STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE

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III. Strategies for Addressing Stress and Conflict within Health Care
Conflict in the health care workplace
Managing conflict in the workplace is a time-consuming but necessary task for the nurse leader.
Conflicts may exist between physicians, between nurses and staff, and between the staff or the
health care team and the patient or patient's family. The conflicts may range from disagreements
to major controersies that may lead to litigation or iolence. Conflicts hae an aderse effect on
productiity, morale, and patient care
Managing Conflict in Healthcare
!ealthcare has always made for stressful workplaces. The high stakes nature of
healthcare plus too many patients plus oerworked staff plus the usual human frailties
and failings"people running late for their shifts, interdepartmental misunderstandings,
garden ariety personality clashes"add up to a lot of potential conflict. That#s not good
for patients.
The Exchange Strategy
$t deries from thirty years of mediation and conflict resolution experience and proides
leaders with a proactie, step-by-step process and uni%ue communication skills to
successfully resole conflicts.
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Here are five tips for managing conflict from The Exchange Strategy:
&- 'espond, don#t react. (ut a pause between action and reaction, especially an
emotional reaction)
* + Choose the right leader. Make sure the parties aren#t ,infantili-ed# by a leader who#s
too far aboe them.
. + /isten. 0sk an open-ended %uestion, then stop. $t can be as simple as, ,1o, tell me,
what#s going on2# 3ou#ll know it#s time to insert yourself again when the discussion turns
negatie
4 + 5se and encourage positie language. Think before you speak. 5se positie, easy-to-
understand language. 0nd remember, it#s a conersation, not a trial)
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6 + 7uild trust. Trust can#t be demanded. 7e sure to ask how each party is affected by the
conflict, and, secondly, what each person really needs.
Conflict-Resolution Skills as Patient Safety Tools
1imple conflict-resolution skills such as structured communication and collaboration as well as
more formal processes such as mediation are being used to resole conflict in a wide range of
formal and informal manners. These conflict-resolution skills and processes hae been used in
many domains, including health care. $t is finally becoming eident that the best way to resole
difficulties is for the parties inoled to get together and talk through their issues.
et In Touch !ith "our #eelings. 0s Mayer 8*999: has noted, ;Communication is at
the heart of conflict and resolution.; Conflict often arises from ineffectie
communication< effectie or assisted communication and positie collaboration promotes
successful resolution of differences. =umerous studies hae highlighted the connection
between poor communication and failures to collaborate as contributors to aderse
outcomes as well as affecting staff morale and staff retention.
Hone "our $istening Skills. >hen it comes to effectie conflict resolution, how
effectiely we listen is at least as important as how effectiely we express ourseles. $t#s
ital to understand the other person#s perspectie, rather than just our own, if we are to
come to a resolution. $n fact, just helping the other person feel heard and understood can
sometimes go a long way toward the resolution of a conflict. ?ood listening also helps
for you to be able to bridge the gap between the two of you, understand where the
disconnect lies, etc.
Practice Asserti%e Co&&unication. Communicating your feelings and needs clearly is
also an important aspect of conflict resolution. The important thing to remember is to say
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what#s on your mind in a way that is clear and assertie, without being aggressie or
putting the other person on the defensie.
Seek a Solution. @nce you understand the other person#s perspectie, and they
understand yours, it#s time to find a resolution to the conflict -- a solution you both can
lie with. 1ometimes a simple and obious answer comes up once both parties
understand the other person#s perspectie. $n cases where the conflict was based on a
misunderstanding or a lack of insight to the other#s point of iew, a simple apology can
work wonders, and an open discussion can bring people closer together.
The following is a synopsis of the history of our awareness of stress'
Han Selye furthered Cannon#s work by defining stress as the ;rate of wear and tear on the body;
and stressors as the ;causatie agents of stress; 8&A6B:. 1elye found that stressors may be
physical, such as infection, injury, and pain, or may be psychological, such as fear, anger, and
sadness. !e identified what he called a general adaptation syndrome 8?01:, whereby the body
seeks to maintain homeostasis or balance.
1eyle, 8Colkman, &AD4: further recogni-ed that stressors can lead to burnout and job fatigue if
there are no coping mechanisms in place - this is especially true for the professional nurse.
0ccording to the 0merican =urses 0ssociation, nurses report that there are many factors that
promote stress and lead to the classic Ecrash and burnF syndrome that many nursing
professionals experience.
The following are (ust so&e of the issues that nurses) face that often contri*utes to stress'
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0nxiety related to demands of the job.
$nefficient coping related to the lack of knowledge for job re%uirements.
1piritual distress related to the inability to find meaning or purpose in professional and
personal life.
