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Conflict Resolution

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David Thompson, DNSc, MS, RN
Jill Marsteller, PhD, MPP
Conflict Resolution
What is Conflict?
• Perception of mutual interference
• A process that begins when goals of one
party are frustrated by another
• Requires interdependence/interaction
Views of Conflict
• Conflict Good (interactionist view)
• Conflict Natural (human relations view)
• Conflict Bad (traditional view)
• Conflict must be managed
Sources of Conflict
• Conflict arises from resource scarcity
• Goals of parties are incompatible
• Other structural factors (size, routinization,
specialization, reward systems)
• Conflicting perceptions, ideas, or beliefs
• Differences between people
• Conflicting thoughts/needs within an
• Lack of communication (maybe)
Types of Conflict
– Task Content conflict (differing opinions related
to the task) G
– Emotional or Relationship conflict (interpersonal
conflict--dislike, negative emotions) B
– Administrative or Process conflict (disagreement
on how to get the task completed—e.g., duties,
decision-making technique) B to N
Goal of Conflict Resolution
• Confront problems, communicate openly
and respectfully with someone of opposing
opinion to provide optimal patient care.
Why address Conflict Resolution?
• Inevitable in dynamic environments
• Conflict can lead to feelings of
• Conflict can cause anyone especially
subordinates to view administrators,
attending physicians as adversaries and
creates conflict and divided loyalties in the
Assertion IS
Being appropriately assertive means:
• Organized in thought and communication
• Technically and socially competent
• Disavowing perfection while looking for
clarification / common understanding
• Being owned by the entire team (this is not
just a “subordinate” skill-set, and it must be
valued by the receiver to work)
Assertion –Is NOT
• Aggressive
• Hostile
• Confrontational
• Ambiguous
• Demeaning
• Condescending
The Assertion Model
• Model to guide and improve assertion in the
interest of patient safety
Helpful Hints in Applying
The Assertion Model
• Focus on the common goal: quality care, the
welfare of the patient, safety – it’s hard to
disagree with safe, high quality care
• Avoid the issue of who’s right and who’s wrong
“Patient Centered care – concentrate on doing
the right thing”
• De-personalize the conversation
• Actively avoid being perceived as judgmental
• Be hard on the problem, not the people
Strategies for Conflict Resolution
1. Withdrawal—little or no significance to either
party (lose-lose)
2. Forcing—force outcome regardless of the
desire of one party (win-lose)
3. Conciliation—giving in to preserve relationship
with other party (lose-win)
4. Compromise—concerned with both outcome
and relationship (?-?)
5. CONFRONTATION—meet the problem head
on (win-win)
Confrontation is an Assertive means of
Conflict Resolution
• Respectful negotiation
• Effective Conflict resolution is what is right
not who is right.
• Never Aggressive. Use to explain
perspectives. If handled appropriately may
be an opportunity to educate the other
party involved.
Two Attempt Rule:
• Using the elements of assertion make 2
attempts to reach a common goal.
• If your viewpoint is disregarded, Traditionally
continue up the chain of command or “escalate”
to achieve resolution.
• Charge nurse
• Nurse Manager
• Fellow
• Attending
Conservative Response
• Non-confrontational method to gain
agreement among 2 or more team
• Used to ensure disagreement does not
escalate to confrontation by seeking input
and advice from another team member or
outside consultant
DESC Script
What is it?
A structured, assertive, communication approach for managing and resolving
Describe the specific situation
Express your concerns about the action
Suggest other alternatives
Consequences should be stated
Ultimately, consensus shall be reached.
When to use it?
Whenever you have a personal conflict with another health team member that
threatens your ability to perform your job well
Key Points
Have timely discussion
DESC Example
• D- When you scream at me in front of my co-workers
about the delay in care, you’re making it personal.
• E- This reduces my credibility with the patients and
undermines my authority with staff. I feel you don’t
respect me.
• S- If you are upset about delays or other patient care
issues, pull me aside and I will address your
• C- If your outbursts continue we won’t have a working
relationship, and patient care will suffer.
LEEN--A Model for Conflict
L- Listen
E- Empathize
E- Explain
N- Negotiate
Conflict with Patients/Families
L- Can you help me understand
why you are upset.
E- That is understandable, I can
see why you are upset.
E- The reason we wanted to do
this was because—
N- Let’s agree on a path forward.
Conflict with Clinicians
• L- Can you help me understand how you
see the situation, how you are weighing
the risks and benefits.
• E- I can see how you see it that way.
• E- Let me explain how I see things.
• N- Let’s put the patient first and agree on a
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