Conflict management: importance
and implications
Laurie McKibben
ABSTRACT
Conflict is a consistent and unavoidable issue within healthcare teams. Despite
training of nurse leaders and managers around areas of conflict resolution, the
problem of staff relations, stress, sickness and retention remain. Conflict arises
from issues with interpersonal relationships, change and poor leadership. New
members of staff entering an already established healthcare team should be
supported and integrated, to encourage mutual role respect between all team
members and establish positive working relationships, in order to maximise
patient care. This paper explores the concept of conflict, the importance of
addressing causes of conflict, effective management, and the relevance of
positive approaches to conflict resolution. Good leadership, nurturing positive
team dynamics and communication, encourages shared problem solving and
acceptance of change. Furthermore mutual respect fosters a more positive
working environment for those in healthcare teams. As conflict has direct
implications for patients, positive resolution is essential, to promote safe and
effective delivery of care, whilst encouraging therapeutic relationships between
colleagues and managers.
Key words: Conflict ■ Patient care team ■ Work performance ■ Leadership
■ Nursing ■ Morale
C onflict, or at least the propensity for it, is considered
inherent to the human condition, therefore, it is
destined to be inevitable, particularly in the
dynamic arena of healthcare with its hierarchical
organisation and complex care issues and
dilemmas. The aim of this article is to highlight that positive
conflict management, with favourable team leadership, can be
beneficial. Positive management fosters mutual role respect,
improves working relationships, recovers staff retention and
sickness, and especially benefits new members of staff who
may find it difficult coming into long-established teams
(Marquis and Huston, 2014; Stanton, 2014). Moreover, if
conflict is not managed effectively, it will have direct
implications for the level and quality of care that is delivered to
patients. Poor delivery of patient care threatens the integrity of
the nurse, the profession, and the health service as a whole.
The Nursing and Midwifery Council (2015) Code highlights a
nurses’ professional responsibility to work cooperatively and
Laurie McKibben, Registered Nurse, Belfast HSC Trust,
Queen’s University, Belfast, lturner12@qub.ac.uk
Accepted for publication: January 2017
100
use effective communication to resolve differences between
colleagues when they arise. The nurse is legally accountable
for providing safe competent care, and is ethically bound to
the non-maleficence principle to ‘do no harm’, therefore there
is a duty and obligation to adapt to challenging situations in a
professional manner, to prevent or resolve conflict, and
promote the health and wellbeing of patients.
In respect to those in management positions, the Health
and Safety at Work Order (1978) identifies that employers
are responsible for employee health, including mental
wellbeing; it is essential that nurse managers therefore also
adhere to their professional responsibilities, and implement
effective resolution techniques to minimise low morale,
stress and illness of team members.
Conflict defined
In order to discuss positive approaches to managing conflict, it
must first be defined and its potential genesis acknowledged.There
are several definitions; it has been described as an interpersonal
disagreement, or discord between two or more individuals, owing
to difference in opinion, competition, negative perceptions, poorly
defined role expectations or lack of communication (Ellis and
Abbott, 2011; Marquis and Huston, 2014).
Johansen (2012) provided a different perspective on conflict in
healthcare, citing such is borne from a disparity in an individual’s
perceptions, in relation to patient care. Prerequisites such as
autocracy, hostility, disrespect, inequities, hierarchy, low morale
and absence of shared goals have been suggested as precipitating
factors (Barr and Dowding, 2012). In presenting several
definitions a wider perspective is provided upon how we define the
larger, abstract concept of conflict in its complexity.The focus of
positive resolution therefore lies in addressing these root causes,
for example, mending relationships, improving communication,
accepting change, all of which may be facilitated via effective
leadership and team management.
Organisational conflict and dynamics
In relation to understanding organisational conflict, it can
be beneficial to apply a model or framework that may act
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as explanatory or predictive. The Pondy (1992) framework
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presupposed that conflict manifested from one of five
re
predisposing phases. The first latent phase is when there is
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unease and conflict is imminent, the second perceived phase is
where there is believed conflict but it is minimised, and the third
felt phase is concerned with personalised conflict, where there
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is discomfort experienced. The final two phases are
manifest, when conflict is expressed, and the aftermath, and
how this affects the individuals and the team. Pondy viewed
conflict as dynamic, and despite how or why conflict arises,
it can still be inspected and managed using this framework.
Thomas’s (1992) model agreed that conflict is dynamic
in that it is continuous, with the outcome of one episode of
conflict leading to another. The model involves awareness,
thoughts and emotions, intentions, behaviour and outcomes.
Thomas suggests conflict is a rolling issue that requires
ongoing management within organisations. Using the
knowledge from such frameworks and models as a
predictor, and also as a tool to manage, can be beneficial in
resolving such conflict, whether it is new or ongoing.
Organisational conflict is classically considered to have a
negative impact on team functioning, weakening stability,
disrupting the status quo and impeding productivity (Barr and
Dowding, 2012). This compounds the earlier discussed
definitions of conflict.To expand, types of specific team
conflict have been shown to include tasks, relationships, and
the processes that enable tasks to be carried out.These conflicts
directly impact on performance, however, the influence of each
varies (Jehn, 1997). Nevertheless, reduced performance will
have a direct impact on patient care and so these factors must
be considered to be precipitating for poor care.