$neffectie leadership ability< ineffectie assertieness training.
$nability to motiate staff.
$neffectie ability to balance work, family, and personal life.
/ack of superisory support.
(oor co-worker relationship
These stressors can lead to the classic Eburn-outF syndrome. $nstead of persisting until this
happens, nurses can learn more effectie coping strategies, become self-aware, acknowledge
their own limitations, and ac%uire emotion-focused and problem-soling skills 81elye, &A6B:.
/ikewise, managers can proide physical and emotional support for staff members because
they alue them and understand the stressful nature of their work.
The following are se%eral strategies that nurses can use co&*at stress'
$earn to Identify #eelings. 7reaking through denial and admitting there's a problem is a step
toward finding solutions to stress. Ceelings can be named in one wordG betrayal, guilt, anger,
sadness, frustration, etc... 'egistered =urses are trained to treat others with compassion, but
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unless they identify their own emotions, they can't generate compassion for themseles and
begin to heal. Hournaling, meditating and praying are strategies to help one get in touch with
those deep rooted inner feelings. 1imilarly, interests such as poetry, gardening, working, animals,
and painting are useful methods to unleash these deep rooted feelings.
Isolation Makes Things !orse. =urses, as professionals, are strong at caring for others, but
when it comes to them, they often beliee that they should be smart enough to handle things on
their own. This misconception often cuts them off from supportie listeners who can offer
constructie feedback. 0 safe place to talk without fear of judgment, reprisal, or breach of
confidentiality is a key tool of good self-care for nurses.
!riting +rings Clarity. Many nurses report that keeping a journal is a helpful method to put a
situation into perspectie. They can reiew the details and see if they should hae handled it
differently. 1imilarly, in order to ealuate professional and personal growth, it is often helpful to
read one#s journals written from preious years. 1uch writings can be helpful when the nurse has
her annual employment ealuation 8nurse together, *9&9:.
Rest and Rela,ation are -ital. 'ecreation and hobbies are not luxuries< after all, eeryone has
the innate right to hae fun. $f we as nurses hae forgotten how to play, we can make an effort to
try new things or rediscoer actiities we used to enjoy.
.%aluate and Rely on Spirituality. =urses often report fatigue and burnout related to their
inability to find meaning or purpose in their professional and personal life. 1imilarly, many rely
on spirituality for coping< and without any sense of spirituality, some nurses might be at a loss.
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Ac/uire Skills in 0eeded Areas. Certainly, a lack of understanding or a feeling of inade%uacy
can contribute to stress. Therefore, nurses hae a responsibility to recogni-e their needs and
ac%uire skills in needed areas. Cor instance, if a nurse has difficulty inserting an $I, she should
seek necessary training. This will improe her skill set, and it will lessen her stress.
STR.SS MA0A.M.0T
a. Conflict Manage&ent. Conflict situations are an important aspect of the workplace. 0
conflict is a situation when the interests, needs, goals or alues of inoled parties
interfere with one another. 0 conflict is a common phenomenon in the workplace.
Jifferent stakeholders may hae different priorities< conflicts may inole team
members, departments, projects, organi-ation and client, boss and subordinate,
organi-ation needs s. personal needs.
@ften, a conflict is a result of perception. $s conflict a bad thing2 =ot necessarily. @ften, a
conflict presents opportunities for improement. Therefore, it is important to understand
8and apply: arious conflict resolution techni%ues.
Co&&on Conflict Manage&ent Strategies
#orcing . 0lso known as competing. 0n indiidual firmly pursues his or her own
concerns despite the resistance of the other person. This may inole pushing one
iewpoint at the expense of another or maintaining firm resistance to another person#s
actions.
.,a&ples of when forcing &ay *e appropriate
$n certain situations when all other, less forceful methods, don#t work or are ineffectie
>hen you need to stand up for your own rights, resist aggression and pressure
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>hen a %uick resolution is re%uired and using force is justified 8e.g. in a life-threatening
situation, to stop an aggression:
0s a last resort to resole a long-lasting conflict
Possi*le ad%antages of forcing'
May proide a %uick resolution to a conflict
$ncreases self-esteem and draws respect when firm resistance or actions were a response
to an aggression or hostility
So&e ca%eats of forcing'
May negatiely affect your relationship with the opponent in the long run
May cause the opponent to react in the same way, een if the opponent did not intend to
be forceful originally
Cannot take adantage of the strong sides of the other side#s position
Taking this approach may re%uire a lot of energy and be exhausting to some indiiduals
!in-!in 1Colla*orating2. 0lso known as problem confronting or problem solving.
