Author(s): Maisa Hamed Al Kiyumi
Conflict resolution is not merely a skill but an essential leadership competency for healthcare professionals. Unaddressed conflicts can have detrimental consequences on patient care, team morale, and organizational productivity. This article delves into the significance of conflict management in healthcare, exploring its multifaceted impact and highlighting the role of leadership in fostering a conflict-resilient work culture. Understanding the root causes of conflicts, such as resource constraints, communication challenges, and differences in personal and professional characteristics, is crucial for developing effective prevention strategies. Healthcare leaders need to adopt proactive approaches to conflict management, emphasizing open communication, mutual respect, and collaborative problem-solving. The article explores various conflict management models, providing healthcare leaders with a toolkit for effective conflict resolution. It highlights the role of emotional intelligence and ethical leadership behaviors in conflict mitigation and discusses the need for a dynamic conflict management framework and its implications in the healthcare environment. It also outlines the need for self-assessment of conflict management skills, essential conflict management strategies and effective leadership tactics to resolve a range of conflict management challenges. It concludes by emphasizing the importance of early intervention and effective handling of conflicts by professional communication. The findings in this article provide a practical roadmap for developing conflict management competencies in healthcare leaders. Importantly, they unravel the nuances of potential conflict management approaches, warranted to establish a conflict-resilient culture in the clinical practice environment.
The Significance of Conflict Management in the Healthcare Sector
A conflict is dissent between people based on differences in their opinions, perspectives, goals, insights, and personal agendas [1]. The unresolved conflict impacts the work culture and deteriorates productivity and organizational outcomes. Conflicts based on major controversies and disagreements also increase the risk of violence and litigation. Potential conflicts between healthcare leaders and/or their team members interfere with their efficiency and add to employee attrition rates [2]. Importantly, conflicts adversely impact the morale, confidence, and competence of healthcare professionals, which eventually reduces their ethical conduct and decision-making abilities. The intergroup, intragroup, interpersonal, and intrapersonal conflicts in the healthcare environment therefore require systematic mitigation to improve the organizational outcomes [3]. The aim of a goal-oriented conflict management approach is to maximize the positives and minimize the passive results emanating from unresolved disagreements between individuals in a clinical setting. The establishment of a robust conflict management framework based on nonconfrontational dialogue and active listening is paramount to minimizing the interprofessional/extraprofessional differences between individuals in the healthcare environment [4,5].
The effective resolution of unmanageable conflicts in healthcare organizations warrants the systematic implementation of five styles of the Thomas-Kilman Instrument, which are measured on a cooperativeness and assertiveness scale [6]. These styles predominantly include compromising, competing, collaborating, avoiding, and accommodating attributes. The compromising style assists in establishing minimal consensus between the individuals and providing them with some concessions in alignment with their desires. While the competing style utilizes authority to suppress the demands of either or both parties, the collaborating approach uses open communication to strengthen their cooperation. The goal of the avoiding style is to neglect the conflict in totality and leave it unaddressed or unattended [7]. The accommodating style; however, prioritizes the perspectives of one individual over the other to establish peace and harmony [6].
Several individual, interpersonal, and organizational factors fuel a range of conflicts in the healthcare setting [8]. The threatening of self-belief/self-focus of one person by another, based on different worldviews, thoughts, or motives, often leads to misconceptions and misinterpretations. Other potential personalized causes of conflict include stress, exhaustion, and resource depletion. The occurrence of these factors leads to biased judgment and a rapid decline in the emotional and cognitive capacity of healthcare professionals, which adversely impacts patient support decisions and overall care quality. The interpersonal attributes leading to potential conflicts in healthcare settings include social distancing/ dominance, miscommunication, stigmatization, prejudice, stereotyping, coercion, and bullying [9]. These factors obstruct the professional interactions between the healthcare teams, which eventually weakens their overall collaboration. The organizational causes resulting in workplace conflicts include staff shortages and the high complexity of patient care services [10]. The high frequency of conflicts within the healthcare teams disengages them from their professional roles, reduces teamwork, increases anxiety and emotional exhaustion in employees, and weakens the trust of patients in the healthcare system.
