Conflict Narratives from the Health Care Frontline: A Conceptual Model

• Published date: 01 March 2016
• Date: 01 March 2016
• DOI: http://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