In the past, conflict in the workplace was regarded as dysfunctional, representing a breakdown in communication that would either go away by itself or be resolved with someone winning and someone losing.² Today, conflict is no longer considered harmful or inherently bad. Instead, it’s expected in a dynamic organizational environment.

Many experts view conflict as a normal aspect of interpersonal relations in organizations and believe that when handled correctly, it can be managed and resolved to achieve beneficial outcomes. In fact, such friction can be a motivator for change and growth, a medium for airing problems, and a dynamic force for preventing stagnation. When managed from a positive perspective, conflict and the resulting resolutions can hold an organization together.² It would be naive to assume everybody comes to the table wielding an equal balance of power. Differences in the parties’ power can affect the decision to address the conflict.³ Because sources of conflict are so diverse and their consequences so important to patient care, all healthcare professionals need to communicate and to be adept at recognizing different types of conflict and employing appropriate strategies to resolve them.³

Healthcare professionals can encounter four levels of organizational conflict: intrapersonal, interpersonal, intragroup, and intergroup.⁴ A healthcare professional can experience intrapersonal conflict when confronted with two or more incompatible demands.

Examples of job-related struggles include ethical dilemmas, role conflict, work overload, and uncertainty about job expectations. Intrapersonal conflict can also be related to organizational structure, supervisory style, and the position that the professional occupies within the organization.² Interpersonal conflict occurs between two or more people when one person perceives or values a situation differently from the other.² It is common in healthcare settings. This type of conflict can happen when there is a clash between core work values, such as determining how a job should be done, or setting different priorities or expectations because of age, experience, sex, race, and other personal attributes. Intragroup conflict is between members of a group who are arguing about responsibilities.⁴ Intergroup conflict occurs between two or more groups and may result from competition between departments within a single healthcare facility or from rivalry among several organizations. Most organizational conflict in healthcare organizations emerges at the interpersonal and intergroup levels. Major sources include:⁴

• Individual differences about values and opinions
  
• Professional differences
  
• Organizational structure; changes due to restructuring
  
• Interpersonal differences in perception
  
• Generational or cultural differences

Additionally, in today’s healthcare environment, change — new policies and procedures, employee layoffs, and rapid growth — or even the threat of change, can contribute to conflict.

Common approaches to conflict resolution

No matter what type of conflict you are involved in or are trying to mediate, it’s important to focus on the issues at hand; it’s critical to separate the problem from the person. Making an issue personal will only extend the conflict and prevent clear thought toward resolution.⁵ Whenever possible, sort through information based on the evidence. This takes the emotional aspect out of the issue, keeping it reality-based. Seek out creative resolutions, and engage in discussion with all involved parties so people feel they are a part of the process and have a stake in the outcome.

Keep in mind that conflict resolution is a negotiation; therefore, it’s an ongoing process. Approach conflict resolution with positive energy, a good attitude, and a goal, to reach the best solution.

Five common approaches to conflict resolution have been identified:⁶ This style approaches the conflict head-on and may invoke high emotional levels. It can be construed as not being considerate of the other person’s viewpoint. Emotions typically run high during confrontations. It is often used when each side’s goals are unclear, relationships are weak, little concern exists about formalities, or there is fear of punishment. There may be a moderate concern for tradition and self-concept.⁶ This approach involves negotiation, tradeoffs, and swapping. Each person gets something, but gives up something else in the process, creating a win-lose/win-lose situation for the two sides. Everyone must cooperate when negotiating, must communicate, and there must be a balance of power.⁷

Collaboration occurs when each party meets the problem head on with equal concern for both the issues and maintaining a working relationship. This approach allows everyone to win by identifying areas of agreement and differences, evaluating alternatives, and selecting solutions that have the full support and commitment of both parties. It requires emotional intelligence and high self-concept.

Accommodation occurs when one person or group is willing to yield to the other. This conciliation, or giving in, involves listening and accepting without resistance. Accommodation may be appropriate when one person admits to making a mistake; the outcome is more important to others than to you; other people’s ideas seem better; and by accommodating now, you may be in a better position to deal with issues in the future.⁷

Levels of conflict

In the workplace (or other settings), you are likely to find two types of conflict — substantive and personalized.⁵ Substantive conflict occurs when two people disagree about a certain issue, such as a policy or how to perform a procedure. With substantive conflict, both parties work toward a win-win outcome that usually provides an innovative resolution to the conflict. This is normally a positive conflict experience; each party walks away feeling that the outcome was worth the struggle involved in resolution.

This type of conflict can be productive, and often leads to richer, more fulfilling working relationships where people feel confident to share honest opinions and work through the details. Substantive conflict may also stimulate new thoughts and ideas and can create an exciting work environment. Keep in mind that emotions may be involved, but they are usually related to the specific issue and not to the people involved. Ambiguous policies or those policies that are not consistently enforced can lead to conflict, which can result in people not understanding what is expected of them or what the results might be. Assumptions can be incorrect and lead to conflict. Another type of conflict, one many people are all too familiar with, is known as personalized conflict. This type of conflict frequently occurs when people don’t like each other, they have no desire to work through an issue, and they elect to use almost any situation to make the other person look bad in front of others.⁵

Frequently, this type of conflict involves others in the form of “taking sides,” and a great deal of energy and emotion are spent on dealing with the repercussions this type of conflict generates. In personalized conflict, emotions run high and mainly involve anger and frustration. Neither party wishes to seek resolution, and the original issue (if there truly was one) is often lost in the heated exchange. New issues are generated to escalate the conflict, and normal problem-solving techniques fail because neither person is willing to address or resolve the issue.

Personalized conflict seldom has a positive ending, and usually worsens over time.⁵ It’s commonly known, or referred to, as a “personality conflict” between two people.

Valerie Restifo, MA, MS, RN; Marilynn Jackson, PhD, RN; and Margi J. Schultz, PhD, MSN, RN, CNE; past authors of this educational activity, have not had the opportunity to influence this version. OnCourse Learning guarantees the content of this educational activity is free from bias. Debra Anscombe Wood, BS, RN, a health writer and editor, practices in ambulatory care in Orlando, Fla.