Effective conflict management plays a pivotal role in developing a positive emotional environment for the healthcare employees as well as the patients [11]. This means that via successful conflict management, healthcare leaders can facilitate effective communications across their teams and strengthen their trust and confidence in the organizational culture. An atmosphere conducive to professional communication is also essential to further improve the behaviors, emotional responses, and shared attitudes among the staff members. It is also necessary to boost the morale of employees and motivate them to improve their working patterns and orientation. Conflict mitigation by healthcare leaders is the key to enhancing the satisfaction levels of employees as well as patients. Additionally, the conflict resolution skills of dynamic healthcare leaders also indicate their emotional intelligence and ability to improve team attitude, proactive behaviors, and work passion [12]. Indeed, conflict management interventions help healthcare leaders create a culture of feedback and continuous improvement, which can prevent errors and inconsistencies in operations, overcome the complexities of healthcare procedures, and support organizational goals.
The incompatible and misaligned assumptions of the healthcare leaders concerning their team members lead to representational or perceptual gaps that substantially barricade conflict resolution interventions [13]. The misrepresentation of the value and meaning of interactions between healthcare leaders and staff members deteriorates their active listening skills and adds to their defensiveness, negative attributions, frustrations, and animosity toward each other. The communication gaps in conflict management challenge the assessment of the effects and intensity of conflicts [14]. For example, the lack of effective communication about the front-line staff shortage, improper medical equipment, and poor treatment decisions consistently overburdens the paramedics, increases their fatigue, and reduces their performance. Healthcare leaders therefore required to establish robust communication channels and motivate their teams to escalate their concerns without fear of repercussions [15]. They need also to develop and comply with the organizational policies, bylaws, and code of conduct to ascertain the regular address of complaints and concerns of employees. In addition, they need to learn and acquire skills to manage their emotions and self- reflect on their public dealings, to consistently explore the areas of prospective behavioral improvements. Importantly, diffusing the circumstances in a non-threatening manner through clear and controlled conversations is a strong way to resolve potential conflicts among healthcare professionals [2].
The occupation stratification of paramedics and nurses by physicians and administrators in healthcare settings influences their professional conduct and organizational behaviors [16]. The healthcare leaders, including physicians, should therefore ascertain to establish equity in the organizational culture and treat all staff members with respect and empathy. They should also discourage submissive behaviors in paramedics and nurses and engage them in healthcare decision-making. It is also important to minimize work-based insecurity in healthcare professionals to strengthen their integrity and trust in the organization [17]. The leaders should ensure that the occupational hierarchy should in no way influence personal attributes as well as professional communication between the employees. These interventions can effectively reduce the risk of conflicts by empowering the healthcare teams and improving their sense of accountability for their profession.
The aim of this review paper is to deep dive into a range of conflict management factors, approaches, theories, models, and attributes, as well as their current challenges and outcomes. The findings will help healthcare leaders to reflect on their organizational and people management challenges, identify potential conflict management gaps, and develop robust mechanisms to minimize disagreements or use them constructively in the best interests of all stakeholders, including patients, caretakers, and healthcare teams.
Root Causes of Conflicts in The Healthcare Settings Potential conflicts between the administrative and the clinical teams often arise due to job characteristics, organizational attributes, weak communication channels, personal features, lack of professional integrity, mismanaged perceptions, and attributes, and managerial incompetence [18]. Interprofessional conflicts also occur due to salary delays, intricate administrative processes, workload mismanagement, organizational policies, disregard for well-being, absence of reward and recognition system, and marginalization of employees by their supervisors. Furthermore, indeterminate work policies and unreasonable staff expectations add to the incidence of workplace conflicts and their deleterious implications. Importantly, the absence of conflict management training, ineffective grievance redressal, and delay in assigning tasks to employees leads to ambiguities that eventually fuel several conflicts in the clinical practice environments. The healthcare teams wherein the professionals with low self-esteem focus on their self-interests while ignoring the organizational goals, fail to demonstrate teamwork that eventually reduces their overall performance [19]. In addition, rivalry between individuals, high variations in salary structures in the organizational hierarchy, and disproportionate entry levels increase the instances of interprofessional conflicts in healthcare settings [20]. Negative competition between employees for rewards and other professional advantages further increases the prevalence of disagreements and conflicts. The instances of conflicts in the clinical settings severely compromise the care processes and well-being of patients, which drastically reduces their confidence in the healthcare system. A real-world study by Castellini provides the incidence rates of significant sources of conflicts in the occupational sector [21].