Bradley et al (2013) agree the focus of conflict in teams is in
terms of task and relationships, however acknowledge other
predisposing conditions such as the characteristics of the conflict
or indeed the individuals. Barr and Dowding (2012) offer three
types of relationship-based conflict; intrapersonal, interpersonal
and inter-group. Intrapersonal conflict is internal discord and
conflict occurring within the individual, which can manifest from
role confusion for example. Interpersonal conflict arises between
two or more people with differing views or goals, which may lead
to harassment and stress, and intergroup conflict involves two or
more teams who, for example, do not share the same
organisational goals. Common interpersonal conflict is
relationship based with interpersonal frictions, tensions and
resentment occurring between two or more team members. It is
essential that this is identified and managed as it can have a
negative impact on team performance (Bradley et al, 2013).
Hierarchy may result in team members feeling dominated or
not having a voice, furthermore, process conflict arising from
incompatible views on how work should be done, for example
distribution of the workload and task ordering, can also affect
individual job performance and overall team functioning (Jehn,
1997). It is therefore important that the conflict is managed
carefully by the team manager, for example, through group
supervision or a forum for team communication, to allow for
shared discussion and problem solving.
Clinical team conflict can equal growth or destruction
depending on how it is managed, importantly it is how a team
© 2017 MA Healthcare Ltd
manages this that determines the end result (Marquis and Huston,
2014). Dysfunctional outcomes of conflict include stress, sickness,
reduced job satisfaction, poor communications, distrust, suspicion,
damaged inter-group relations, resistance and reduced function
(Marquis and Huston, 2014). Counterproductive
British Journal of Nursing, 2017, Vol 26, No 2
PROFESSIONAL ISSUES
situations such as those mentioned above compromise
patient care and safety, one’s professional registration, and
overall reputation of the healthcare organisation.
Resolution
Effective resolution and conflict management can be beneficial
if managed practically. However, this is dependent on
transparent communication, listening, and understanding the
perceived focus of disagreement (Ellis and Abbott, 2011;
Stanton, 2014). Pondy (1992) stated that recognising the signs
of conflict and sourcing the origins will determine the best
means for preventing it. Escalation can be prevented by
recognising early signs and acting on them (Stanton, 2014).
Ellis and Abbott (2011) recommended avoiding seven Cs as
ground rules before approaching conflict: commanding,
comparing, condemning, challenging, condescending,
contradicting and confusing. Commanding by way of telling
people how to behave will induce resistance and comparing the
person or situation to other people and situations should be
avoided as each case is individual. Conflict resolution seeks to
solve a problem, not the person, therefore condemning
individuals is not the solution. Challenging behaviour and
condescension may cause distress by reducing morale and
creating bad feeling, likewise, contradictory or confusing
actions may lead to uncertainty and frustration, all of which
create bad feeling and demonstrate lack of respect.
The Tuckman (1965) model has been used for decades in
health care in understanding conflict. This model suggests that
groups work though sequential stages of evolution before
performing in a cultivated and efficient manner. The forming
stage incorporates group efforts to come together, storming
exposes conflict and hostility, norming involves group settling,
and performing concludes in optimum performance.The fifth
stage, adjourning, occurs if the team demobilises and members
move on to other duties.The model provides insight into team
dynamics, however, an unhealthy level of conflict still exists in
many healthcare teams.
In order to minimise conflict or manage it effectively, it
is useful to understand the person, or people at the centre of
it. Thomas and Kilmann’s (1974) theory provides an
alternative method of conflict management, identifying five
varying styles of management in relation to scope of
assertiveness and cooperativeness.The theory argues that
individuals favour a particular style and acknowledge
certain styles were more useful.The Thomas-Kilmann
Conflict Mode Instrument (TKI) was developed to identify
conflict style. The five styles were: collaborating,
compromising, accommodating, competing and avoidance.
Collaborators meet everyone’s needs, compromising
individuals implement problem solving to find a solution
that satisfies the greatest number of people, while
accommodators meet the needs of other team members
while sacrificing their own. A competing style is operated
from a position of authority, and avoiders simply do not
solve the problem, which can make problems worse in the
long term (Ellis and Abbott, 2011).
In understanding what kind of style a person adopts in
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 relation to conflict we enhance our ability to manage it more
effectively. In understanding styles we must also understand
and respect roles within the clinical team; this encourages
collaborative practice. Collaboration in a multidisciplinary
team impacts on shared decision making and patient
involvement, it is therefore essential for increased patient
satisfaction and outcomes (Aston et al, 2010).
