Conflict resolution strategies in managed healthcare settings

Conflict Resolution

It is common knowledge that the utilization of conflict resolution offers the essential plans to cut down arguments and encourages nonviolent clarifications. Melinda G. Lincoln (2001) elaborates on this point by asserting, "Diffusing heated arguments, identifying issues, setting emotions aside, and learning new ways to communicate enables the disputants to incorporate the processes and problem-solving skills of mediation, negotiation, and collaboration. The impact of illustrating, modeling, and blending conflict resolution education and communication skills facilitates the use of valuable listening and reasoning skills. Analytical thinking, re-framing main issues, and empathizing or understanding another's point-of-view creates an atmosphere of tolerance for successful negotiation and agreement to take place in a peaceful society (Melinda G. Lincoln, 2001)."

Kimberley Strom-Gottfried (1998) provides a comprehensive definition of "conflict." She writes, "Conflict is variously defined as a direct disagreement of ideas or interests, a battle or struggle, antagonism or opposition, and incompatibility and interference (Kimberley Strom-Gottfried, 1998)." The term "conflict" is frequently used in healthcare environment because of the complex dynamics of the professional settings. This poses serious problems for healthcare professionals who have not been trained to manage conflicts with healthcare settings.

This paper looks at the emerging trends within the concepts "Conflict Resolution" and the various strategies that have been adopted in the managed-healthcare field. It is important to note here that the pioneering theoretical era of conflict resolution strategies had been the 1990's. Almost all the techniques being used today have been strongly anchored and researched in the managed-healthcare settings in the 1990's. The utilization of these techniques has produced noteworthy results for the healthcare managers within the managed-care settings. This paper explores some of the most successful techniques that have been productively employed by the healthcare managers within the managed care settings.

Defining the scope of managed care

Kimberley Strom-Gottfried (1998) defines managed care as, "a range of strategies for ensuring that services are carefully structured and scrutinized to assure both fiscal responsibility and acceptable quality of care. Managed care is now the primary model under which health and mental health services are delivered in the for-profit, nonprofit, and public sectors."

While many scholars have asserted that the concept of "conflict resolution" should not be taught to the managed care professionals because they will not encounter grave workplace conflicts. This is because, they believe, the managed care settings offer very little room for disagreements and that it is a simple and straight forward task of supervision. However, Kimberley Strom-Gottfried (1998) writes, "Although conflict is not inevitable in managed systems, some professional groups, client populations, areas of the country, and sectors of service may experience more difficulty adapting to the changes managed care brings than others. Disputes can occur when members of a treatment team differ about the services needed for a patient approaching discharge from a hospital or residential facility. Disputes can occur between a provider and a utilization reviewer, who disagree about whether certain services are 'medically necessary' or covered by a client's benefit plan. And they can occur between a worker and a supervisor, when the worker objects to precise performance standards and the supervisor views them as essential for accountability and funding. As the climate for the provision of health and mental health services becomes increasingly competitive, as budgets become tighter and expectations increase, the stakes in such disputes go beyond the substance of the disputes themselves."

Comprehending the conflict within managed care systems

Managed care systems are very complex and dynamic healthcare settings and as a result need careful and thorough examinations. Regrettably, very little research exists on the subject of conflicts within managed care settings. This has created a gap between the quality of services expected by the patients and the reality on ground. However, some scholars have gone out of their way to deliver what can be regarded as ground-breaking and revolutionary research work in this field. Kimberley Strom-Gottfried (1998) classifies the origins of conflicts with the managed care settings. She writes, "inconsistencies in data; relationship issues; value conflicts; structural problems, such as unequal power or resources or geographic or physical barriers; and conflicts about interests." These classifications have been considered as the most common situations for the mushrooming of conflicts within managed care settings.

Principles and Practices of Conflict Resolution

Thomas and Kilmann (1974) offered the most innovative and the most widely used strategies of conflict resolution that are being used not only in the managed care settings but also innumerous other workplace settings. Their strategies include five different styles and each style is considered to have its own advantages and disadvantages. These styles are adopted in accordance with the context of the situation being dealt with. Health care managers have found these techniques to be extremely successful, despite the fact that they had been presented almost three decades ago. Their five styles of conflict resolution are; "(1) avoiding ("I leave and you win"), (2) accommodating ("I let you win"), (3) compromising ("We both win some and lose some"), (4) competing ("I win and you lose"), and (5) collaborating ("We both win").( Thomas and Kilmann, 1974)"

