How to Manage Difficult Situations and Decisions: Conflict Resolution

Fig. 12.1
Types and levels of conflicts (after Westbrook-Stevens). Conflicts range from the impersonal that tend to be of low severity to the personal that are characterized by high severity because they involve personalities. Between these two are conflicts that arise on a political level that are semi-personal in origin. When personalities are involved conflict resolution is difficult and special skills are needed to clearly define the issues that exist

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].

Traditional view

More realistic view

Conflict bad for morale and must be avoided at all cost

Conflict is inevitable, a natural result of change and can be beneficial

Conflict is caused by troublemakers and prima donnas who will not accept group norms

Conflict is usually caused by organizational factors and work procedures

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.

12.3 Causes of Conflict

Gary Furlong has proposed the six most common drivers of conflict and has arranged them as the Circle of Conflict (Fig. 12.2). Specifically he cites values, relationships, externals/moods, data, interests and structure and has fashioned a pie chart to graphically illustrate where each of the drivers fit [5]. Values include one’s belief systems and ideas of right versus wrong while the relationship driver includes stereotypes, poor or failed communications and repetitive negative behaviors. Factors unrelated to the conflict or the psychological or physiological issues of the parties in a conflict define the driver he calls externals/moods. These three drivers appear at the top of Furlong’s pie chart while data, interests, and structure reside in the bottom of the chart. Data as a driver of conflict involves lack of or too much information, misinformation or data collection problems. Each party’s wants, needs, desires, fears, or concerns defines the interests driver while structure as a driver involves limitations on resources (time, money), geographical constraints, organizational structure, and authority issues. In Furlong’s view conflict is more easily resolved if the focus is on drivers in the bottom half of the circle since the parties have some control over these and dealing with them offers a more direct path toward managing a conflict. If the discussion gets into the top half of the circle it is highly likely that the conflict will escalate since these drivers, for the most part, are not within an individual’s control. However it is clearly within the realm of possibility to work together to gather appropriate information, recognize each party’s needs and desires and overcome geographical constraints or organizational structure issues in order to achieve resolution.


Fig. 12.2
Furlong’s circle of conflict (Ref. [5]). Furlong has proposed the six most common drivers of conflict and placed them in a pie chart. Conflict is more easily resolved if the focus is on drivers in the bottom half of the pie chart (With kind permission from Craig Stevens, from www.​westbrookstevens​.​com)

In its most basic form conflict really is nothing more than a disagreement among two or more individuals and there are two main reasons for conflict in the workplace. Having to depend on others to get a job done and goal differences account for the majority of conflicts that may arise no matter the type of workplace. However the conflicts that may arise when having to depend on others may, paradoxically, result in a positive outcome since it forces individuals to work more closely together as a team. In addition the increased loyalty that results from working together and the need to focus on the task at hand also may have positive benefits to the overall entity. On the negative side the anger and resentment that may be a byproduct of conflict can result in a reduction of communication that ultimately may prove harmful.

It is human nature to seek out the simplest explanation to a problem and in the workplace it is tempting to blame conflict on personalities when the real underlying cause, more likely than not, is the situation itself [6]. The default for most people is to ascribe any difficulty with another person to personality differences or quirks. Focusing on people rather than situations is faster and simpler and focusing on only a few attributes of an individual instead of on the whole person is even easier. The explanation that someone is a micromanager or that “so and so” is self – absorbed may be true but is unlikely to be the source of the conflict though its convenient to be able to put a label on someone. The real reasons for conflict likely are much more complex. It may be that two people’s interests truly may be opposed or each individual’s roles may be poorly defined. Incentives may exist that paradoxically promote competition instead of collaboration and this may only be apparent as conflict arises. Of real concern is the possibility that the work environment is accepting of minimal accountability or transparency regarding what people do or say. Simply blaming personality differences as the source of conflict actually may divert leadership from the real issues that are at the root of a disagreement and delay discovery of the situational dynamics that are causing or worsening already existing conflict. It is important to recognize how both parties in a disagreement need to take risks to change the status quo and it is the role of the leader to be able to effectively convey this concept. Identifying the real underlying cause or causes instead of simply blaming personalities allows for a better opportunity to effectively manage conflict.