Collaboration inoles an attempt to work with the other person to find a win-win
solution to the problem in hand - the one that most satisfies the concerns of both parties.
The win-win approach sees conflict resolution as an opportunity to come to a mutually
beneficial result.
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$t includes identifying the underlying concerns of the opponents and finding an
alternatie which meets each party's concerns.
.,a&ples of when collaborating &ay *e appropriate'
>hen consensus and commitment of other parties is important
$n a collaboratie enironment
>hen it is re%uired to address the interests of multiple stakeholders
>hen a high leel of trust is present
>hen a long-term relationship is important
>hen you need to work through hard feelings, animosity, etc
>hen you don't want to hae full responsibility
Possi*le ad%antages of collaborating
/eads to soling the actual problem
/eads to a win-win outcome
'einforces mutual trust and respect
7uilds a foundation for effectie collaboration in the future
1hared responsibility of the outcome
3ou earn the reputation of a good negotiator
Cor parties inoled, the outcome of the conflict resolution is less stressful
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So&e ca%eats of collaborating'
'e%uires a commitment from all parties to look for a mutually acceptable solution
May re%uire more effort and more time than some other methods. 0 win-win solution
may not be eident
Cor the same reason, collaborating may not be practical when timing is crucial and a
%uick solution or fast response is re%uired
@nce one or more parties lose their trust in an opponent, the relationship falls back to
other methods of conflict resolution. Therefore, all inoled parties must continue
collaboratie efforts to maintain a collaboratie relationship.
Co&pro&ising. Compromising looks for an expedient and mutually acceptable solution
which partially satisfies both parties.
.,a&ples of when compromise &ay *e appropriate'
>hen the goals are moderately important and not worth the use of more assertie or more
inoling approaches, such as forcing or collaborating
To reach temporary settlement on complex issues
To reach expedient solutions on important issues
0s a first step when the inoled parties do not know each other well or haen#t yet
deeloped a high leel of mutual trust
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>hen collaboration or forcing do not work.
Possi*le ad%antages of compromise'
Caster issue resolution. Compromising may be more practical when time is a factor
Can proide a temporary solution while still looking for a win-win solution
/owers the leels of tension and stress resulting from the conflict
So&e ca%eats of using compromise'
May result in a situation when both parties are not satisfied with the outcome 8a lose-lose
situation:
Joes not contribute to building trust in the long run
May re%uire close monitoring and control to ensure the agreements are met
!ithdrawing. 0lso known as avoiding. This is when a person does not pursue herKhis
own concerns or those of the opponent. !eKshe does not address the conflict, sidesteps,
postpones or simply withdraws.
.,a&ples of when withdrawing &ay *e appropriate'
>hen the issue is triial and not worth the effort
>hen more important issues are pressing, and you don't hae time to deal with it
$n situations where postponing the response is beneficial to you, for example -
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>hen it is not the right time or place to confront the issue
>hen you need time to think and collect information before you act 8e.g. if you
are unprepared or taken by surprise:
>hen you see no chance of getting your concerns met or you would hae to put forth
unreasonable efforts
>hen you would hae to deal with ostility
>hen you are unable to handle the conflict 8e.g. if you are too emotionally inoled or
others can handle it better:.
>hen you see no chance of getting your concerns met or you would hae to put forth
unreasonable efforts
>hen you would hae to deal with ostility
>hen you are unable to handle the conflict 8e.g. if you are too emotionally inoled or
others can handle it better:.
Possi*le ad%antages of withdrawing'
>hen the opponent is forcing K attempts aggression, you may choose to withdraw and
postpone your response until you are in a more faourable circumstance for you to push
back
>ithdrawing is a low stress approach when the conflict is short
?ies the abilityKtime to focus on more important or more urgent issues instead
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?ies you time to better prepare and collect information before you act
So&e ca%eats of withdrawing'
May lead to weakening or losing your position< not acting may be interpreted as an
agreement. 5sing withdrawing strategies without negatiely affecting your own position
re%uires certain skill and experience
>hen multiple parties are inoled, withdrawing may negatiely affect your relationship
with a party that expects your action
S&oothing. 0lso known as Accommodating. 1moothing is accommodating the concerns
of other people first of all, rather than one's own concerns.
.,a&ples of when smoothing &ay *e appropriate'
>hen it is important to proide a temporary relief from the conflict or buy time until you
are in a better position to respondKpush back
>hen the issue is not as important to you as it is to the other person
>hen you accept that you are wrong
>hen you hae no choice or when continued competition would be detrimental
Possi*le ad%antages of smoothing'
$n some cases smoothing will help to protect more important interests while giing up on
some less important ones
?ies an opportunity to reassess the situation from a different angle
So&e ca%eats of smoothing'
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There is a risk to be abused, i.e. the opponent may constantly try to take adantage of
your tendency toward smoothingKaccommodating. Therefore it is important to keep the
right balance and this re%uires some skill.