Another strategy for resolving conflicts within managed care settings is to detach the concerned people for the problem. This is an extremely complex strategy and involves highly skilled communication experts. The person resolving the conflict not only has to put himself/herself in the position of the concerned party by asking the right questions but also ensure that he/she does not spark negative emotions as it will derail the entire process. Kimberley Strom-Gottfried (1998) writes, "A negotiator must listen well and put himself or herself in the other's place, perceiving the situation from that perspective without making presumptions about that perspective based on his or her own fears and biases. This may be accomplished by asking how they see the situation and by seizing opportunities to defy negative expectations. If a supervisor expects only to be challenged about a new service standard or policy, the adept negotiator would empathize with the difficulties inherent in implementing such a policy and ask the supervisor his or her thoughts about how it can reasonably be accommodated. Embedded in this strategy are the skills of being in touch with one's own emotions, not reacting defensively when others express strong emotions, and communicating in a nonjudgmental and non-inflammatory manner. When dealing with difficult people over difficult problems, the temptation is to avoid them at all costs. Symbolically, this raises difficulties in bridging the emotional barriers between the parties, and it raises practical difficulties because people are naturally suspicious if they feel they have not had sufficient input into a given plan. When the urge is to withdraw, the best strategy is to reach out (Kimberley Strom-Gottfried, 1998)."

Many conflict resolution theorists and practitioners have undermined the process of understanding the interests of the concerned parties. They believe that the process and strategies mediation and arbitration can be successfully implemented without the correct understanding of the interests of the concerned parties. It should be made clear that no conflict can be resolved without proper understanding of the interests of all the concerned parties. Kimberley Strom-Gottfried, (1998) reveals not only the importance of understanding the interests of the concerned parties but also provides effective strategies to comprehend them. She reveals that the understanding interests of other parties requires, "Taking proactive steps to find existing areas of agreement; uncover different, but complementary, needs; and recognize multiple interests so that areas of disagreement are minimized and a greater range of possible, mutually satisfying outcomes can be reached. It involves looking behind the positions of each participant and behind the emotions and statements to ask the questions why and why not (Kimberley Strom-Gottfried, 1998)."

The success of the concept of conflict resolution rests on finding the right solutions. The right solutions can be defined as results that have been agreed upon by all the parties concerned. However, rushing towards finding the right solutions or going too slowly can seriously harm the process of conflict resolution. This is because when people start giving their judgments, they are prone to become less imaginative. For example, Fisher (1991) puts in writing, "Judgment hinders imagination (Fisher, 1991)."

The concept and importance of finding solutions is further elaborated by Kimberley Strom-Gottfried (1998), she writes that successful conflict resolution strategies, "involves not rushing to premature solutions and inventing options for mutual gain. This does not mean that mutually acceptable agreements should be delayed, only that there are potential dangers in making precipitous decisions. The fundamental rules in any brainstorming exercise involve avoiding premature criticism and premature closure. The discomfort of disagreement can lead either party to accept the first viable option he or she hears, if only to draw the conflict to a close. Agreeing to forestall a decision and to make a concerted effort at generating a range of possibilities helps keep participants from viewing this as a zero-sum game and allows creative, mutually beneficial options to emerge (Kimberley Strom-Gottfried, 1998)."

Kimberley Strom-Gottfried (1998) provides another effective strategy for resolving conflicts with managed care settings. She writes that it is important for the concerned parties to swap places with each other so that they can understand and accept them with open arms instead of trying to oppose and defy them. She writes, "Difficult negotiations involve the use of "negotiation jujitsu" wherein one negotiator embraces the other's positions rather than resisting them. In some ways this strategy is the culmination and integration of all the preceding steps. The skills for this step include asking questions, making oneself open to correction, using silence, looking behind the proposals, and inviting criticism of one's proposal."

Conclusion

The strategies presented above have been derived from various online academic and peer reviewed journals. Importance have been given to those studies that have yielded ground-breaking and pioneering results and have been able to assist the managed care professionals to enhance their work ethics and mannerisms by providing them with innovative strategies to deal with conflicts arising in their workplace settings.

It should be noted here that while the conflict resolution strategies presented in this paper have been successfully proven in the managed healthcare settings over the years, these strategies have been used within a certain context as not all situations present the same dilemmas and as these strategies are not universal cures. However, the importance of conflict resolution cannot be undermined because it is believed that with time the healthcare settings are going to become increasingly complex and dynamic and the healthcare managers will have to come up with innovative conflict resolution strategies to resolve every day workplace disputes.