Literature Review 2 of 11 damage. Functional conflict involves the “healthy and vigorous challenge of ideas, beliefs, and assumptions” (Menon, Bharadwaj, & Howell, 2001, p. 303). Since conflict can result in necessary changes within an organization, Haraway and Haraway (2005) suggest leaders “not to try to eliminate conflict” but instead manage differences productively in order to increase efficiency and proficiency (p. 11). This is contradicted by Dougan and Mulkey (1996) who posit, “elimination of conflict is always the goal,” even if the conflict seems constructive in the onset (p. 3). This latter view of conflict corresponds to the traditional understanding of conflict that stemmed from the 1930s that viewed conflict as destructive, dysfunctional, and disruptive. It was to be “avoided, suppressed, or eliminated” (Almost, 2006, p. 447). Only later, circa 1956, were the positive effects of conflict studied, beginning with Coser (Lewicki, Weiss, & Lewin, 1992). Nonetheless, Almost (2006) posits that resolution of conflict is necessary due to the fact that if allowed to be prolonged will eventually generate new causes of conflict. ANTECEDENTS OF CONFLICT What situations generate conflict? Conflict is more apt to take place under certain circumstances; by making themselves aware of these antecedents, organizational leaders can prepare for it and intervene when appropriate. Kreitner and Kinicki (2010) list the following circumstances as tending to create conflict: personality and/or value differences, blurred job boundaries, battle for limited resources, democratic decision-making, collective decisionmaking, poor communication, competition amongst departments, unreasonable work expectations (policies, rules, deadlines, time restriction), unmet and/or unrealistic expectations (regarding salary, advancement, or workload), more complex organizations, and unsettled or repressed conflicts. Most conflict research reveals that the majority of health care conflict arises from “interpersonal or professional communication difficulties” (Shin, 2009). Many of these factors are discussed in recent literature and will be reviewed in the subsequent paragraphs, along with findings from studies specifically limited to health care practitioners. PERSONALITY DIFFERENCES Almost, Doran, Hall, and Spence Laschinger (2010) noted that dispositional characteristics were found to be a major cause of conflict in the nursing field in three separate Canadian research studies. Incompatibilities between and amongst persons can include “personality clashes, tension and annoyance” (p. 982). Individuals have unique personalities and vary in “attitudes, opinion, beliefs, culture emotional stability, maturity, education, gender, language, etc.” (Jha & Jha, 2010, p. 77). Therefore, their reactions to specific stimuli also differ. These differences cause some individuals to perceive some matters as undermining their positions or refuting their worldviews or values. Oftentimes, individual differences can adopt moral and/or emotional undertones, turning a disagreement over who is factually right or wrong into “a bitter squabble over who is morally correct” (p. 77). Though Jha and Jha seem to suggest that differences contribute to situations of conflict, it is noteworthy to consider Mulford, Mulford and Wakeley’s (1977) study that concluded, “conflict may be absent when organizations try to recruit members from different age categories (as cited in Dougan & Mulkey, 1996).