Kendall Regional Medical Center’s Change and Conflicts

The Role of Conflict in Change Management

Conflict comprises wide-ranging emotional reactions to incompatible or divergent views or needs. It results from misunderstandings or a difference of opinion, professional values, or beliefs, which, if not managed well, degenerate into a dreadlock or inaction. Conflict in nursing roles originates from intra-group disputes and physician disruptions (Higazee, 2015).

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Although conflict is considered in a negative light, it can signal a problem in the current operations to necessitate change. Through constructive conflict management, the diversity of viewpoints on clinical matters can be evaluated based on their merits and subsequently integrated into more innovative decisions. Further, a conflict management program generates positive feedback from opposing groups that could be used to formulate effective corrective actions.

The Role of Negotiation in Change Management

Negotiating change in organizations is a process fraught with uncertainty and distress. It requires effective negotiation skills to persuade or win the approval of the key stakeholders, who, in the practicum project, include STEMI patients and their families, ER physician, paramedics, and ER. Negotiation helps build rapport with staff and establish personal credibility and relationships that lay the foundation for bringing in the desired change to an institution.

It also enables change leaders to determine the needs of the staff and organizational forces that could promote or impede the planned change. The institutional variables may include people factors, internal politics, and unit policies. In principle, negotiation is one way a leader can gain stakeholder support and buy-in for the suggested changes.

The Role of a Leader/Manager in Conflict and Negotiation

In hospitals, nurse leaders/managers have a role of establishing and communicating guidelines for acceptable workplace ethics (Wright, Mohr & Sinclair, 2014). As departmental leaders, they have to employ effective strategies to manage conflict to maintain morale and improve efficiency. In conflict situations, a nursing manager plays a mediator role in resolving the dispute to keep the department functional.

The managerial role in a conflict entails creating a constructive environment for both parties, listening to the divergent positions, seeking solutions from the stakeholders, and developing an agreeable compromise or solution to the conflict. According to Kaitelidou et al. (2012), managers can use avoidance, accommodation, dominance, compromise, or collaboration as a strategy to manage conflicts. In contrast, the managerial role in negotiation centers on seeking agreements with stakeholders, initiating corrective action, and acting as a broker/mediator in negotiations.

The Role of Power in Conflict, Negotiation, and Communication

Power is the influence people have over others. It is the legitimate, charismatic, expert, coercive, reward, or connection power a person acquires by personal characteristics or position. In a conflict, a varying amount of power is applied to manage the dispute. Conflict resolution may involve avoidance, negotiation, arbitration, or coercive force.

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For example, authoritative mediators, e.g., executives, often use coercive power to enforce agreements. In negotiation, supervisors can exercise legitimate power to support their legitimacy as negotiators to arrive at a settlement. Legitimate power could be gained through position/rank or by dispelling misconceptions related to fairness. Charismatic power inspires positive emotions and enthusiasm in the subjects.

Aspects of Conflict in the Change Process

Although in most cases conflict is considered disadvantageous or harmful, it is not completely devoid of positive outcomes. One helpful aspect of conflict in the change process is that it signals the existence of a structural or interpersonal problem in the organization that needs to be addressed (Patton, 2014). On the other hand, conflict, if not well managed, may degenerate into hatred or inaction, which could increase resistance to change.

A review by Patton (2014) revealed that dysfunctional conflicts affect patient outcomes, lowers job satisfaction and retention, causes stress, and stifles collaboration. Further, conflict originating from the management may cause employees to manifest destructive behaviors and poor support for innovative solutions. Guidroz, Wang, and Perez (2012) propose a model that connects interpersonal conflict to fatigue, poor health, and poor nursing outcomes. Therefore, at an individual level, conflict is a leading cause of stress, lower employee satisfaction, and turnover in the workplace (Guidroz et al., 2012).

Conflicts may arise in the implementation of evidence-based strategies to improve the Door to Balloon (D2B) time for STEMI patients at the Kendall Regional Medical Center. Brown et al. (2011) outline three causes of conflicts in primary healthcare settings, namely, “role boundary issues, lack of understanding of the scope of practice, and accountability” (p. 6).

The practicum project may lead to a restructuring of clinical tasks in the ER department. The specific tasks will include preparing two IV sites in STEMI patients, placing the defibrillator pad on the chest, seeking consent, and capturing the order for cardiac catheterization in a computer system.

These tasks require inter-professional collaboration. Wright, Mohr, and Sinclair (2014) identify including unfair treatment by colleagues, unclear work structure, differences of opinion over a clinical situation as the key sources of conflict in healthcare. In this project, conflicting opinions on patient disposition, territorial strife, lack of familiarity with the project’s protocols on STEMI, and competition for training opportunities on STEMI patient preparation and management may cause conflicts.

Dealing with any conflict that may arise

Managing conflicts at the Kendall Regional Medical Center is required because the practicum project brings together multiple professions and stakeholders. One strategy I would use to address conflicts is through building a STEMI coalition/alliance in the hospital that includes the ER physician, paramedics, STEMI patient and family, RNs, cardiologist, and PBX operator. This cooperative approach will foster collaboration and support information exchange/negotiation to improve inter-role rations and resolve disagreements. I would also use compromise and problem-solving strategies to develop agreeable solutions to conflict.

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Brown, J., Lewis, L., Ellis, K., Stewart, M., Freeman, T. R., & Kasperski, M. (2011).

Conflict on Interprofessional Primary Health Care Teams- Can it be Resolved?. Journal Of Interprofessional Care, 25(1), 4-10.

Guidroz, A. M., Wang, M., & Perez, L. M. (2012). Developing a Model of Source-specific

Interpersonal Conflict in Health Care. Stress & Health: Journal of the International Society for the Investigation of Stress, 28(1), 69-79.

Higazee, M. (2015). Types and Levels of Conflicts Experienced by Nurses in the Hospital Settings. Health Science Journal, 9(6), 1-6.

Kaitelidou, D., Kontogianni, A., Galanis, P., Siskou, O., Mallidou, A., Pavlakis, A.,…Liaropoulos, L. (2012). Conflict Management and Job Satisfaction in Paediatric Hospitals in Greece. Journal Of Nursing Management, 20(4), 571-578.

Patton, C. (2014). Conflict in Health Care: A Literature Review. The Internet Journal of Healthcare Administration, 9(1), 1-11.

Wright, R. R., Mohr, C. D., & Sinclair, R. R. (2014). Conflict on the Treatment Floor: an Investigation of Interpersonal Conflict Experienced by Nurses. Journal Of Research In Nursing, 19(1), 26-37.

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