Fear of Conflict: Management and Ethical Costs

Fear of Conflict: Management and Ethical Costs

Healthcare Management Ethics Fear of Conflict: Management and Ethical Costs Paul B. Hofmann, DrPH, FACHE Wanting to avoid conflict is natural but sh...

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Healthcare Management Ethics

Fear of Conflict: Management and Ethical Costs Paul B. Hofmann, DrPH, FACHE

Wanting to avoid conflict is natural but should not inhibit appropriate behavior.

Few people seek and enjoy conflict. In fact, people generally take constructive steps to prevent and avoid it. Nonetheless, at least some conflict is inevitable, so the ability to determine which conflicts should not be averted or circumvented is a key attribute of effective executives. The other essential characteristic is the ability to manage the conflict properly. Recognizing Fear of Conflict An old aphorism notes that one can avoid criticism by saying nothing, doing nothing and being nothing. The same might be said of conflict. Most executives want to be liked and would prefer to say yes to requests, especially from patients and their family members, influential managers, physicians, board members and prominent citizens. Making only politically safe or popular decisions, however, is a manifestation of an executive’s fear of conflict, and it is unrealistic and impractical. Competing appeals for limited resources, such as money, space and even time, make it impossible to approve every request. Another reason executives should overcome their fear of conflict is that conflict aversion promotes a continuing tolerance for inappropriate and/or incompetent behavior. Although confronting such


Reprinted from Healthcare Executive jan/feb 2012 ache.org

behavior by an employee, a physician or a board member is difficult, the costs of not taking timely action are almost always much greater. But problems associated with making tough choices are not the only source of conflict. Conflicts also occur when subordinates in a group setting express strong differences of opinion about critical issues. An executive uncomfortable with conflict may intervene prematurely to mediate the dispute rather than allow the participants to resolve their own disagreements, potentially suppressing a productive discussion and inadvertently discouraging future candor. Executives rarely recognize that they suffer from a fear of conflict; furthermore, subordinates and peers may not diagnose this fear and, even if they do, are unlikely to bring it to the executive’s attention. Given these factors, a candid selfappraisal is crucial. Among the warning signs that an executive is conflict averse are the following: • Delaying key decisions beyond a reasonable time frame • Making excessive compromises • Rationalizing or ignoring performance problems of others,

particularly if the executive hired those employees • Withholding constructive criticism of ideas and suggestions • Approving recommendations without a full and honest appreciation for either predictable or unintended consequences • Smothering intense debates • Discouraging the free expression of opposing ideas • Delegating difficult problems, such as dealing with a disruptive physician, to a subordinate to resolve Addressing Fear of Conflict In the July/August 2011 issue of Healthcare Executive, Scott Bullock, FACHE, wrote a superb CEO Focus column titled “Empowering Staff With Communication.” It discusses why successfully addressing conflict and reversing a culture of silence contribute to safer patient care. He explains how MaineGeneral Health dealt with a disturbing response to an otherwise positive employee satisfaction survey in which more than 20 percent of respondents indicated they disagreed with two statements: • Conflict in this organization is addressed in an open manner • People in my work group feel safe expressing their opinions/ views openly As one component of a comprehensive, systemwide approach to tackling these concerns, the MaineGeneral leadership added “speaking up” to the organization’s Values and Standards, making it not only a right but “an obligation and a moral imperative” (italics added). Bullock describes the specific steps MaineGeneral has taken to change the organizational culture;

Healthcare Management Ethics

they include implementing training based on the Crucial Conversations program by VitalSmarts, subsequently certifying a dozen senior managers to teach the program and then tracking the results. In 1972, Ken Thomas, PhD, and Ralph Kilmann, PhD, developed the Thomas-Kilmann Conflict Mode Instrument to measure a person’s behavior in conflict situations. According to an article by Thomas and Kilmann on Kilmann’s website (www.kilmann.com/conflict.html), “‘Conflict situations’ are those in which the concerns of two people appear to be incompatible. In such situations, we can describe an individual’s behavior along two basic dimensions: (1) assertiveness, the extent to which the person attempts to satisfy his (or her) own concerns, and (2) cooperativeness, the extent to which the person attempts to satisfy the other person’s concerns. These two basic dimensions of behavior define five different modes for responding to conflict situations.” They include competing, collaborating, compromising, accommodating and avoiding. The article continues, “Each of us is capable of using all five conflicthandling modes. None of us can be characterized as having a single style of dealing with conflict. But certain people use some modes better than others … whether because of temperament or practice.” In an August 2011 article of the Center for the Health Professions at the University of California, San Francisco, Ed O’Neil, PhD, the center’s director, referenced the work of Kilmann and Thomas. He wrote


Reprinted from Healthcare Executive jan/feb 2012 ache.org

that six issues require consideration when trying to handle conflict in a more productive way: 1. Power—Who has the power? Is it formal or informal? How will I use my power in this conflict? Will I give up or gain power in this possible conflict? 2. Quality—Is there a ‘technically correct’ approach to take in this situation? Who is right in this conflict? Is it even possible to know who or what is right in this situation, or is it all opinion? 3. Importance—How important is this to me? Why? How important is it to the other party? Do I really understand why it seems important to them? 4. Time—How much time do we have to resolve this conflict? Is the clock running? Will we know more if we take more time? Is knowing more worth the effort it takes to gain that knowledge? Is my sense of time demands real or just part of my style? 5. Relationship—Is this a long-term relationship? How do I value it? Could this conflict harm the relationship? Could the way we resolve this improve the relationship? 6. Buy-in—How much engagement do I need of others to go forward? Will I lose interest if we don’t account for some of my concerns? Concluding Observations Conflict is a natural and normal component of a healthy work environment and should ultimately

produce better decision making. But any organization that aims to achieve this balance must have a level playing field for conflict resolution and alternatives to win-lose scenarios. The management and ethical costs of dealing poorly with conflict can be significant. Regardless of your executive position, some subordinates within your organization will probably emulate the way you handle conflict because (1) they simply assume you do so appropriately and/or (2) they believe it is an acceptable way to address conflict. Being a good role model becomes even more critical when others rely on you to demonstrate exemplary behavior by promoting candor, negotiating fairly and acting both objectively and decisively. Healthcare employees, physicians and trustees often feel they are working in an organizational pressure cooker, experiencing more stress as a result. Conflicts can certainly add to this stress, but we must remember that an organizational culture that suppresses conflict and penalizes people who speak out is unhealthy for patients as well as staff. s Paul B. Hofmann, DrPH, FACHE, is president of the Hofmann Healthcare Group and a Senior Fellow of the Health Research & Educational Trust. Dr. Hofmann is co-editor of the books Management Mistakes in Healthcare: Identification, Correction and Prevention, published by Cambridge University Press, and Managing Healthcare Ethically: An Executive’s Guide, published by Health Administration Press (ache.org/HAP). He may be reached at [email protected] hofmannhealth.com.