May negatiely affect your confidence in your ability to respond to an aggressie
opponent
$t makes it more difficult to transition to a win-win solution in the future
1ome of your supporters may not like your smoothing response and be turned off.
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+. 3ecision &aking . The process by which members of an organi-ation choose a specific
course of action to respond to the opportunities and problems that confront them. ?ood
decisions help an indiidual, group, or organi-ation to be effectie. 7ad decisions hinder
effectieness and result in poor performance and negatie attitudes at all organi-ational
leels. Jecision making in response to opportunities occurs when members of an
organi-ation make choices or act in ways that result in benefits or gains.
The Rational Model4 +ounded Rationality4 and Intuition
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Rational 3ecision Making
>e often think the best decision maker is rational and makes consistent, alue-
maximi-ing choices within specified constraints. These decisions follow a six-step rational
decision-&aking &odel.The rational decision-making model relies on a number of assumptions,
including that the decision maker has complete information, is able to identify all the releant
options in an unbiased manner, and chooses the option with the highest utility. 0s you might
imagine, most decisions in the real world don#t follow the rational model. (eople are usually
content to find an acceptable or reasonable solution to a problem rather than an optimal one.
Choices tend to be limited to the neighborhood of the problem symptom and the current
alternatie. 0s one expert in decision making put it, EMost significant decisions are made by
judgment, rather than by a defined prescriptie model.F
Steps in the Rational 3ecision-Making Model
&. Jefine the problem.
*. $dentify the decision criteria.
.. 0llocate weights to the criteria.
4. Jeelop the alternaties.
6. Laluate the alternaties.
B. 1elect the best alternatie.
+ounded Rationality
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@ur limited information-processing capability makes it impossible to assimilate and
understand all the information necessary to optimi-e. 1o most people respond to a complex
problem by reducing it to a leel at which they can readily understand it. 0lso many problems
don#t hae an optimal solution because they are too complicated to fit the rational decision-
making model. 1o people satisfice; they seek solutions that are satisfactory and sufficient. Cew
people made their college choice this way. $nstead of optimi-ing, you probably satisficed.
7ecause the human mind cannot formulate and sole complex problems with full rationality, we
operate within the confines of *ounded rationality . >e construct simplified models that extract
the essential features from problems without capturing all their complexity. >e can then behae
rationally within the limits of the simple model. !ow does bounded rationality work for the
typical indiidual2 @nce we#e identified a problem, we begin to search for criteria and
alternaties. 7ut the criteria are unlikely to be exhaustie. >e identify choices that are easy to
find and highly isible and that usually represent familiar criteria and tried- and true solutions.
=ext, we begin reiewing them, focusing on alternaties that differ little from the choice
currently in effect until we identify one that is Egood enoughF"that meets an acceptable leel of
performance. That ends our search. 1o the solution represents a satisficing choice"the first
acceptable one we encounter"rather than an optimal one.
1atisficing is not always a bad idea"a simple process may fre%uently be more sensible
than the traditional rational decision-making model. To use the rational model in the real world,
you need to gather a great deal of information about all the options, compute applicable weights,
and then calculate alues across a huge number of criteria. 0ll these processes can cost time,
energy, and money. 0nd if there are many unknown weights and preferences, the fully rational
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model may not be any more accurate than a best guess. 1ometimes a fast-and-frugal process of
soling problems might be your best option.
Intuition
(erhaps the least rational way of making decisions is intuiti%e decision &aking , an
unconscious process created from distilled experience. $t occurs outside conscious thought< it
relies on holistic associations, or links between disparate pieces of information< it#s fast< and it#s
affectively charged, meaning it usually engages the emotions. >hile intuition isn#t rational, it
isn#t necessarily wrong. =or does it always contradict rational analysis< rather, the two can
complement each other. 7ut nor is intuition superstition, or the product of some magical or
paranormal sixth sense. 0s one recent reiew noted, E$ntuition is a highly complex and highly
deeloped form of reasoning that is based on years of experience and learning.F Cor most of the
twentieth century, experts belieed decision makers# use of intuition was irrational or ineffectie.
That#s no longer the case. .D >e now recogni-e that rational analysis has been oeremphasi-ed
and, in certain instances, relying on intuition can improe decision making. 7ut we can#t rely on
it too much. 7ecause it is so un%uantifiable, it#s hard to know when our hunches are right or
wrong. The key is neither to abandon nor rely solely on intuition, but to supplement it with
eidence and good judgment.
