Lawrence and Lorsch in their classic book, Organization and Environment, noted that organizational conflict arises because different constituencies within an organization face different technical, economic and geographic “environments” [1]. They thus have different “cognitive and emotional” orientations, which they labeled “differentiation”. Differentiation varies both across and within industries and may differ in both kind and degree. It is incumbent on leadership to assess the degree and type of differentiation and put into place mechanisms to integrate this differentiation within the organization. For an organization to perform optimally the differentiation that exists must be matched by appropriate integration.

According to Bell and Hart there are eight causes of conflict that seem to be applicable to any organization where people have to work together to accomplish a common goal [2]. It is safe to say that all eight may be found in University Departments of Surgery since these departments are comprised of a diverse group of individuals none of whom are lacking in ego identity. The first cause, according to Hart, is conflicting needs. Individuals working in an organization have to compete for resources, power, and perhaps most importantly, recognition. It is well known in University Departments of Surgery that recognition on local, regional and national levels is critical to success especially for those who have ambitions of ascending to leadership roles. Those without resources and power usually spend a significant amount of time complaining about those who have the resources and power. Not uncommonly in academic environments “superstars” arise who, because of their reputation and skill attract patients, grants, additional responsibility, and due to their status, attract and at times demand special attention and concessions. Needless to say this type of behavior can create significant conflict among others members of the department but the “care and feeding” of such individuals often does deserve special consideration and unless their behavior becomes disruptive ultimately benefits the institution. In any organization power is related to dependence [3]. If a person’s expertise is rare, the power of that individual rises. An individual who has that type of influence becomes central to the organization and the rules that apply to others in the organization do not necessarily apply to them. However these highly talented and valuable people can go too far if they attack the enterprise or exhibit behavior detrimental to the institution. The trade-off between talent and disruptive behavior depends on how much the organization values teamwork and morale as being important to the culture. These “superstars” can be more of a challenge to manage in cultures that demand top-flight results, like Departments of Surgery, while simultaneously valuing cooperation and teamwork. Failure to address a “star’s” bad behavior allows resentment to build among others in the organization, which eventually undermines the performance of the entire enterprise. Ultimately the deciding factor is the value that a “star” brings vis a vis the “cost” that accompanies it with cost being much more than simply dollars. However as long as the star performer is producing and the behaviors do not run contrary to the culture of the organization, an organization that is able to absorb such diversity usually becomes stronger. This further underscores how conflict may, when managed, actually result in a strengthening of an organization. When the behavior strays from the values and principles of the organization or if the behavior becomes an unacceptable role model then peer counseling should at least be tried prior to elevating it to a higher level. Executive coaching may also be helpful for some individuals depending on their role in the organization. Disruptive behavior, in certain settings, can be damaging especially with regard to patient care but also in the academic setting. In the operating room disruptive behavior can be especially dangerous since it may promote a climate of fear and intimidation that can lead to silence and subsequently a detrimental effect on patient safety.

The second cause of conflict according to Bell and Hart, conflicting styles, is characterized by the way different individuals handle situations with the recognition that no two individuals always agree in the same way. Conflicting perceptions are similar to styles and individuals view them in different ways. Two or more individuals responsible for different duties but trying to achieve the same goals often results in conflict while conflicting pressures may result when two or more are responsible for separate actions with the same deadline. When someone is asked to perform outside of their job description conflict may result because of the conflicting roles. Currently with our modern diversified workforce the possibility of differing values can lead to falsehoods creating an environment ripe for conflict. Finally if company policies and procedures are inconsistently applied misunderstandings may result underscoring the need for consistency. Ideally disputes may be resolved internally either by intervention from management or ideally by peer review. Peer review may be very effective since it may be perceived as less threatening but also credible especially if done by peers specifically selected to counsel the individual in question.

If workable situations result from conflict in the workplace it must be assumed that all conflict does not necessarily have to be viewed as negative. In the purest sense conflict means that people care enough to feel strongly about their own views and thus conflict should be looked upon as a process to be managed, not eliminated. The following table shows the traditional view of conflict versus a more realistic view [4].

The importance of managing conflict is obvious but leadership must walk a fine line between trying to reduce conflict altogether or allow some conflict to remain in order to enhance overall results. Effective leaders must distinguish and manage conflict that boosts productivity and contributes positively from that which decreases output and hinders teamwork.