Getting to Cooperation. Conflict and Conflict Management in a Norwegian Hospital. Hospital Professionals’ Perceptions, Attributions and Behaviours in Conflict

Skjorshammer, Morten (2002): Getting to Cooperation: Conflict and Conflict Management in a Norwegian Hospital. Hospital Professionals’ Perceptions, Attributions and Behaviours in Conflicts. NHV-Report 2002: 02. Dissertation from the Nordic School of Public Health, Goteborg, Sweden. The purpose of the research was to investigate conflicts related to work coordination in hospitals. Increasing specialisation and professionalisation, coupled with high degrees of work interdependence over the past years, have greatly increased the conflict potential in hospitals. Because hospital professionals have to work together, they cannot avoid differences, disagreements and disputes that may result in conflicts. Conflict is a factor in poor communication, which causes adverse events and harm to patients. Some of the questions addressed include: How do professionals go about managing conflicts? What kind of behaviours do they use? How are conflicts perceived and what are the reasons for having conflicts? What kind of emotions accompany conflicts? How do professionals talk about their conflicts? The data are based on a nation-wide survey in 1993 of the work environment and living conditions of doctors in Norway, and an ethnographic study of a Norwegian urban hospital (from 1996 through 1999) utilising data gathered through interviews, observations and review of existing documents. One reason for using these methods is that they allow for exploration of the emotional factors in conflict, which have been neglected in previous studies. Triangulation was used to discover similar patterns in the findings produced by each method and to increase the validity of the findings. The study found that all hospital professionals share the same attributional style related to conflict where personality factors are emphasised as opposed to situational factors. Such an attributional style encourages avoidance and deprives the organisation of learning opportunities. Anger behaviour is frequently part of conflicts and may in itself cause work conflicts. Anger behaviour, in particular from physicians, is a major stress factor in the workday of nurses, and has a negative impact on their work environment and professional cooperation and may even reduce the quality of patient care. Anger behaviour may be understood as an expression of strained interpersonal relationships where contextual factors serve to lower the threshold for keeping such feelings private. The data from different methods converge on a number of findings. The research confirms the challenge in professional cooperation to manage disagreements, disputes and conflicts. It shows that conflict is endemic in hospitals. When in conflict, hospital professionals use three approaches to manage the situation: avoidance, forcing and negotiation, usually in that order. Avoidance behaviour or suppression is the most common reaction to an emerging conflict in Norwegian hospitals. If use of power does not re-establish a balance between the participants, one negotiates. These conflict styles are determined by two major factors: The perceived interdependence between parties and the perceived urgency of doing something about the situation. Nurses and physicians differ considerably in their perception of what is a conflict and when to do something about it. Storytelling in conflicts provides a way to give structure and meaning to the experience. Through constructing a story a person seems to cope better and to be better able to handle the stress and challenge of sense making that comes with a conflict. All conflict stories share the same narrative structures such as emplotment, a temporal development, diversions of plots, characterisation of participants, a struggle for the dominant storyversion, and the impact of larger stories. These concepts provide a language for working with conflicts closer to the participants’ life world than allowed by other approaches. In order to make improvements in conflict management at the study hospital, a new comprehensive system was designed to improve the study hospital’s conflict resolution structures and to strengthen the negotiation skills of hospital professionals and leaders. The study suggests that conflicts represent learning opportunities in an organisation and that improvement in the conflict management competence may improve organisational learning and quality to patients.