Impact of Conflicts on The Quality of Healthcare Processes The ongoing conflicts in the healthcare environment potentially deteriorate the professional conduct and personal behaviors of patient care personnel [22]. The productive time invested in mitigating disagreements between professionals impacts the organizational goals and increases the overall work burden of employees. The intra-professional conflicts significantly impact the job outputs and increase the emotional burden as well as work dissatisfaction among the employees. The low professional conduct due to consistent conflicts reduces the focus of the healthcare teams on their patient management tasks [23]. Healthcare professionals eventually deprioritize their tasks, which reduces the overall efficiency of the patient management system. The compromise in the patient care procedures due to the professional negligence based on the inter/intra-professional conflicts increases the risk of clinical complications. Significant treatment errors due to improper medical decision-making and non-adherence to the care algorithms sometimes prove life-threatening for critically ill patients [24]. Additionally, unresolved conflicts between healthcare professionals also hinder whistle-blowing activities, which at times, leads to the uninterrupted administration of ineffective treatments or medical malpractices. Unnoticed medical negligence in such scenarios profoundly impacts the patient care paradigm and increases the risk of patients to debilitating complications [25]. The overall outcomes of conflicts in healthcare settings include the interruption of patient-centered care, reduction in the safety and effectiveness of treatments, delay in treatment administration, and minimization of equity in patient management procedures [23].
The systematic prevention of workplace conflicts is the key to improving employee/patient satisfaction, productivity, and teamwork [26]. Conflict mitigation is also necessary to improve care safety and minimize the risk of preventable complications in patients. The successful execution of shared responsibility by the healthcare teams is never possible with their ongoing professional conflicts. Long-term conflicts in the clinical practice environment increase burnout and psychological distress, trigger a toxic work culture, and elevate stress and anxiety in healthcare professionals [27]. Potential conflicts barricade the professional communication between the healthcare teams, thereby leading to the avoidance of important patient concerns and sensitive treatment requirements. Conflicts eventually challenge care continuity, hinder diagnostic assessment, induce the frequency of unnecessary evaluations, add to the iatrogenic complications and increase the incidence of safety events [21]. The healthcare professionals engaged in workplace disagreements tend to deviate from their responsibilities, while their misunderstandings impact their patient management decisions [23]. Their overall analytical attitude, micromanagement of situations, and hostility towards each other negatively influence their alliance with patients and caretakers [28]. These deficits further deteriorate the healthcare quality and increase the apprehension of patients regarding their treatment decisions.
The conflict management tool by Thomas-Kilman is a robust procedure to evaluate the conduct and behaviors of people engaged in inter/intra-professional conflicts [29]. The assessment of the five tenets of the Thomas-Kilmann theory and the calculation of the Thomas-Kilman Conflict Mode Instrument (TKI) scores assist in formulating robust conflict management strategies in healthcare settings [6]. The scores are individually obtained for each TKI mode, including collaborating, compromising, avoiding, accommodating, and competing. The TKI scores ranging between 0–25%, 26–75%, and 76–100% indicate low, medium, and high levels of conflict-handling modes [30]. The interpretation of the individual conflict-handling behaviors relies on the nature of conflict and its circumstances. The dual concern conflict management model advocates five unique conflict resolution strategies in organizational settings [31]. Its implications in the healthcare settings are well recognized and appreciated. The contentious style of the dual concern conflict approach utilizes coercive tactics and raises unreasonable requirements to downgrade the opponent. The accommodating strategy prefers to offer concessions and capitulation for mitigating the conflict. The avoidant approach aims to end the conflict by shifting the accountability to an unrelated person [32]. The compromise strategy assists the healthcare leaders to act as intermediaries and subside the conflict by selectively accepting the concerns of both parties and establishing a mutual consensus. The integrating strategy facilitates open communication between healthcare professionals to help them exchange their views and explore differences in their perspectives to arrive at a mutually agreeable solution [33]. The interest-oriented relational strategy; however, identifies the differences in perspectives of individuals in conflict and reestablishes good relationships between them by reflecting on disagreements and deriving a mutually agreeable solution [34]. The healthcare leaders utilizing the relational strategy require safeguarding the confidential information of the concerned professionals and suggesting a viable solution that may differ from the initial perspective of both parties. This approach also advocates the establishment of a therapeutic relationship between healthcare leaders and employees [35]. The use of this strategy warrants a high level of calm/patience, avoidance of partisan, and equitable consideration of the interests of both parties.
