Conflict management in public hospitals: the Cyprus case

Interprofessional Team Conflict Resolution: A Critical Literature Review

INTRODUCTION

Although concern related to conflicts within health care teams has been discussed in the literature, most studies have focused on individuals' personal conflict management style identification or on managers resolving workplace conflicts between parties. The purpose of this review was to identify significant components in the field of conflict with particular attention to conceptual findings that may be integrated into understanding interprofessional health care team conflict and its resolution.

METHODS

A critical review of the conflict literature across many fields was undertaken using the method identified by Grant and Booth, incorporating literature-search, appraisal, synthesis, and analysis.

RESULTS

This critical review explored existing models and schools of thought to provide an overview of how conflict is conceptualized, its focus on interpersonal and workplace issues, team conflict application and training in team conflict resolution, and finally a summary of this review's contribution to interprofessional health care team conflict and its resolution.

CONCLUSIONS

Team conflict is comprised of three forms-relationship, task, and process. When team building occurs that incorporates training in the use of an adapted constructive controversy approach, there is a greater opportunity to enhance the quality of a cooperative approach to patients' care planning. Training in team conflict resolution is needed as a key ingredient to ensure all team members can enhance the effectiveness and quality of interprofessional client-centered collaborative practice. This benefits not only the health providers in the team, but also their clients/patients who are recipients of their shared teamwork.

Development and validation of conflict management attitude questionnaire for medical students

BACKGROUND

Medical students should effectively manage conflicts in teamwork and communication with other team members. This study aimed to develop and validate a tool to evaluate attitude of medical students and physicians toward conflict management.

METHOD

A multi-step process was employed to develop and validate a Conflict Management Attitude Questionnaire (CMAQ) based on the steps recommended in AMEE Guide No. 87. First, the initial items were obtained from the literature review and focus group. After cognitive interviews with the medical students and revision of the questionnaire, content validity was performed by experts. The construct validity and reliability of the questionnaire were assessed using exploratory Factor Analysis (EFA) and Cronbach's alpha coefficient, respectively.

RESULTS

This multi-step process resulted in a 12-item, five-point Likert-type questionnaire with satisfactory construct validity. Exploratory factor analysis revealed three factors, comprising the four items from the "perceived interactions in conflict management" subscale loading on the first factor, and five items from the "perceived value of learning conflict management" subscale loading on the second factor, along with three items from the "perceived application of conflict management" subscale loading on the third factor. All subscales described 56.48% of the variance. Validation results showed that Content Validity Index (CVI) and Content Validity Ratio (CVR) were greater than 0.75. Cronbach's alpha coefficient was 0.791.

CONCLUSION

This study showed that CMAQ has valid evidence for assessing the attitude of medical students toward conflict management with favorable psychometric properties and strong evidence of construct validity. However, due to the lack of evidence on any specific questionnaire to evaluate the attitude towards conflict management, future studies should conduct a confirmatory investigation regarding other aspects of medical students' attitudes toward conflict management.

Knowledge, causes, and experience of inter-professional conflict and rivalry among healthcare professionals in Nigeria

Introduction

The healthcare workforce is regarded as an essential component of any functioning health system, and a lack of optimal collaboration among this group can result to poor quality healthcare services to the population. In Nigerian setting, the health sector is faced with challenges of inter-professional conflict and rivalry. This study aimed at understanding knowledge, causes, and experience of inter-professional conflict and rivalry among healthcare professionals in Nigeria.

Methods

A cross sectional study was undertaken to administer questionnaires to healthcare personnel in various healthcare facilities in Nigeria. Data were analysed using Statistical Package for Social Sciences.

Results

A total of 2207 valid responses were received, and male participants were in majority as indicated by 63.7% of the sample. Collectively, doctors and pharmacists represented two-thirds of the sample, and majority of the participants were in the public sector (82.5%). Disparity in salary structure was the highest source of conflict. Whilst almost all the participants indicated that inter-professional rivalry and conflict are prevalent in health sector, about three-quarters of them (73.2%) disagreed that this practice is productive. A considerable number of the respondents had experienced inter-professional conflict and rivalry.