Co&&on +iases and .rrors in 3ecision Making
Jecision makers engage in bounded rationality, but they also allow systematic biases and errors
to creep into their judgments. To minimi-e effort and aoid difficult trade-offs, people tend to
rely too heaily on experience, impulses, gut feelings, and conenient rules of thumb. These
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shortcuts can be helpful. !oweer, they can also distort rationality. Collowing are the most
commonbiases in decision making.
5%erconfidence +ias $t#s been said that Eno problem in judgment and decision making is more
prealent and more potentially catastrophic than oerconfidence.F >hen we#re gien factual
%uestions and asked to judge the probability that our answers are correct, we tend to be far too
optimistic.
Anchoring +ias The anchoring *ias is a tendency to fi,ate on initial infor&ation and fail to
ade%uately adjust for subse%uent information. $t occurs because our mind appears to gie a
disproportionate amount of emphasis to the first information it receies. 0nchors are widely used
by people in professions in which persuasion skills are important"adertising, management,
politics, real estate, and law.
Confir&ation +ias The tendency to seek out information that reaffirms past choices and to
discount information that contradicts past judgments.
A%aila*ility +ias The tendency for people to base their judgments on information that is readily
aailable to them.
.scalation of Co&&it&ent 0n increased commitment to a preious decision in spite of
negatie information.
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Rando&ness .rror The tendency of indiiduals to beliee that they can predict the outcome of
random eents.
Risk A%ersion The tendency to prefer a sure gain of a moderate amount oer a riskier outcome,
een if the riskier outcome might hae a higher expected payoff.
Reducing +iases and .rrors
/ook for $nformation That Jisconfirms 3our 7eliefs. @ne of the most effectie means for
counteracting oerconfidence and the confirmation and hindsight biases is to actiely
look for information that contradicts your beliefs and assumptions. >hen we oertly
consider arious ways we could be wrong, we challenge our tendencies to think we#re
smarter than we actually are.
Jon#t Try to Create Meaning out of 'andom Lents. The educated mind has been trained
to look for cause-and-effect relationships. >hen something happens, we ask why. 0nd
when we can#t find reasons, we often inent them. 3ou hae to accept that there are
eents in life that are outside your control. 0sk yourself if patterns can be meaningfully
explained or whether they are merely coincidence. Jon#t attempt to create meaning out of
coincidence.
$ncrease 3our @ptions. =o matter how many options you#e identified, your final choice
can be no better than the best of the option set you#e selected. This argues for increasing
your decision alternaties and for using creatiity in deeloping a wide range of dierse
choices. The more alternaties you can generate, and the more dierse those alternaties,
the greater your chance of finding an outstanding one.
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Indi%idual 3ecision Making
$ndiiduals think and reason before they act. This is why an understanding of how people make
decisions can be helpful for explaining and predicting their behaior. $n some decision situations,
people follow the rational decision-making model. 7ut few important decisions are simple or
unambiguous enough for the rational model#s assumptions to apply. 1o we find indiiduals
looking for solutions that satisfice rather than optimi-e, injecting biases and prejudices into the
decision process, and relying on intuition.
!hat can &anagers do to i&pro%e their decision &aking6
0naly-e the situation. 0djust your decision-making approach to the national culture
you#re operating in and to the criteria your organi-ation ealuates and rewards. 0djust
your decision approach to ensure its compatible with the organi-ation#s culture.
1econd, be aware of biases. Then try to minimi-e their impact.
Third, combine rational analysis with intuition. These are not conflicting approaches to
decision making. 7y using both, you can actually improe your decision-making
effectieness. 0s you gain managerial experience, you should feel increasingly confident
in imposing your intuitie processes on top of your rational analysis.
Cinally, try to enhance your creatiity. 0ctiely look for noel solutions to problems,
attempt to see problems in new ways, and use analogies. Try to remoe work and
organi-ational barriers that might impede your creatiity.
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C. 0egotiation . $s the process in which parties with conflicting interests meet together and
make offers, counteroffers, and concessions in the attempt to resole their differences.
=egotiation is an important techni%ue that managers use to increase the likelihood of
reaching compromise between indiiduals and groups in conflict. Through negotiating
and bargaining, the parties to a conflict discuss different ways to allocate resources in
order to reach a solution acceptable to them all.
+argaining Strategies
There are two general approaches to negotiation" distributive bargaining and integrative
bargaining.
3istri*uti%e *argaining . =egotiation that seeks to diide up a fixed amount of resources< a
win+lose situation.
Integrati%e *argaining. =egotiation that seeks one or more settlements that can create a win+
win solution.
