Negotiation and conflict management in health care power struggles

¶ … 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).

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

A growing body of research indicates that the health care professions are different from many other occupations, but a debate remains concerning the extent to which health care professionals are "altruistic and committed to service vs. self-interested agents who exploit opportunities to maximize their powerful positions for their own benefit" (Loughry & Elms, 2006, p. 547). It would be disingenuous to suggest, though, that even the most altruistic health care professionals are not concerned about their own self-interest. In this regard, Loughry and Elms (2006) recommend that health care human resource managers draw on professional associations, incident reporting mechanisms and the peer-review process to help prevent the pursuit of self-interest.

Conclusion

The research showed that conflict in organizational settings in inevitable, but there are some effective ways that stakeholders can approach the process to ensure that they do not lose sight of their goals and achieve the maximum from any negotiation process. Power struggles in health care organizations are no exception, and there are some useful frameworks available to resolve these as well. The research also showed that health care organizations are characterized by wide divisions of power that facilitate the potential for abuse, but human resources can help prevent such abuses and the pursuit of self-interest through informed policies that draw on professional associations, incident reporting programs and peer review to improve the transparency of their operations.