Negotiation and Conflict Management to Resolve Power

¶ … Negotiation and Conflict Management to Resolve Power Struggles in Health Care Settings

Many health care organizations, especially tertiary facilities, consist of large numbers of diverse professional and support staff. Not surprisingly, as with all types of organizations, turf battles take place on a regular basis, conflicts occur, and the potential for health care workers to place their self-interest above the organization's best interests is always present. To determine how managers can best use the principles of effective negotiation and conflict management to resolve power struggles within health care settings, and what types of power struggles in health care settings are most amenable to the application of negotiation and conflict management techniques, specific ways to limit the potential abuse of power in health care organizations, as well as specific human resources strategies and transparency mechanisms that can prevent stakeholders from pursuing self-interested goals, this paper provides a review of the relevant peer-reviewed and scholarly literature, followed by a summary of the research in the conclusion.

Review and Discussion

Effective negotiation and conflict management

Effective negotiation can assume a number of forms, ranging from the highly informal to the highly structured, with the approach being used depending on the specific circumstances of the conflict that is involved. Generally speaking, effective negotiation will require a format in which the stakeholders:

1. Present a sequence of arguments to support their case;

2. State their preferences;

3. Recognize and acknowledge what the other side sees as important;

4. Try to achieve an in-depth understanding of all the issues;

5. Ascertain areas of agreement and disagreement;

6. Enter into a series of offers and bids relating to personal targets;

7. Seek out options to overcome areas of disagreement;

8. Engage in a process of mutual concession-making; and,

9. Formally agree and ratify a final deal that is acceptable to both sides, and that can be successfully implemented (Hargie & Dickson, 2004, p. 372).

Unfortunately, as anyone who has ever engaged in negotiations can readily testify, the process rarely works in this fashion or this smoothly, and people can become so frustrated and angry at their inability to persuade others that they lose sight of what they are actually seeking to accomplish. In these situations, a best alternative to negotiated agreement (BATNA) should be sought that achieves the most important aspects of the negotiations while allowing compromises that promote mutual acceptance of the outcome (Hargie & Dickson, 2004). According to Bateman (2000), a BATNA is "the standard against which any proposed agreement should be measured. That is the only standard which can protect you both from accepting terms that are too unfavorable and from rejecting terms it would be in your interests to accept" (p. 120). This means that negotiators should compare any proposal with their bottom line requirements to determine if it satisfies their best interests (Bateman, 2000).

Power struggles that are especially amenable to negotiation and conflict management

There are some enormous divisions of power in many health care settings, with physicians and administrators at the top of the hierarchy, followed by other professionals such as service directors, nurse practitioners, pharmacists, radiologists and so forth. This division of power means that people at the top of the hierarchy enjoy a tactical advantage in negotiations and conflict management efforts, but that does not mean they can wield uncompromising authority; however, it does mean that some health care professionals will have views that differ markedly from the organization's that will require resolution. As Loughry and Elms point out, "Professionals tend to resist organizations' attempts to exert control over them or in any way limit their freedom to make important decisions independently" (2006, p. 548). In power struggles involving the determination of best practices for the care of patients, for example, administrators will likely be more willing to concede to the will of physicians because of their training and expertise. Likewise, power struggles involving scarce resources can frequently be resolved when the realities of the situation are made known to all of the parties who are affected. Every health care setting is unique, though, and power struggles that are easily resolved in one setting might become full-blown crises in others, making the need for effective conflict resolution techniques all the more important.

Ways to limit the potential abuse of power

There are some subjective considerations involved in this area that must be taken into account. For instance, it might well appear that power is being abused in health care settings from the perspective of others when in fact the exercise of such power is fully within the discretion and scope of the individual involved (Golembiewski, 2000). Large health care organizations such as the Department of Veterans Affairs employ inspectors general, risk-management, peer-review and quality assurance teams to help prevent the abuse of power but not all health care organizations enjoy this level of support. Nevertheless, the same type of independent oversight can be used in virtually any health care organization to ensure that individuals do not abuse their power.

Human resources strategies and transparency mechanisms to prevent pursuit of self-interest