Strengths and Limitations of Conflict Management Strategies The conflict management approaches directly or indirectly influence the emotional intelligence of individuals and help them achieve stable professional relations [36]. Therefore, the assessment of their outcomes in the context of their emotional impact on individuals is paramount to evaluating their success or failure. Therefore, the measurement of each of the conflict management interventions based on emotional intelligence parameters including emotionality, sociability, well-being, and global traits is necessary to determine their true potential in the given circumstances. Furthermore, a comprehensive assessment of the strengths and limitations of conflict management styles is paramount to determining their real-time applications in healthcare settings [37]. While the accommodation approach is swift and easy to implement, it could result in frustration and resentment in employees. The avoidance style effectively controls the conflict and associated stress for some time; however, the result is not long-lasting and is difficult to mitigate after its recurrence. The competition approach fast-tracks the conflict resolution but at the cost of risking the professional relationships that may reignite the conflict at any point in time. The compromise strategy helps to strengthen the professional relationships of people in conflict; however, it may lead to suboptimal solutions [6]. Finally, the collaboration style is the most effective way to resolve conflicts, but it can be a slow and complex process.
The transformational and transactional attributes of healthcare leaders predominantly influence the choice and effectiveness of conflict management interventions [38]. The transformational characteristics include individualized consideration, intellectual stimulation, idealized influence, and inspirational motivation. The transactional attributes include exception-based active/passive management and a contingent reward-based approach. In addition, the Laissez-faire leadership strategy is a hands-off intervention that empowers the team members to resolve their conflicts [39]. The employees receive the required support and training from their leaders and collaborate to decide the fate of their conflicts. Other potential factors impacting the conflict management approaches include the core competencies, cognition, and personality traits of healthcare professionals as well as their leaders [40]. The core competencies of healthcare leaders include their clinical, communication, problem-solving, decision-making, teamwork, and leadership skills. Leaders with strong core competencies aptly perform the root cause analysis of the conflicts and initiate their de-escalation by selecting an appropriate approach. The frequency of their follow-ups with the employees helps them to anticipate the outcomes of their conflict management interventions. Accordingly, they get the privilege to improve or modify their conflict resolution strategies to increase the scope of positive outcomes. Importantly, the personality traits including neuroticism, conscientiousness, openness, extroversion, and agreeableness variably influence the integrating approach for conflict management and its results [41]. The long-term orientation and avoidance of uncertainty also influence the selection of emotional intelligence-based integration, obliging, and compromising leadership styles and their outcomes [42]. Social behavior and culture in the healthcare setting further impact the selection and outcomes of conflict management styles [43]. For example, healthcare leaders could prefer to adopt a conflict management approach in concordance with their cultural beliefs. A physician with cultural values based on avoiding a direct conflict may adopt the compromising conflict management style, leading to dissatisfaction in both parties at a later stage. A collaborative conflict management approach may not bring the desired results in a work culture where people use reasoning- based assertions to settle their disputes. Healthcare leaders can also utilize their consultation tactics, appreciation, and power to influence the thinking patterns of their team members [44]. They may also use the dominating conflict management approach with legitimate sources and expertise to improve workplace behaviors and professional relationships within their teams and to engineer viable solutions to mitigate their disagreements.
A thorough assessment of the emotional demands of a situation is paramount to the successful resolution of workplace conflicts [45]. Healthcare leaders should be aware of their emotions and thoughtfully manage them in an integrating style to minimize the stress levels of their teams. They should utilize a cooperative conflict management strategy to settle the issues between the healthcare professionals deployed in the urgent care settings [45]. The conflict management approaches in the healthcare settings reciprocate with the interpersonal skills, intrapersonal capacity, adaptability, stress management ability, and general mood of professionals as well as their leaders. Healthcare leaders should also determine the emotional intelligence scores of their team members to select the most appropriate conflict prevention approaches in the clinical practice environment [46]. Accordingly, they should utilize an emotional quotient inventory to evaluate the emotional self-awareness, self-regard, assertiveness, self- actualization, independence, empathy, interpersonal relationships, social responsibility, problem-solving, reality testing, flexibility, stress tolerance, impulse control, happiness, and optimism scores of individuals engaged in conflict [47]. The healthcare leaders rendering their services in a collectivist culture should aim to improve harmony between the professionals based on the similarities and differences between their values, beliefs, and perceptions. They need to further emphasize the concept of mutual benefit, respect the ideology of each team member, and aim to gain the trust of employees by using obliging, compromising, and integrating conflict management approaches [48]. The use of interpersonal skills with the collaborating strategy also influences the emotions of healthcare professionals in conflicting situations [49].