Conclusion

Evidence from this study can help policymakers in developing framework that can be utilised in addressing rivalry and conflict in the healthcare sector.

Psychosocial factors associated with conflicts among health professionals in the operating room in a Greek sample

AIM

The purpose of this study is to investigate conflicts and identify the factors that cause the creation of conflicts in the operating room as well as coping strategies for conflict resolution.

BACKGROUND

The operating room is a special and changeable working environment, which is constantly evolving, and requires interdisciplinary team collaboration. Therefore, it is an environment that may cause conflict among employees.

METHOD

The study was conducted at three Public Hospitals of Athens, during the period from 1 April 2018, to 15 June 2018. The research tool used to conduct the research was the questionnaire of Kontogianni et al. (2011). The questionnaire consisted of four sections dealing with conflict issues and their management. The sample consisted of 185 nurses and medical staff. The level of statistical significance was set equal to .05. The questions were analysed through the statistical package SPSS 20.

RESULTS

Τhe majority of participants had conflicts with colleagues (79%), with doctors (69.5%) and with nurses (43.7%). Τhe majority of the sample was unaware of conflict management strategies (60%). One of the important factors that intensify the conflicts is the burdensome workload in combination with the unsatisfactory salary. Avoidance is the preferred conflict management strategy (64.7%), followed by mutual benefit trading (55.4%.) Acceptance is the least appropriate strategy (10.9%).

CONCLUSIONS

In order to deal with conflicts in the operating room effectively, it is necessary for nurses and physicians to be trained in conflict management.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers should support the training of nurses in conflict management in order to create a climate of cooperation and reduce conflicts.

The relationship between nurse managers' personality traits and their conflict management strategy preferences

AIM

To investigate the relationship between nurse managers' personality traits and conflict management strategies.

BACKGROUND

Despite the important role of personality traits in conflict management strategy preferences, no study to date has addressed the relationship between personality traits and conflict management in nurse managers.

METHODS

A descriptive and cross-sectional design was applied. The study sample consisted of 114 nurse managers from six hospitals, and 111 participants completed forms for a total response rate of 97.36%.

RESULTS

The main findings revealed that the conflict management strategies used by nurse managers participating were as follows: integrating (39.21, range = 29-45), avoiding (38.39, range = 23-65), compromising (31.51, range = 24-40), dominating (20.05, range = 12-28 ) and obliging (19.42, range = 14-25). It was seen that managers whose personality traits were extraverted, agreeable or conscientious chose the integration strategy to manage conflict, whereas managers with emotional inconsistency in personality traits preferred the avoiding strategy.

CONCLUSIONS

Nurse managers are important to effectively managing conflicts in the clinical environment. Personality trait may be linked to the successful management of conflict.

IMPLICATIONS FOR NURSING MANAGEMENT

Revealing the relationship between nurse managers' personality traits and associated conflict management strategies can help senior management organise useful training programmes to improve the conflict management capabilities.

Conflict and conflict management in hospitals

PURPOSE

Hospitals are complex and complicated organizations and are prone to the conflict. The purpose of this paper is to identify the intensity and type of conflict experienced by hospital managers and explore their conflict management strategies in hospitals affiliated with Tehran University of Medical Sciences.

DESIGN/METHODOLOGY/APPROACH

This quantitative, descriptive and cross-sectional study was conducted in 2015. A self-administered questionnaire was used to collect data from top, middle and front line managers. In total, 563 managers from 14 hospitals responded to the questionnaires. Data were analyzed using SPSS software version 19.

FINDINGS

Hospital managers reported average level of conflict (2.73 score out of 5). Organizational factors produced more conflict for managers than personal factors. High workload, resource shortage, bureaucracy and differences in managers' personality, knowledge, capabilities and skills were the main causes of organizational and personal conflict. Top managers experienced more conflict than middle and front line managers. Conflict was higher in specialized hospitals compared to general hospitals. Less conflict was observed in administrative and support departments than diagnostic and therapeutic departments. Conflict was meaningfully associated with management level, education, size of hospital, number of employees and willingness to leave the hospital. The dominant conflict management style of managers was collaborating. There were significant relationships between collaborating style and management level, manager's age, work experience and management experience.