$n terms of intraorgani-ational behaior, all things being e%ual, integratie bargaining is
preferable to distributie bargaining because the former builds long-term relationships.
$ntegratie bargaining bonds negotiators and allows them to leae the bargaining table feeling
they hae achieed a ictory. Jistributie bargaining, howeer, leaes one party a loser. $t tends
to build animosities and deepen diisions when people hae to work together on an ongoing
basis.
3istri*uti%e -ersus Integrati%e +argaining
+argaining Charcteristics 3istri*uti%e +argaining Integrati%e +argaining
Goal ?et as much of the pie as Lxpand the pie so that both
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possible parties are satisfied
Motivation >in-lose >in-win
Focus (ositions 8E$ cant go beyond
this point on this issue.:
$nterests 8ECan you explain
why this issue is so important
to you2F:
nterests @pposed Congruent
nformation sharing /ow 8sharing information will
only allow other party to take
adantage:
!igh 8sharing information will
allow each party to find ways
to satisfy interests of each
party:
!uration of relationship 1hort term /ong term
The 0egotiation Process
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Preparation and Planning 7efore you start negotiating, you need to do your homework. >hat#s
the nature of the conflict2 >hat#s the history leading up to this negotiation2 >ho#s inoled and
what are their perceptions of the conflict2 >hat do you want from the negotiation2 >hat are
your goals2
3efinition of round Rules @nce you#e done your planning and deeloped a strategy, you#re
ready to begin defining with the other party the ground rules and procedures of the negotiation
itself. >ho will do the negotiating2 >here will it take place2 >hat time constraints, if any, will
apply2 To what issues will negotiation be limited2 >ill you follow a specific procedure if an
impasse is reached2 Juring this phase, the parties will also exchange their initial proposals or
demands.
Clarification and 7ustification >hen you hae exchanged initial positions, both you and the
other party will explain, amplify, clarify, bolster, and justify your original demands. This step
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needn#t be confrontational. 'ather, it#s an opportunity for educating and informing each other on
the issues, why they are important, and how you arried at your initial demands. (roide the
other party with any documentation that helps support your position.
+argaining and Pro*le& Sol%ing The essence of the negotiation process is the actual gie-and-
take in trying to hash out an agreement. This is where both parties will undoubtedly need to
make concessions.
Closure and I&ple&entation The final step in the negotiation process is formali-ing the
agreement you hae worked out and deeloping any procedures necessary for implementing and
monitoring it. Cor major negotiations" from labor+management negotiations to bargaining oer
lease terms to buying a piece of real estate to negotiating a job offer for a senior management
position"this re%uires hammering out the specifics in a formal contract. Cor most cases,
howeer, closure of the negotiation process is nothing more formal than a handshake.
Indi%idual 3ifferences in 0egotiation .ffecti%eness
Personality Traits in 0egotiation.=egotiators who are agreeable or extraerted are not ery
successful in distributie bargaining. >hy2 7ecause extraerts are outgoing and friendly, they
tend to share more information than they should. 0nd agreeable people are more interested in
finding ways to cooperate rather than to butt heads.
Moods8.&otions in 0egotiation. 0ngry negotiators also feel more focused and assertie in
striking a bargain. This appears to hold true een when the negotiators are instructed to show
STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE
27
anger despite not being truly angry. @n the other hand, for those in a less powerful position,
displaying anger leads to worse outcomes.
0nxiety also appears to hae an impact on negotiation. Cor example, one study found that
indiiduals who experienced more anxiety about a negotiation used more deceptions in dealing
with others.
Culture in 0egotiations
ender 3ifferences in 0egotiations
0 popular stereotype is that women are more cooperatie and pleasant in negotiations than are
men. The eidence doesn#t support this belief. !oweer, men hae been found to negotiate better
outcomes than women, although the difference is relatiely small. $t#s been postulated that men
and women place une%ual alues on outcomes.
R59P 3"0AMICS
0AT9R. 5# R59PS A03 T.AMS !ITHI0 H.A$TH CAR.
0 group is a a collection of two or more people who work with one another regularly to
achiee common goals
is often depicted as a collection of people sharing leadership of and working together on a
specific project. 8Lrofee, ?la-er, M $anitskaya, *99A:
STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE
28
a team can eole from a pre-existing group. !oweer, a group by itself cannot be
considered a team. 0 team tends to be more close knit and works together oer a longer
period of time than a group. 0 team also holds a stronger sense of collectie identity than
a group.
R.AS50S #5R R59P #5RMATI50
&. !ae a sense of security
*. !ae a status
.. Jeelop self-esteem
4. 0ffiliation
6. (ower
.ffecti%e groups achie%e high le%els of'
&. Task perfor&ance - members attain performance goals.
