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The Trouble with Hidden Conflicts

The Incident…
Nancy has recently joined Unit 12. After watching Nancy perform a dressing change, Susan realizes that the technique Nancy used is different from what she knows as “best practice.” When questioned, Nancy says that that was the way it was done where she came from and she didn’t plan to change her technique. After much worry about this, Susan decides not to raise the issue any further – “after all, if our manager was paying attention as she should be, she’d know that Nancy was not following our organization’s best practices standards.”

Conflict is a given – wherever there are people who must interact with each other on a daily basis, there will be conflict. And conflict is a dirty word, right? For most healthcare leaders it signals discontent, dissatisfaction and potential disruption. But conflict, when managed appropriately, can lead to a more satisfy solution for all.

The first step is to recognize how conflict is expressed and ultimately resolved –or not resolved – is specific to each organization. Many factors determine the “conflict culture” that operates within a company, including the nature of the industry, the structure of the decision-making process, and the unique skills and ambitions of the workforce.

To further complicate this issue, there are two types of conflicts that propagate a workplace. The first, public conflicts, are overt, visible and at times dramatically affect the organizations operations. Typically, management is forced to deal with these types of situations by opening communications and putting processes in place.

But hidden conflicts, the ones we don’t see, can be the most damaging. These conflicts are rarely articulated, hard to resolve, cause a continuous pattern of disruption and, eventually, can drive managers to the brink! Not only can they impact those involved, but a bystander witnessing such a situation may also lose focus and productivity.

Interpersonal interactions and relationships play a primary role in these situations. Many times these conflicts are nonrational, based on emotions and cause negative feelings and stress, such as found in the incident above. One Unit 21, Susan is hiding her conflicts. She “accommodates” Nancy by allowing the behavior to continue, and she “avoids” approaching her manager who she believes is not fully engaged in supervising new hires. In the end, Susan is “hiding” her conflicts.

Beyond impacting an individual’s satisfaction and/or productivity, hidden conflicts cost an organization in a number of ways, including:

• Missed opportunities – If conflicts are hidden, an organization misses possible opportunities for innovation and change. Addressing conflict in an open, creative manner often leads to a more productive solution.
• Unmet goals – Suppressed conflict can generate resistance to strategic initiatives and goals without managers being aware of why success cannot be achieved.
• Ineffective management – Many of these situations become the responsibility of managers who are not natural mediators. Even with a trained manager, often the parties feel that the manager is exercising authority, not unbiased resolution.

Managing hidden conflicts causes major stress for employee and puts patients at risk because employees are distracted. Is Susan avoiding telling her manager out of spite or because she doesn’t know how to handle the public conflict that might result if she does?

With greater understanding of how hidden conflicts could ultimately impact patient care, and with a practiced communication model in their back pocket and the clear support of management, employees are empowered to make better decisions about effectively addressing situations where in the past they might have resorted to avoidance or accommodation to suppress a conflict.