This is the sixth in a series of columns on EMS leadership. Each month, Dr. Breaux will cover leadership applications such as behavioral, managerial, situational, path-goal, leader-member exchange, full-range transformational and transactional leadership. Other areas like conflict management, effective communications and organization structure will also be addressed.
Ralph, who is director of Shade Tree County EMS, has a lot of conflict regarding his crews, and especially their interfacing with hospital staff at the local emergency room. He has had to reschedule crews because certain individuals don't get along with their fellow crew members, which has been a problem since he took over this EMS organization two years ago. Additionally, his crews are increasingly getting into heated arguments with emergency room staff. He has been putting this crisis off, but things are getting worse and he must address these issues now.
Ralph recently met with a professor at a local university to ask for suggestions on how to address these issues. The professor told him about a book titled Managing Conflict in Organizations by Dr. Afzalur Rahim, who defines conflict as an interactive process manifested in incompatibility, disagreement or dissonance within or between social entities.1 Dr. Rahim recommends the following preventative conflict management processes:
- Separate anger from situations
- Attack problems, not persons
- Focus on issues, not your position on issues
- Develop common agreement
- Communicate feelings assertively, not aggressively
- Focus on common interests and agreement
- Accept and respect individual opinions
- Avoid jumping to conclusions
- Listen without interrupting
- Ask for clarification.
Dr. Rahim also recommends the following conflict management actions:
- Be impartial and strive to be fair
- Clarify the problem and focus
- Restate what is said
- Confirm the accuracy of the re-statement and give opportunity for corrections or clarifications
- Identify mutual needs or goals
- Encourage sincere and practical solutions
- Actively check for agreement to solutions
- If no agreement, analyze alternative solutions
- Review to ensure accepted solution is working and there is agreement.
Ralph is using both the preventative and action checklist to resolve conflicts, and the operational environment is becoming more calm. He met with individual crews to identify and resolve conflicts, as well as to identify problem crew members. Ralph then met with the individual problem crew members using the same aforementioned checklist and has experienced conflict resolution with all but one or two crew members, with whom he will meet again to better understand the situations and possibly resolve further conflict.
Ralph also met with emergency department leadership to ascertain what issues they were having with his crews. He shared that information with the ambulance crews and established solutions and agreements on how to handle conflict with ED staff. He also shared the solutions and agreements with ED leadership, who shared the information with their staff. There has been significant improvement in building professional relationships between ambulance crews and hospital staff that has in turn significantly reduced conflict to one misunderstanding over a three-month period, which was resolved without negative personal feelings between involved ambulance and hospital staff. This does not mean that Ralph does not need to continually monitor and manage conflict in his organization. Conflict management will always be a top priority for Ralph and his crew chiefs; however, the operational environment has improved significantly, and the EMS crews are providing much improved health care for their patients due to less conflict in the operational environment.
According to Dr. Rahim, there are two types of conflict: affective and substantive. Affective conflict occurs when two interacting social entities trying to solve a problem together become aware that their feelings and emotions regarding some or all of the issues are incompatible. Substantive conflict occurs when two or more organizational members disagree on their task or content issues. Dr. Rahim recommends encouraging substantive conflict, minimizing affective conflict, assuring collective learning and applying an integrated style of handling conflict, which is addressed below. He identifies five styles of handling conflict regarding interpersonal, intrapersonal, intergroup and intragroup conflict:
- Integrating--strategic integration of conflict management into an organization
- Obliging--delaying conflict for later consideration
- Dominating--quick decisions when needed
- Avoiding--delaying minor conflict for later resolution
- Compromising--addressing conflict with higher authority using intermediate alternatives.
Dr. Rahim recommends conflict diagnosis using measurement and analysis, as well as addressing conflict intervention by making changes to organizational processes and structure.
- Amount of conflict
- Identify management styles being used
- Sources of conflict
- Degree of organizational learning and effectiveness
- Amount/style classified by organizational unit
- Relationships of amount/style to sources
- Relationships of amount/style to learning and effectiveness
- Process: Involves improving organizational effectiveness by changing members’ style of handling conflict
- Structural: Involves improving organizational effectiveness by changing organizational structural characteristics.
According to Ahuja and Marshall, there is inevitably conflict between patients and caregivers, patients and administrative staff, patients and physicians, as well as myriad conflicts that arise between and within healthcare organizations that are trying to care for too many patients without adequate resources.2 The techniques they espouse regarding conflict management include brainstorming, option generation and considering all ideas as valid, thus avoiding critical analysis until a later defined time when the most viable options are identified and refined. They also recommend establishing an implementation plan that includes a goal statement (i.e. expected outcome), a mechanism to measure progress (i.e. performance indicators), and specific implementation steps detailing responsible persons or committee, a start and end date, and any support required with financial implications.
Zweibel, et al.3 conducted a study regarding two-day workshops on conflict resolution to enhance the ability of residents and academic healthcare faculty to collaborate in multidisciplinary teams, patient care, hospital committees, public health issues, teaching and research in Canada. The study concluded that the workshops allow participants to understand that conflict doesn't need to be overwhelming and destructive, and gives them confidence to approach conflict systematically, rather than just reacting to people and events.
In 2005, Hendel, Fish and Galon4 conducted a study in leadership and conflict management with Israeli nurse managers in general hospitals. Their study concluded that managing conflict effectively requires many professional qualities and skills, and organizations need to change to become conflict-positive, which requires on-going persistent action. They recommend teaching problem-solving and decision-making as a foundation for cooperative conflict resolution in an integrated fashion. They also recommend not waiting for conflict resolution skills to be obtained solely by experience, but they should be addressed immediately or things will escalate quickly and negatively impact the mission and relationships both internal and external to the organization.
In conclusion, conflict management should concentrate on:
- Keeping emotions and feeling out
- Minimizing affective conflict
- Encouraging substantive conflict
- Knowing that conflict is not avoided, but managed
- Applying double-looped learning (i.e., involves the diagnosis of and intervention in problems without changing the underlying polices, assumptions, and goals)
- Using the integrating conflict management style.
1. Rahim AM. Managing Conflict in Organizations. Westport, CT:Quorum Books, 2003.
2. Ahuja J, Marshall P. Conflict in the emergency department: Retreat in order to advance. ED Administration 5(6):429-433, 2003.
3. Zweibel EB, Goldstein R, Manwaring JA, Marks MB. What sticks: How medical residents and academic health care faculty transfer conflict resolution training from the workshop to the workplace. Conflict Resolution Quarterly 25(3):321-350, 2008.
4. Hendel T, Fish M, Galon V. Leadership style and choice of strategy in conflict management among Israeli nurse managers in general hospitals. Journal of Nursing Management 12:137-146, 2005.
Paul Breaux, PhD, LP, has a doctorate in Leadership Studies and conducts research in EMS, firefighting, law enforcement and military leadership environments. He is in his 11th year as a volunteer licensed paramedic (LP) for Bandera County Texas EMS, and is an adjunct professor at Our Lady of the Lake University. His full-time leadership job is in applied electromagnetic research and development with Southwest Research Institute.
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