*. Me&*ers satisfaction - members beliee that their participation and experience are
positie and meet important personal needs.
.. Tea& %ia*ility - Members are sufficiently satisfied to continue working together on an
ongoing basis
Situations in which groups are superior to indi%iduals'
>hen there is no clear expert in a particular problem or task
>hen problem soling can be handled by a diision of labor and the sharing of
information
>hen creatiity and innoation are needed.
ASS5CIAT.3 PR5+$.MS I0 R59PS
STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE
29
S5CIA$ #ACI$ITATI50. The tendency for a person#s behaiour to be influenced by
the presence of others.
positiely affects performance when a person is proficient in the task
negatiely affects performance when the task is not well-learned.
S5CIA$ $5A#I0. $s the tendency of people to work less hard in a group than they
would indiidually.
$ndiidual contributions are less noticeable in the group context
1ome indiiduals prefer to see others carry the workload
!ays of pre%enting social loafing
&. Jefine member roles and tasks to maximi-e indiidual interests
*. /ink indiidual rewards to performance contribution to the group
.. 'aise accountability by identifying indiidual#s performance contributions to the group
A. roup 3yna&ics. Concerns the forces operating within groups that affect the way
members relate to and work with one another. ETeamwork and collaboration between all
health professionals results in high %uality clinical care, and increased job satisfaction for
staffF87egley, *99A:
!hat goes on within a group6
&. 'e%uired behaiours
-those formally defined and expected by the organi-ation
-norms that are expected to each members
*. Lmergent behaiours
-those that group members display in addition to what the organi-ation asks of them
+. Types of roups
#5RMA$ R59PS
-formally defined by the organi-ation#s structure
-designation of work assignments are formally established 8T. H5J?L, *9&&:
I0#5RMA$ R59PS
-neither formally structured nor organi-ationally determined
-natural formations in the work enironment that appear in response to the need for
social contact
STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE
30
C. roup 3e%elop&ent
Tuck&an)s #i%e Stages of roup 3e%elop&ent
: Stages of roup 3e%elop&ent
#or&ing
- ?roup is initially coming together.
- (eriod is characteri-ed by shyness, and uncertainty among members.
- Lxtraerted outspoken members may rapidly assume some kind of leadership role.
- Maintenance concerns are predominating.
- >hy are we here2 >hat are we doing2
- >hat is our goal, our purpose2
- 0wareness, $nclusion.
Stor&ing
- @nce established - period of ying for positions and roles within the group.
- 1ome seek out and compete for status, control, authority and influence.
- $nner conflict. 0 period of ;testing-out; the leaders.
- Jisagreements and arguments arise, are fuelled and manufactured.
- $n the end, roles are eentually allocated.
- The initial leaders may not surie this periodG it is the most uncomfortable phase of
the group's life - akin to adolescence.
0or&ing
- $nternal group structure now sorted, ?roup $dentity takes shape.
STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE
31
- >hat kind of behaiors M contributions are acceptable and normali-ed within the
group2 >hat is not tolerated2
- Cormation of - $mplicit M Lxplicit ?roup =orms.
- =orms create structure >hat do we stand for2
- ?roup can readily slip back into 1torming stage.
- Cooperation.
- Cohesion.
Perfor&ing
- >ork and progress commences on the basis of a relatiely stable group structure.
- Moing in unison, towards goals and completion.
- 0ction, 'esults.
- (roductiity.
- Team cohesion and identity.
Ad(ourning
- Completion and disengagement.
- 1eparation and ending from tasks and members.
- (ride and accomplishment may be felt.
- 1ome describe stage as ;Jeforming and Mourning; - recogni-ing the sense of loss
felt by group members.
3. Roles within roups
STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE
32
$ncreasing costs of health care and rapid knowledge growth hae led to collaboration among
health care professionals to share knowledge and skills.
P9RP5S.S'
To characteri-e the %ualitatie nature of team interaction and its relation to training health
professionals, drawing on theoretical and analytical frameworks from the sociocognitie
sciences.
M.TH53S'
0ctiities in a primary care unit were monitored using obserational field notes,
hospitaldocuments, and audio recordings of interiews and clinical interactions.
R.S9$TS'
The demarcation of responsibilities and roles of personnel within the team became fu--y in
practice. Continuous care was proided by primary care proiders and speciali-ed care by
intermittent consultants. The nature of indiidual expertise re%uired was a function of the patient
problem and the interaction goal. These team characteristics contributed to the reduction of
unnecessary and redundant interactions.