Healthcare leaders need to comply with communicative ethics to effectively manage the interactions between their team members [50]. The exclusion of non-compromising dominance, aggressive conduct, and improper use of power is paramount to strengthening the confidence of healthcare professionals in their leadership. Ethical leadership behaviors assist in balancing constructive intention (i.e., acts to improve the loyalty perceptions of employees for the organization) and constructive deviance (i.e., acts to enhance the organizational well-being) of employees [51]. Healthcare leaders must focus on minimizing normative conflicts (i.e., disagreements between organizational policies and the personal values of staff members) to establish harmony and reduce the risk of animosity between employees. Furthermore, adherence to the principles of bioethics is conducive to enhancing the autonomy perceptions of the healthcare teams and empowering them to mitigate their disagreements [52]. The implementation of the bioethics approach also assists in reducing the conflicts of interest between healthcare professionals and helps them manage their differences with professional judgment by improving their moral integrity [53]. The ethical behaviors of the healthcare leaders help them optimize the resource allocation practices and improve the sense of inclusion of the staff members in the organizational culture. Findings in the contemporary literature advocate a significant correlation between the work patterns of healthcare employees and ethical leadership behaviors [54]. The servant leadership approach is the best strategy to utilize ethical behaviors in clinical settings to promote the overall well-being and growth of healthcare professionals. The formulation of an ethical climate in healthcare settings is a necessary step to promote and improve ethical leadership behaviors. The harmonization of intra/ interprofessional relationships between healthcare professionals also requires the establishment of a healthy psychological climate by the organizational leadership. Healthcare leaders should further take accountability to implement a reward and punishment strategy for stringently improving the adherence of employees to the code of ethics, to minimize their conflicts [55]. These findings testify that ethical healthcare leadership can improve employee occupational behaviors, strengthen social bonding and mutual trust, and reduce the frequency of potential conflicts and associated productivity losses.
A robust conflict management framework in the healthcare environment aims to emphasize the benefits of teamwork and improve the sense of team association among the staff members [56]. It also fosters an environment conducive to using conflict management strategies and increases the motivation levels of employees. It has a key role in improving self-expression, emotional intelligence, assertiveness, empathy, and communication among employees. Healthcare leaders require customizing the conflict management framework in harmony with the organizational culture to create an employee-friendly environment. The aim of this framework is to prevent/resolve conflicts based on disagreements between employees. Healthcare leaders can utilize a two-staged conflict management framework to prevent or reduce the occurrence of inter/intra-professional conflicts [57]. The first stage should aim to enhance the awareness of employees about the potential conflict drivers. The healthcare leaders are required to discuss these drivers with their team members during the handovers or daily huddles. The conflict management framework should be able to track the occurrence of conflicts and escalate them to the healthcare leaders. Subsequently, the leaders are required to collaborate with the conflict-affected professionals and prepare an action plan to de-escalate the inter/intra-professional disagreements. However, the failure of Stage 1 should be followed by the implementation of Stage–2 in the healthcare setting. This stage should call and involve senior management and aim to resolve the conflict through effective communication, perspective- taking, and empathetically supporting both parties [58]. Healthcare leaders should train team members to understand the causes and effects of their conflicts and the importance of resolving them effectively.
