Management roles and responsibilities

Negotiation and Conflict Management in Health Care

While there has always been conflict in the health care environment, conflict appears to be on the rise because of changes in how health care is provided in the modern United States. Many of these conflicts are resolved or occur after care has been provided, so that they do not impact the quality and timeliness of patient care. However, any conflict in the health care environment runs the risk of impacting patient care, which makes these conflicts potentially very detrimental to patients and health care providers. What is fascinating is that many of these conflicts have very little to do with conflicts between patients and providers, but are actually driven by disputes between competing interests among health care providers. Research into the root causes of disputes in the health care field reveal that healthcare institutions are "buffeted by significant interpersonal, organizational and interinstitutional conflicts. These conflicts appear primarily a function of powerful, interacting social forces, including aspects of medical and nursing practice and culture, organizational dynamics, the needs and characteristics of the hospital's patient population, and above all, the hospital's declining economic base" (Kressel et al., 2002). The fact that there are so many different sources of conflict makes it clear that healthcare professionals need to be aware of different methods for managing conflict and negotiating in the healthcare setting. Furthermore, even when conflict is resolved, it can have negative impacts on decision-making, retention, and even the safety and quality of healthcare

(Kaufman, 2009).

Discussion

Managers across all fields spend roughly 1/5th to 1/4th of their time dealing with conflicts (Kaufman, 2009). Furthermore, they can use various approaches to conflict management. In the healthcare setting, the principles of effective negotiation and conflict management can best be used to resolve power struggles within health care settings if managers attempt to use principled negotiation in their approaches to conflict resolution. There are four steps to principled negotiation, which can be used as a negotiating tool and as a means of conflict management. First, "separate the people from the problem" (Hayes, 2010). Second, "focus on interests, not positions" (Hayes, 2010). Third, generate a variety of possibilities before decision-making (Hayes, 2010). Fourth, look for an objective standard for measuring results, and then insist that the result be based on that standard (Hayes, 2010).

The problem is that it can be impossible for a person to unilaterally engage in principled negotiation. There are five different styles to conflict resolution and negotiations: competing, collaborating, avoiding, accommodating, and compromising (Kaufman, 2009). In competing, each person focuses on their own concerns, which makes it is a win-lose scenario (Kaufman, 2009). In collaborating, the parties seek to find a solution that meets all parties' needs (Kaufman, 2009). The avoiding style seeks to avoid conflict (Kaufman, 2009). The accommodating style is a lose-win scenario, with one party sacrificing to meet the other party's needs (Kaufman, 2009). Compromising looks for the middle-ground, which means that both parties win, but it also means that both parties lose (Kaufman, 2009). A manager must identify the positions of the parties and focus on how to shift those positions in order to manage conflict in an effective manner. How a manager does so frequently depends on whether a manager is a participant in the conflict or whether the manager is being asked to resolve the conflict.

There are several different types of power struggles in health care settings that are amenable to using negotiation and conflict management techniques. Perhaps the most basic conflict is interpersonal conflict between coworkers. The reality is that coworkers are not always going to be able to get along in a successful and productive manner without manager intervention. A manager cannot avoid the conflict and hope that it disappears, because that runs the risk of the conflict erupting or simply spreading like a cancer throughout the entire organization. Instead, the manager must address the issue. Furthermore, while the manager cannot dictate the approaches of the coworkers, the manager, because the manager has some power over the coworkers, can ensure that the conflict is resolved and that no person is expected to simply accommodate the wants of a person who enters into conflict from a competing perspective.

Another power struggle in the health care setting that is amenable to negotiation and conflict management techniques is conflict with patients over payments. The payment environment for health care is incredibly complex and patients may genuinely misunderstand what payments are due, or be told conflicting information by their insurance companies and healthcare providers. As the primary point-of-contact with patients, healthcare providers have to be able to negotiate with clients about payment disputes. Understanding that a patient who cannot pay a bill will not be any more able to pay the bill if the doctor's office takes a heavy-handed approach can help a manager approach the person in a way that facilitates a fair payment for the office and a manageable payment for the patient.