PRACTICAL IMPLICATIONS

The nature of hospitals requires that managers use collaborating, compromising and accommodating styles to interact better with different stakeholders. Managers by acquiring necessary training and using the right conflict resolution strategies should keep the conflict in a constructive level in hospitals.

ORIGINALITY/VALUE

This is the first study conducted in Iran examining the level of conflict, its types and identifying managers' dominant conflict resolution strategies at front line, middle and top management levels.

Islamic principles of conflict management

This article explores and analyzes Islamic principles that govern conflict management within the Islamic human resource management (HRM) context and provides new insight into the theoretical development of conflict management from an Islamic HRM perspective. Current models are analyzed through Islamic principles and integrated into a comprehensive Islamic framework that can function as a guide for HRM toward developing a proactive nonlinear conflict management strategy. This study shifts the dialogue of Islamic conflict management from intervention to organizational culture. The premise of this study is to develop a model for HRM practitioners among a Muslim workforce. The proposed model suggests that conflict is referred back to Quran and Sunnah, the two primary sources of Islam. Islam mandates selection of Shura (council) and appointment of a Muslih (mediator) whose function is (1) al-tathabbut (verification) and (2) nasīhah (advice). HRM must consider proactive organizational traits based on Islamic principles: (1) ta’awun (cooperation), (2) sabr (patience), (3) al-ta’akhi (brotherhood), and (4) husn al-dhann (good assumptions).

Managing and mitigating conflict in healthcare teams: an integrative review

AIM

To review empirical studies examining antecedents (sources, causes, predictors) in the management and mitigation of interpersonal conflict.

BACKGROUND

Providing quality care requires positive, collaborative working relationships among healthcare team members. In today's increasingly stress-laden work environments, such relationships can be threatened by interpersonal conflict. Identifying the underlying causes of conflict and choice of conflict management style will help practitioners, leaders and managers build an organizational culture that fosters collegiality and create the best possible environment to engage in effective conflict management.

DESIGN

Integrative literature review.

DATA SOURCES

CINAHL, MEDLINE, PsycINFO, Proquest ABI/Inform, Cochrane Library and Joanne Briggs Institute Library were searched for empirical studies published between 2002-May 2014.

REVIEW METHODS

The review was informed by the approach of Whittemore and Knafl. Findings were extracted, critically examined and grouped into themes.

RESULTS

Forty-four papers met the inclusion criteria. Several antecedents influence conflict and choice of conflict management style including individual characteristics, contextual factors and interpersonal conditions. Sources most frequently identified include lack of emotional intelligence, certain personality traits, poor work environment, role ambiguity, lack of support and poor communication. Very few published interventions were found.

CONCLUSION

By synthesizing the knowledge and identifying antecedents, this review offers evidence to support recommendations on managing and mitigating conflict. As inevitable as conflict is, it is the responsibility of everyone to increase their own awareness, accountability and active participation in understanding conflict and minimizing it. Future research should investigate the testing of interventions to minimize these antecedents and, subsequently, reduce conflict.

'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital

Background and Objectives

This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital.

Methodology

The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings.

Ethics Statement

Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned.

Results

Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients.

Conclusion

To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in place. Additionally promoting communication and interaction among health workers can foster team spirit. Also resolving conflicts using the collaborating response may help to create a conducive work environment that will promote healthy work relations, which can facilitate the delivery of quality maternal and neonatal health care. However, such an approach requires that unequal power relations, which is a root cause of the conflicts is addressed.