Healthcare leaders should self-evaluate their conflict management potential and perspectives before finalizing their mitigation approaches [59]. They need to reflect on their emotions and feelings in the context of the conflict and investigate its possible causes. After assessing the conflict situation, they need to address the emotions, feelings, and needs of the involved professionals. In addition, the healthcare leaders have the privilege to decline the proposed conflict management solutions from either party or seek assistance from a third party/reviewer before trying to reach an agreement with the affected professionals. Additionally, they should self-manage their stress to reduce bias in conflict outcomes [60]. The self-assessment of circumstances and the causes of conflict is necessary to determine the personal factors contributing to the conflict and anticipate its outcomes. It also helps to minimize the emotional responses, including resentment, frustration, and anger, that may further aggravate the conflict. Self-reflection on conflicts is an ongoing and evolving process that enhances healthcare leaders’ coping skills, resilience, and ability to address and resolve complex conflicts, thereby reducing the likelihood of adverse outcomes. A study by Long and Long (2022) utilized a robust self-assessment tool to evaluate the conflict-management skills of professional nurses[59]. Healthcare leaders can use this measure proactively to determine their conflict management potential and reflect on the improvement areas.
The appropriate use of conflict management skills in the healthcare sector assists in strengthening patient care quality, enhancing team collaboration, and minimizing burnout/stress and associated productivity losses [23]. It also minimizes the risk of medical errors and safety events in clinical settings [61]. The attainment of high expertise in conflict management assists in improving organizational profits, minimizing staff turnover, and elevating patient satisfaction levels. Healthcare leaders should accordingly utilize their empathy, problem-solving, active listening, and communication skills to address professional confrontations in healthcare settings. The conflict resolution model by Stanley and colleagues is an effective way to manage professional disagreements (2008). This approach to conflict resolution begins by creating a win-win strategy and mediating a resolution that engages both parties as partners, rather than adversaries. The next step is to minimize interruptions and utilize problem-solving and active listening skills to implement a reflective structured dialogue for addressing the conflict [62]. Healthcare leaders are required to construct a safe environment for communication and avoid blaming or judging the team members. They also need to modulate their non-verbal and verbal language to comfort both parties. Emphasizing the matter with objectivity and without personalizing it, is the best approach to gaining the trust of the opponents. It is important to evaluate the interests, disinterests, and assumptions of the adversaries and explore the relevant options to reach a mutually agreeable solution (2008). The healthcare leaders should evaluate the non-verbal cues of the opponents along with their feelings and background information. Paraphrasing of the comments by each opponent is always needed to reduce the risk of ambiguities and misinterpretations. Both parties should be encouraged to use their problem-solving skills to suggest viable solutions for mitigating their conflicts [63]. The use of objectivity in conversation and engagement of external sources to clarify data is often recommended to modify the perspectives of the opponents [64]. The proposed solutions should meet the requirements of both opponents and evoke their emotions.
Conflict Management Challenges for Healthcare Leaders Healthcare leaders often find it difficult to deal with the perspectives of highly diverse sections of multidisciplinary professionals [65]. For example, it is challenging for them to simultaneously align with the perceptions of physicians/nurses, accountants, patients, and caretakers in the same healthcare setting. Healthcare leaders’ lack of authority to initiate employee welfare sessions and support programs, as well as their inability to change the structure of teams based on organizational policies, further impair their decision- making and limit their conflict resolution interventions. Healthcare leaders in clinical settings with undefined/undocumented job descriptions find it increasingly difficult to define the scope of work for their teams, which increases the risk of inter/intra- professional conflicts [66]. The healthcare leaders associated with resource-limited settings are unable to expand the employee welfare provisions, including incentives and rewards for extra working hours. Importantly, clinical settings with unfavorable infrastructure/working conditions and limited equipment add to the occupational stress of the healthcare teams and challenge the management of their professional conflicts [67]. Bureaucracy in clinical settings profoundly influences the working patterns of healthcare teams [68]. For example, the high engagement of physicians and nurses in administrative tasks restricts their engagement in patient management activities, which impacts their performance outcomes as well as patient satisfaction levels. Confrontations between the dissatisfied patients and their caretakers with the healthcare teams eventually result in conflicts and workflow disruptions. The healthcare leaders in facilities with