C50C$9SI50S'
Jistributed responsibilities allow the team to process massie amounts of patient information,
reducing the cognitie load on indiiduals. The uni%ueness of indiidual professional expertise
as it contributes to the accomplishment of team goals is highlighted, suggesting emphasis on
conceptual competence in the deelopment of indiidual professionaleducation programs.
.. 3.CISI50 MA;I0
(also known as collaborative decision making)
$s a situation faced when indiiduals collectiely make a choice from the alternaties
before them.
This decision is no longer attributable to any single indiidual who is a member of the
group
!hy roups can &ake higher /uality decision6
according to Gary John, there are three assumptions that for basis on this argument
N ?roups are more igilant than indiiduals
N ?roups can generate more ideas and deelop more alternatie solutions than indiiduals
STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE
33
N ?roups can ealuate ideas better than indiiduals
I&portance of /uality decision &aking
-The %uality of decision is important, and the same may be made by the manager himself
or by the group. The same may be in the following scenariosG
N The extent to which the manager possesses the information and expertise to make a high-
%uality decision
N The extent to which the subordinates hae the necessary information to assist in
generating high-%uality decision
N The probability that the manager#s decision will be accepted by the subordinates
N The extent to which the subordinates would go to attain organi-ational goals
N The extent to which acceptance on the part of the subordinates is critical to effectie
implementation of the decision
N The extent to which the subordinates are likely to disagree oer preferred solutions
Types of roup 3ecisions'
&. 9nilateral - a decision made by one person, often the nominal leader, without
consultation with other group members. 0t times, it can be appropriate. Cor example, a
minor decision that needs to be made right away. $f it is repeated and inappropriate, this
type of decision can carry a ery low group commitment.
*. Handclasp - decisions made by two members. @ne suggests, the other endorses and
carries it through without ade%uate discussion or group consideration. This type has high
commitment for the two who made it, but generally not for the others.
.. Cli/ue - similar to the !andclasp but with more people inoled. This type usually
occurs when a close sub-group decides what is good for the rest of the group. 'epeated
cli%ue decisions cause splintering of the group and low commitment.
4. +aiting - a techni%ue that reduces discussions around decisions. 0 person will say, ;=ow
we are all agreed, right2); and only the ery brae will speak up. This usually suppresses
obious dissention and lowers group commitment.
6. Ma(ority Rule - a popular way of making decisions. !oweer, if the outcome of a secret
ballot ote would produce any surprises, it is not a good time to make majority rule
STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE
34
decisions. >hat happens is that a si-eable segment of the group may feel dealued and
decrease their commitment to the decisions in which they ;lose; to the majority ote.
B. Consensus - similar to Majority 'ule, but eeryone knows that what they think and alue
is being considered by all, and there will be no surprises if you ote. Lach person will
agree that, under the circumstances, which may not be ideal, the decision made is a fair
and workable one that they can lie with and support.
A3-A0TA.S 5# R59P 3.CISI50 MA;I0
&. ?roup members may hae different specialties
*. More alternaties are examined
.. $mplementation of the decision may be more efficient
4. Lliminates biases
6. Jemocratic in nature
3ISA3-A0TA.S 5# R59P 3.CISI50 MA;I0
&. Time consuming
*. The group#s decision may be dominated by one indiidual or a small coalition
.. @wn interests to protect
4. $ndiiduals may be compelled to conform to the apparent wishes of the group
6. ?roupthink + the tendency of highly cohesie groups to lose their critical ealuation
capabilities
Reference'
0ppelbaum, 1. 8*9&*:. Stress Manage&ent for Health Care Professionals <
nd
edition
p.
=:->?4@A:-@@<4B=:-B?:
7ryar,'. M 7ytheway, 7. 8*9&9:. Changing (rimary !ealth Care 6
th
edition p. &BD-&D9
STRATEGIES FOR ADDRESSING STRESS AND CON FLICT WITHIN HEALTH CARE
35
Chernis, C. 8*9&9:. Staff *urnoutG (o* stress in the hu&an ser%ices B
R3
edition p. >C-
DA4 @==-@=?4 <A:-<@:
Coward, h. M (hillips, M., 8*99A:. ?roupsG 0 ?uide to 1mall ?roup >ork in !ealthcare,
Management, Lducation 0nd 'esearch *
nd
edition, p.&6-*4, 6B-B*
'obins, 1. M Hudge, T. 8*9&&:. @rgani-ational 7ehaior &6
th
edition, p. &O4 -&B4, 46B +
4BB
http'88www.study&ode.co&8essays8Tea&s-And-Tea&-Processes-roup-3yna&ics-
?DD=?C.ht&l
www.psclg.org.sa8we*8ppt85rganiEational-+eha%ior8chAD.pps