Conflict Narratives from the Health Care Frontline: A Conceptual Model

AuthorElizabeth Buttrick,Elise Frans,Ryan Fehr,Sarah E. Shannon,Isaac Bohannon,Sara Kim
Published date01 March 2016
Date01 March 2016
DOIhttp://doi.org/10.1002/crq.21155
C R Q, vol. 33, no. 3, Spring 2016 255
© 2016 Wiley Periodicals, Inc. and the Association for Confl ict Resolution
Published online in Wiley Online Library (wileyonlinelibrary.com) • DOI: 10.1002/crq.21155
Con ict Narratives from the Health Care Frontline:
A Conceptual Model
Sara Kim
Elizabeth Buttrick
Isaac Bohannon
Ryan Fehr
Elise Frans
Sarah E. Shannon
We examined health care confl icts through interviews with health care
leaders, providers, and patients. Ninety-two medical providers, nurses,
technologists, hospital leaders, and patients/families shared 156 confl ict
stories. We identifi ed individual, interpersonal, and organizational
factors contributing to interprofessional confl icts. Individual contribu-
tors included resource depletion (i.e., stress and fatigue), perceptions
of others’ seemingly selfi sh motives, and judgment toward colleagues’
competence. Interpersonal confl icts involved prior unresolved confl icts,
dehumanization, power diff erentials, or communication breakdown.
Organizational factors included navigating within complex organi-
zational structures and noncompliance with group norms. Confl icts
resulted in negative consequences for patients (safety, satisfaction), pro-
viders (career, relationships, satisfaction, morale), and organizations
(performance, staff turnover).
Confl ict in the workplace is ubiquitous in modern organizations. When
it is unaddressed and unresolved, it has erosive and even devastat-
ing impacts on individual workers, teams, and organizational culture (de
Wit, Greer, and Jehn 2012; Friedman et al. 2000). Prior research shows
that unresolved team confl icts pose grave consequences for patient safety
and quality of care (Azoulay et al. 2009; Catchpole et al. 2008; Christian
256 KIM, BUTTRICK, BOHANNON, FEHR, FRANS, SHANNON
C R Q • DOI: 10.1002/crq
et al. 2006; Maxfi eld et al. 2005; Rogers et al. 2011). Confl icts in hospital
settings occur within professions (e.g., nurse to nurse), interprofession-
ally (e.g., nurse and physician), and across professional teams (e.g., critical
care unit and interventional radiology) (Otero, Nallamshetty, and Rybicki
2008). Some of these confl icts can evolve to a serious level resulting in dis-
ruptive behaviors such as verbal outbursts, threats, or refusal of tasks, which
the Joint Commission (2008) recognizes as an important threat to patient
safety. In a large-scale survey of 3,604 medical residents who were trainees,
those who personally experienced more than one source of confl ict involv-
ing another resident, a supervising physician attending, or a nurse were
more likely to report both serious medical errors and adverse outcomes
compared to those who reported either one or no confl icts (Baldwin and
Daugherty 2008).  e negative eff ects of poorly managed confl icts within
health care organizations call for better understanding of the nature of
workplace confl icts to allow targeted interventions. Yet studies examining
confl icts specifi c to health care have lacked rigorous theoretical grounding
and clear conceptual frameworks (Paradis and Whitehead 2015).
A conceptual framework of workplace confl ict emerging from the
domain of business is the confl ict-outcome moderated model, which
describes moderating factors of confl ict and the impact on both proximal
(e.g., trust, satisfaction) and distal (e.g., performance) outcomes (de Wit
et al. 2012). In this model, confl icts are largely described as task or relation-
ship based (Barki and Hartwick 2004; Janssen, van de Vliert, and Veenstra
1999; Simons and Peterson 2000). Task-based confl icts involve workfl ow
effi ciency and quality of care, such as equipment needs or compliance with
policies. Task-based confl icts may be heated, but typically they lack an
emotional undertone. Relationship-based confl icts involve interpersonal
dynamics such as personality frictions or diff erences in norms and values;
examples are assigning blame to others or using disrespectful language.
ese confl icts are particularly challenging in health care due to complex
and rigid power hierarchies that may discourage providers from speaking
up (Dankoski, Bickel, and Gusic 2014; Rogers et al. 2011).
In practice, task- and relationship-based confl icts often become over-
lapping (Jehn 1995; Pinkley 1990; Pinkley and Northcraft 1994; Yang and
Mossholder 2004).  e cognitive interpretations and emotional responses
of individuals can lead to the escalation of a task-oriented confl ict into
a personality-driven confl ict. As a result, mutual goal setting and con-
structive problem solving become challenging (Edmondson and Smith
2006; Rogers et al. 2011).  erefore, eliciting an individual’s frame for the

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