workforce shortages struggle with high workloads, which increases the frequency of their conflicts with other team members [69]. Moreover, the lack of in-service training, inexperienced educators, and improper preemployment leave the staff members puzzled about their key result areas and key performance indicators. These inadequacies also undermine employee motivation, thereby intensifying professional conflicts and making them less responsive to healthcare leader’s intervention. The productive employees in workplaces, that are devoid of performance metrics, experience a high level of demotivation and that is why healthcare leaders find it challenging to persuade them for improved outcomes [65]. The professional conflicts between these employees are difficult to resolve due to the absence of objective measures. Furthermore, the diverse motives and requirements of the employees as well as differences in their income, social class, profession, and education levels substantially challenge their dealings with the healthcare leaders. The difficulty in assessing their attitudes impacts the selection and outcomes of the conflict management styles. The nature of the work of the healthcare teams and shift patterns also challenge their professional communication and positive interactions with healthcare leaders [28]. Frequent reallocation in shift hours often exacerbates employee irritability, exhaustion, and stress. Also, the frequent changes in regulations and programs can create confusion and low motivation among staff [65]. The professional collaboration between the healthcare team members is often challenged by the differences in their values and culture. It is challenging to manage the high-stress levels of remotely located employees who must travel long distances to reach their healthcare setting [70]. Air and noise pollution further degrades their quality of life, life satisfaction, and performance, leading to professional conflicts that are difficult to resolve without addressing the root causes [71]. Healthcare leaders without on-the-job training, struggle to adapt to organizational culture and develop leadership skills, which ultimately undermines their ability to manage conflict [65]. A comprehensive assessment of the conflict management challenges is, therefore, necessary to unravel potential gaps in leadership and explore the areas of prospective improvement.
Leadership Tactics for Conflict Management/Prevention The principal strategy for conflict management is to collaborate with the contenders and gather their responses and suggestions to derive a mutually agreeable solution [72]. The summoning of each contender is therefore required to understand their perspectives and initiate a positive dialogue in a comfortable environment, which is devoid of distractions. The healthcare leaders should remain neutral throughout the conversation and actively listen to the complaints or disagreements from both parties. They should further allow uninterrupted open discussions between the contenders and explain their reasons for the arguments. It is important for healthcare leaders to explain the benefits of accommodation and emphasize the requirement of prioritizing the organizational and healthcare goals to improve patient outcomes [73]. The healthcare leaders should further signify the value and power of teamwork and its role in improving the professional development of both parties. The explanation of the organizational policies and disciplinary actions against the violators is also necessary to convince the professionals to settle their disputes. Another way of dealing with professional conflicts between employees is to intervene with objectivity and set alarms or issue memos/warnings to the troublemakers [21]. This approach has no room for negotiation and it rather prefers to track and question the instigators and make them accountable for impacting the workflow. The next leadership tactic for healthcare leaders is to avoid a conflict and refer the affected professionals to the employee assistant programs or senior management [74]. However, the disadvantage of this approach is that the employees may lose trust in their supervisor. Additionally, by following the conflict management toolkit developed by Elizabeth Angelo, healthcare leaders can effectively address various types of conflicts that may arise among or within professional groups in the workplace [75]. The initial measure of this toolkit is to elaborate on the professional expectations and follow up with the team members to address their complaints and clarifications. The next step is to emphasize and strengthen team dynamics by connecting with the sentiments of employees and discussing their disappointments. Subsequently, healthcare leaders should construct a strong sense of purpose within their teams and provide them with regular feedback regarding their conduct and improvement areas [15]. Treating the team members with dignity and improving their self-worth is necessary to control their negative behaviors. Healthcare leaders must provide clear instructions to contenders regarding their improvement areas while maintaining the confidentiality of their performance reviews [76]. This measure is essential to strengthen their sense of professional growth while safeguarding their identity. The prompt anticipation of employee responses, while addressing professional conflicts, is paramount to deciding the next steps for their effective resolution [75]. The establishment of open feedback channels is the final step to improve transparency and develop potential measures for diffusing workplace conflicts [76].
