Managing conflict in an urban health care setting: what do "experts" know?

Conflict within and among health care institutions is increasing as the result of major structural and economic shifts in the health care sector. The vast majority of these conflicts never reach the threshold of formal mechanisms for dispute management, yet there is reason to believe that they often compromise the delivery of health care services and are a major source of stress for health care workers. The current study seeks to increase our understanding of the nature and dynamics of health care conflict by focusing on a group of health care professionals with a reputation within an urban teaching hospital as skilled, if informal, conflict interveners The investigation took the form of a series of in-depth, semi-structured interviews with health care professionals at University Hospital in Newark, New Jersey, who were nominated by colleagues as being particularly skilled at dealing with conflict. Interviews were conducted with 17 such individuals. Seven of the respondents were nurses, three were physicians, and seven were non-medical personnel. The majority of the respondents had significant managerial responsibilities in a variety of hospital departments. Respondents were asked to discuss a recent health care related conflict, in which they had been involved. The "critical incident" method (Hoffman, Krandall, & Shadbolt, 1998; Klein 1998) was used to get a detailed account of their approaches to intervention. Respondents were also asked for their general views on the major obstacles to constructive conflict management in a health care setting; the extent to which the Newark environment affected either the nature of the conflicts they had to deal with or the skills needed to be effective; their views on the importance of training in conflict management; and aspects of their personal history which they felt might have influenced their approach to conflict. The findings reveal an institution being buffeted by significant interpersonal, organizational and inter-institutional conflicts. These conflicts appear primarily a function of powerful, interacting social forces, including aspects of medical and nursing practice and culture, organizational dynamics, the needs and characteristics of the hospital's patient population, and above all, the hospital's declining economic base. The respondents function as a "hidden" but valuable resource for managing the tensions within the institution. Although most of them have had little formal training in conflict management, they appear to use intervention strategies very similar to those of professional mediators. Like experts in other domains of life, many of them also rely on highly organized, if implicit cognitive schema, which may be triggered "automatically" at critical moments in the unfolding of a conflict. The respondents are aided in their efforts at conflict management by a number of hospital settings. While these settings are not formally charged with resolving conflict, they appears to provide useful opportunities for people to raise and constructively confront important differences. Despite their reputation for skill at managing conflict, many respondents seem uncertain or ambivalent about their roles as conflict mangers; perhaps a reflection of the hospital's own ambivalent stance toward conflict. The relevance of the findings for conflict management training and for research on health care conflict are discussed.