While recognizing that personality differences likely are not the cause of most conflicts those of us in positions of leadership cannot simply ignore the fact that personality differences do exist. Liane Davey has commented on how to manage two people who hate each other, a situation that likely arises periodically in any organization [7]. Managing these types of conflict is a fundamental part of a leader’s job. Most of these conflicts arise out of fear and if you as the leader can get to the root of the fear you can help the two individuals rebuild the relationship. It is important to first rule out more systemic issues that may be present and then ensure that both individuals have clarity regarding their roles as well as their levels of authority. The expectations for each person should be clearly articulated and leadership must assure that metrics are in place that promote and reward collaboration as opposed to competition. It is also incumbent on the leader to reflect on his or her own views about the individuals involved in the dispute because the presence of existing frustration or judgments regarding the individuals makes it difficult to work with them to achieve resolution and accommodation. Davey recognizes that hatred stems from miscommunication, misunderstanding, and fear. Realizing this, it is the job of the leader to work with the parties to resolve the conflict. This should begin by meeting individually with both individuals. During this initial meeting the inciting situation should be discussed and feedback should be provided whenever there is overt evidence of the poor relationship such as rolling the eyes when something is mentioned. Feedback regarding the less than desirable behavior should be called out at every opportunity and it is helpful if the feedback ends with an open-ended question that prompts the person to talk. The enlightened leader attempts to get beneath the person’s biased perceptions of the situations in question and into their motives and beliefs and encourages expressions of feelings not judgments or assumptions. The leader redirects back what is heard and starts to generate some thoughts as to what has occurred. The goal is to make sure each individual understands how their own thoughts and feelings affect their perceptions of the other. After meeting with each person individually and facilitating their individual understanding of the dysfunctional relationship the two are brought together to have a conversation with the leader saying little except to point out, based on knowledge gained from the individual meetings, what isn’t being said. Once each individual begins to see how the other thinks and feels it is likely that the animosity will be at least attenuated if not alleviated.

12.4 Managing Conflict

Having established that conflict is inherent in any organization and especially in academic medical centers it is safe to say that anyone in a leadership position spends a considerable amount of their time managing conflict. Effective conflict management is perhaps the defining job of leadership. Managers at all levels within an organization must be not only comfortable with managing conflict but be proficient at it if they are to be successful. In medical school departments conflict management is not just the province of the chair but must be part of the portfolio of division chiefs since most conflicts may be managed without the need to involve the department chair. Department chairs ultimately have to deal with some conflicts that arise within their own department in addition to dealing with those that arise between departments. The Dean’s main job in addition to allocating resources also is conflict management.

When managing conflict it is helpful to analyze the various styles involved (Fig. 12.3). Much depends on whether you are focused on your own issues (internal focus) or those of the other party (external focus). A high level of internal focus with little regard for the other party characterizes a dominating conflict management style that really comes down to a power grab but when utilizing this style any attempt at resolution could be significantly prolonged. This style really comes into play when a decision must be made quickly. Conversely if your focus is on the other party with less concern for your own issues, a situation that is ideal when the issue is of great importance to the other party and only of slight importance to you, the accommodating style may be seen as a gesture of good will. At times it is ideal if the focus is placed on both your own needs and that of the other party but this will only be successful if both of you are able to work together to find the best solution. Any solution found with this collaborative style likely will be of higher quality than if each of you came up with a solution on your own. This style truly typifies the “win-win” scenario. If both you and the other party need some time to step back it may be best for each to focus on internal issues and avoid further discussion. Sometimes this may be ideal in that it offers additional time to seek more information that will inform a better discussion in an attempt to reach a solution. Compromise may allow for a resolution but the solution reached usually is not the best for either you or the other party but may suffice for both of your needs. This is especially true when you and the other party have essentially the same amount of leverage but your goals are mutually exclusive.


Fig. 12.3
Conflict management styles. The various styles of conflict management. Styles vary according to whether the focus is on your own issues or those of the other party. Ideally the problem solving mode where the focus is both on your own issues as well as on the other party will be the style used much of the time. Compromising results in a solution that is not the best for either party but may suffice if the parties have mutually exclusive goals

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May 26, 2018 | Posted by in GENERAL SURGERY | Comments Off on How to Manage Difficult Situations and Decisions: Conflict Resolution
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