The successful management of potential healthcare workplace conflicts warrants the establishment of realistic objectives [77]. Healthcare leaders need to flexibly allow their team members with professional conflicts to escalate and share their concerns in the absence of coercion. They need to reinvestigate the causes and situations associated with the workplace conflict, initiate several interactions with the contenders, and perform a root-cause analysis of the dispute. It is important to predefine the timing and duration of the interactions and ascertain the presence of the contenders to avoid any delay in implementing the conflict resolution measures [5]. The interactions with the contenders must be organized in a neutral environment, with minimal diversions. The meetings with the contenders should be undertaken in a collaboration zone. Healthcare leaders must establish rules or protocols for such interactions and seek assistance from independent professionals to determine external influences and critical issues. All participants should be allowed to share concerns and opinions to the best of their satisfaction. Subsequently, they should identify the shared interests and values of the participants and use them to achieve a consensus [53]. The demarcation of ambiguities, differences, unresolved disputes, and disagreements should be followed by small agreements while concomitantly surpassing interjections, negative personal comments, and other communication blockers. The healthcare leaders require follow-up with the participants to emphasize the progress and outcomes of the recommended conflict management approaches. They need to address gaps or shortcomings of the agreed measures and develop an action plan to track the results of further interventions. They also need to assign specific conflict management roles to each participant and recast ongoing challenges with mutual consensus [50]. Finally, the conflict prevention measures must aim to reduce the risk of recurring conflicts between the contenders.
The clinical settings should mandate and periodically organize training sessions for healthcare leaders to improve their conflict management knowledge, skills, and expertise [64]. The training modules should be customized in concordance with the organizational goals and must aim to improve the overall professional skills and people management capacity of the healthcare leaders. For example, a typical professional skills development training program for healthcare leaders may include specific modules based on science policy, entrepreneurship, resilience, problem- solving, intercultural competency, networking, career awareness, mentoring, goal establishment, time management, collaboration, critical thinking, teamwork, project management, communication, and leadership [79]. The sessions on conflict negotiation should also cover important lessons, including constructive conflict, root cause analysis, emotional intelligence, focus improvement, safe dialogue, collaborative negotiation, covert negotiations, role- playing, cognitive dissonance, anchoring, factual presentation, and safety net, and minimum acceptable results [80]. These sessions will equip healthcare leaders with the techniques and tools to deal with power differential and de-escalate a range of potential conflicts in the clinical practice environment.
The current body of evidence on conflict management is majorly based on observational studies, evaluating the conflict management skills of healthcare professionals. To the best of our knowledge, no study to date has compared different conflict levels, their clinical practice implications, and corresponding management strategies. Accordingly, future studies should investigate the differences in various conflict types and their outcomes to inform the future approaches for healthcare leaders. They should also evaluate the influence of organizational culture on the selection and outcomes of various conflict management styles. Prospective studies should utilize a randomized sampling approach to evaluate viable conflict management strategies tailored to the evolving patient care demands. More studies should investigate the causes and barriers of inter/intra-professional conflicts with larger sample sizes and extended follow-up durations to inform future conflict resolution practices. Studies should also focus on determining the possible implications of technology in terms of resolving interpersonal disputes within and between healthcare teams. They should further evaluate the influence of contemporary conflict resolution strategies on the overall collaboration and performance of healthcare leaders as well as patient care outcomes.
A timely and systematic resolution of disagreements between healthcare professionals is paramount to mitigating inter/intra- professional conflicts at the workplace. The healthcare leaders are accountable for performing the root cause analysis of workplace conflicts and establishing amicable agreements between the contenders. Professional communication and emotional intelligence of healthcare leaders significantly influence their conflict resolution abilities. The organizational norms, contradictory work policies, diversity of the cross-functional teams, and personal characteristics of the employees predominantly influence the selection and outcomes of the conflict management approaches. The greatest of the leadership tactics for conflict resolution is to engage the contenders and facilitate a positive dialogue in a safe and comfortable environment. Healthcare leaders need to adopt compromising, competing, collaborating, avoiding, and accommodating styles for managing a range of potential intra/ inter-professional conflicts within the healthcare teams. They need to establish realistic conflict resolution objectives, address gaps in the suggested recommendations, and consistently follow up with both parties to analyze their satisfaction levels. Importantly, healthcare leaders need to consistently improve their conflict resolution skills by enhancing their people’s management and problem-solving abilities. The limitations of this paper include the absence of real-time analysis of conflict management case studies and limited assessment of the organizational and personal factors impacting the conflict resolution skills of healthcare leaders. Due to data limitations, this review paper also did not compare different types of workplace conflicts, their influences on the clinical practice environment, and relevant strategies to be customized for their effective resolution. Future studies should aim to mitigate these limitations and determine innovative solutions to improve the professional development of healthcare teams as well as patient management outcomes.
