Conflict A ProcessBased Approach for Organizational Leaders1,2 A Presentation for Nurse Leaders

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ConflictA Process-Based Approach for
Organizational Leaders1,2A Presentation for
Nurse Leaders

• Kendall L. Stewart, MD, MBA, DFAPA
• February 25, 2008

1I intend to describe a practical process you can
begin following today. 2Please let me know
whether I have succeeded on your evaluation forms.
2
Why is this important?

• Conflictin every part of our livesis
  inevitable.
• It can be good or bad.
• Wed all like to minimize destructive conflict
  and maximize constructive conflict.
• But thats hard.
• Most of us avoid conflict when we can.
• And we handle it poorly the rest of the time.1,2
• This presentation will offer a practical process
  to follow that can produce better results.

• After mastering the material in this
  presentation, you will be able to
• Identify three factors that promote constructive
  conflict,
• Describe three causes of destructive conflict in
  the workplace,
• Point out three mistakes that leaders often make
  when attempting to manage conflict, and
• Detail three key steps in a practical process for
  managing conflict effectively.

1Dr. Jitendra Patel recently described one way to
manage conflict. 2A woman approached a pharmacist
and asked for cyanide.
3
When is conflict constructive?

• When it stimulates creativity and innovation
• When it encourages critical thinking and careful
  care preparation
• When it discourages group think1,2
• When it builds commitment for the ultimate
  decision
• When its resolution builds real relationships

1The conventional wisdom is often wrong. 2A nurse
aide offered the real answer for why our patients
were dissatisfied with the food.
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What promotes constructive conflict?

• More facts
• Less opinion
• Humor
• Respect
• Multiple alternatives
• Less ego
• A mutual desire to find the best option
• A diminished power differential
• Adherence to a dispassionate problem-solving
  process
• A focus on position instead of person
• A desire for constructive conflict1,2

1Imagine for a moment that you an SOMC executive
attempting to forecast the number of ED visits in
FY 09. 2Why will the number of visits increase?
Why will they decrease?
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What are some causes of destructive conflict in
the workplace?

• Miserable people
• Lack of clear goals
• Weak leaders
• Autocratic leaders1,2
• Lack of data
• Pushy people
• Insistence on consensus
• Strong feelings
• Sensitive people
• Conflict avoidance
• Moody leaders
• Lazy people

• Unchallenged negativism
• Selfish people
• Gossip on life support
• Discouragement of disagreement
• Impulsive decision making
• Limited alternatives
• Perceived favoritism
• Lack of participation in decision making
• Unpredictability

1A fellow medical student went to see a professor
to ask why the answers to the same questions had
changed. 2We hissed a professor who gave one A,
two Bs and the rest Cs to our medical school
class.
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Why do we tend to avoid conflict?

• Because it makes us uncomfortable
• Because we dont know what to do
• Because we dont have much experience
• Because our role models handle it badly
• Because no one will help us
• Because its the course of least resistance
• Because we can get away with it
• Because its what everybody else does
• Because there are so many other less important
  things to do.
• And, sometimes, because its the best option.1,2

1I decided to see whether my wife and I could
actually put off an argument. 2When we pulled
into the parking space at the steakhouse, I asked
whether we could table this until after dinner.
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What is a typical conflict scenario?
A nurse manager concludes that she must revise
the schedule to decrease overall overtime and to
achieve a sense of fairness on the unit. Two
long-term employees were hired years ago with the
promise that they would not have to work on the
weekends. These employees have resisted any
changes in their schedules using that history as
their defense. Meanwhile, resentment has grown
along with overtime. After informing the
employees of her intent, the manager posts the
new schedule. All heck breaks loose. The
employees threaten to quit. They solicit support
from their colleagues who resent being put in the
middle.
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What mistakes do leaders often make when dealing
with conflict?

• Avoiding it altogether
• Trying to keep the peace at any price
• Not holding troublemakers and slackers
  accountable
• Not holding high performers accountable
• Not holding anyone accountable
• Taking one side before hearing both
• Holding secret meetings with individuals
• Showing favoritism
• Putting people in the middle

• Permitting dissidents to exercise veto power
• Making unilateral changes without consulting or
  informing those affected
• Procrastinating
• Making partial decisions over an extended period
  of time
• Making decisions when angry or frustrated
• Accepting the monkey from disgruntled workers
• Arguing instead of listening
• Failing to accept feelings
• Using someone else as the hammer

1I always urge my patients to never say, Well,
Dr. Stewart says . . . 2If you agree with the
position say, My position is . . .
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What processif followedwill produce the best
results?

• Expect it.
• Remind yourself that you always have options and
  that you always have a best option.
• Remember that doing nothing may be the best
  option.
• Monitor your arousal and strive to remain
  dispassionate.
• Listen carefullyto both sides.
• Never agree to confidentiality beforehand.
• Document complainers positions and hold them
  accountable for their behavior and their
  positions.
• React quickly when it is appropriate.
• Beware requests to vent.
• Do not participate in ambushes.1,2
• Accept perceptions for what they are.

• Insist on data.
• Focus on behavior instead of motive.
• Attach unpleasant consequences to bad behavior.
• Look for a way for everyone to save face.
• Explore possible consequences from the start.
• Focus on the common ground.
• Start with the easy stuff.
• Put off the hard stuff.
• Get some agreement to build momentum.
• Agree to disagree agreeably.
• Set realistic expectations.
• Extrude net-negative people.
• Trade up at every opportunity.

1Psychiatrists try all kinds of crazy stuff. 2Two
women wanted to confess their infidelities in
my presence. Thats why people watch The Jerry
Springer Show.
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What have we learned?

• Conflict is inevitable.
• It can be a very good thing.
• It can be very destructive.
• Conflict will not manage itself.
• Leaders will be most successful in dealing with
  conflict if they follow a process that works.
• That will not be easy, but it can be done.
• And the results will be worth the effort.1,2

1Sometimes, confrontation is the only way to
right the little wrongs of everyday life. 2I
confronted the greedy missionary and the
manipulative evangelist.
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Where can you learn more?1

• Stewart, Kendall L., et. al. A Portable Mentor
  for Organizational Leaders, SOMCPress, 2003

1Please visit www.KendallLStewartMD.com to
download related White Papers and presentations.
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How can you contact me?1
Kendall L. Stewart, M.D. VPMA and Chief Medical
Officer Southern Ohio Medical Center President
CEO The SOMC Medical Care Foundation, Inc. 1805
27th Street Waller Building Suite B01 Portsmouth,
Ohio 45662 740.356.8153 StewartK_at_somc.org
KendallLStewartMD_at_yahoo.com www.somc.org www.Kend
allLStewartMD.com
1All speaking and consultation fees are
contributed to the SOMC Endowment Fund.
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