Organizational culture in general hospitals and its relationship with job satisfaction

Introduction: Organizational culture is formed via communication, resolving conflicts, team work and interconnection. The aim of the study was to present the connections between organizational culture and job satisfaction indicators. Methods: A quantitative descriptive approach was used. The study included nursing employees and medical practitioners in six Slovenian hospitals. A 30 per cent quota sample was used, with a response rate of 35.2 % (n = 310). The Organization Culture Assessment Instrument (OCAI) (α = 0,818) and Index of Work Satisfaction (α = 0,921) questionnaires were used. The data was processed with SPSS 20.0 statistical software by using the t-test, single variance analysis, correlation, factor and regression analysis. Results: The greatest total average value among employees of both job groups with regard to organizational culture was the market (x = 28.21) and hierarchy (x = 27.57). Job satisfaction indicators (collaboration, leadership, decision-making, autonomy) can be explained in 20 % of cases with adhocracy organizational culture (β = 0.318, p < 0.001), market (β = 0.219, p < 0.001) and clan (β = 0.161, p = 0.006). Discussion and conclusion: In Slovenian hospitals, control over work, abiding by the rules and attaining, goals prevails. An overview of the literature reveals the influence of culture on satisfaction. Other factors affecting satisfaction, including stress and abuse of hierarchical power, should be studied.

Conflict management styles, emotional intelligence and implicit theories of personality of nursing students: a cross-sectional study

BACKGROUND

Conflict management is an essential skill that nursing students need to master as conflict is unavoidable in clinical settings. Examining nursing students' conflict management styles and the associating factors can inform nurse educators on how to equip nursing students for effective conflict management.

OBJECTIVES

This study aimed at examining undergraduate nursing students conflict management styles in managing conflict with their supervisors in clinical placement. The associations of emotional intelligence and implicit theories of personality with conflict management styles were also investigated.

DESIGN

This is a cross-sectional quantitative survey.

SETTING

This study took place at a nursing school at a university in Hong Kong.

PARTICIPANTS

568 undergraduate nursing students participated in the study.

METHODS

Students completed a questionnaire which consisted of demographics, Measure of Implicit Theories of Personality, The Schutte Emotional Intelligence Scale (SEIS) and The Rahim Organizational Conflict Inventory-II (ROCI-II) and received a HKD 20 book coupon as compensation. The data were analyzed by descriptive statistics, reliability analyses, t-tests, correlational and linear regression analyses.

RESULTS

For managing conflict with clinical supervisors, students used obliging and integrating most frequently whereas used dominating least. Emotional intelligence was a significant predictor of all five conflict management styles. The higher the emotional intelligence, the more students used integrating, obliging, compromising and dominating. The lower the emotional intelligence, the more students used avoiding. There was a significant association between implicit theories of personality and compromising. The less malleable students perceived personality to be, the more they used compromising.

CONCLUSIONS

Emotional intelligence was significantly associated with all five conflict management styles while implicit theories of personality were significantly associated with compromising style only. Efforts of nurse educators to enhance students' conflict management skills and emotional intelligence to face conflicts in clinical settings are discussed.

Cypriot and Greek nurses' perceptions of the professional practice environment

BACKGROUND

Research evidence supports that the role of the professional practice environment is crucial for the delivery of quality care as it is significantly correlated with patient and nurse outcomes. However, in countries sharing similar cultural and ethnic backgrounds, like Cyprus and Greece, as well as the increased mobility of patients and healthcare workers, there is a lack of information regarding this issue. The aim of this study is to explore and compare Cypriot and Greek nurses' perceptions of their professional practice environment.

METHODS

A descriptive comparative survey was employed using a sample of nurses in Cyprus (N = 150) and Greece (N = 147). Information was collected with the Revised Professional Practice Environment Scale (RPPE).

RESULTS

The results revealed significant differences between the two countries in three out of eight factors of the RPPE, with Greece's mean value being higher than Cyprus's: Handling Disagreements and Conflicts, Leadership and Autonomy in Clinical Practice, and Teamwork.

CONCLUSIONS

The findings generate additional knowledge about the organizational context of care delivery that might help nursing leaders to understand how nurses perceive their work environment and how this influences their work, and consequently the care provided. The results can be utilized by nurse ward managers to improve the quality of nursing care provided. Further research is needed using different approaches to explore nurses' experience in more depth.

IMPLICATIONS FOR NURSING OR HEALTH POLICY

Measuring nurses' perceptions of their professional practice environment may assist managers and policymakers in introducing interventions that contribute to a better practice environment and consequently to improved nursing, as well as patient, outcomes.