Leadership
There is leadership responsibility from nurse managers in
acknowledging and managing conflict positively. In order to
manage conflict, the source must first be identified, including the
type of conflict, and how and why it has arisen (Pondy, 1992; Barr
and Dowding, 2012). A good leader will encourage negotiations
and a level of compromise, and when particular team members are
central to the conflict, they should be encouraged to admit
accountability (Ellis and Abbott, 2011; Johansen, 2012). This is in
keeping with the collaborator or compromising conflict styles
posited by the TKI (Thomas and Kilmann, 1974).
Doody and Doody (2012) stated that a transformational
leader shows good leadership qualities and will inspire and
motivate other team members, thus enhancing morale and team
function. Burns (1978) introduced the concept of
transformational versus transactional leadership, defining
transformational leaders as the most effective, as transactional
leaders simply tell people what to do and cause increased
tensions. Transformational leaders, however, wish to resolve
disagreements in order to push forward. Individual views are
explored enabling commonalities to be built upon. It is clear
that decades later the qualities of a transformational leader
remain widely regarded and actively promoted in nursing.
Good leadership entails someone who displays qualities
such as honesty, resilience, good communication and
assertiveness. A good leader is approachable and can
effectively delegate, escalate concerns, they will be competent
and innovative, and seek to improve collaboration through
education and training (Barr and Dowding, 2012; Sullivan and
Garland, 2013). These are all qualities in keeping with a
transformational style that Burns (1978) spoke of, qualities that
also incorporate the avoidance of behaviours such as the seven
Cs suggested by Ellis and Abbot (2011). In essence effective
leadership will help prevent or resolve conflict positively,
through harmonious team function and raised morale.
In contrast if a manager is too open, or adopts a poor TKI
conflict style such as that of an avoider, it can lead to problems
when exerting discipline or authority; this results in reduced
respect for authority and diminishment of boundaries.This poor
leadership style can aggravate conflict, or in some occasions be
the root cause (Barr and Dowding, 2012). In cases where the
problem is top down and management cannot be approached,
then conflict resolution must be processed upward within the
organisation, or autonomous mediation may be required
(National Health Service Improving Quality (NHSIQ), 2013).
Change
Change and conflict are intertwined as one can precipitate
the other. For example, unplanned change with poor
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communication can be a cause of conflict due to resistance,
negative perceptions, uncertainties and lack of
understanding. Individuals are responsible more so than the
situation or objectives of the team, and this is dependent on
psychological self-confidence, therefore, people
management via effective leadership is implicit (Tavakoli,
2014). In this circumstance conflict may be intrapersonal,
interpersonal, or both (Barr and Dowding, 2012).
Change can induce stress if one cannot adapt, for example,
entering a new team is a change for the new member and existing
members; it is how this situation is managed by each individual
and the team manager that determines whether potential conflict
will arise or not. If conflict arises in this instance, if it is
acknowledged and managed through practical avenues such as
group supervisions, increased one to ones, plans of action or
communication forums, this will promote longer term resolution.
Where possible change should be planned, as it then
satisfies the criteria for a cohesive well-functioning team,
which minimises the risk of negative conflict.This
acknowledges that episodes of conflict in these circumstances
are not necessarily negative, and that management of conflict
using a framework such as that proposed by Pondy (1992) can
be constructive for the team overall. As a result group unity
and dynamics will increase, which creates a feeling of identity.
Moreover, this positive working environment will augment
staff morale, thus reducing long-term issues such as high staff
turnover and sickness levels (Ellis and Abbott, 2011).
Conflict as beneficial
Weber (1947) and Fayol’s (1949) old theories argued a
bureaucratic system of mechanistic structure to discourage and
eliminate conflict altogether, and to maintain harmony within
the organisational team. However, these theories are outdated
and to date have not been successful in their application to
teamwork or team dynamics in clinical practice.These theories
are based upon and suited to an organisational framework in
which there is minimal change, and an environment whereby
management are not questioned by subordinates. Whereas
sources such as Jehn (1997), Aston et al (2010) and Doody
and Doody (2012) have argued the issues with hierarchy within
organisations remain a source of conflict, and actively promote
collaboration, communication, teamwork and transformational
leadership within management. Clinical practice is dynamic
and must employ the application of more suitable approaches
to conflict (Marquis and Huston, 2014; Stanton, 2014).
Conflict, when used positively, can stimulate and encourage
change if team function has become stagnant, increase
productivity, and inspire critical thinking. Pondy (1992) stated
that conflict involving varying perspectives and ideas carries
the potential to be positive, this includes improved team
performance and innovation (Jehn, 1997). Negotiation and
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problem solving, with manager mediation, can be successful
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in preventing escalation (McConnon and McConnon, 2010).
Thomas (1992) supports this with his model that proposed
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that conflict status needs reassessed regularly, with ongoing
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management taking into account factors such as emotions,
behaviours and outcomes.
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Conflict highlights diversity and divergent, but equally
important, viewpoints, it promotes mutual respect for one
another, encourages dialogue and negotiations, and
improves understanding of roles. This is pertinent where
there is generational divide within a team for example,
hence there is a necessity for compromise (McConnon and
McConnon, 2010; Moore et al, 2016).
The NHSIQ (2013) concur that conflicts are more about people
than the problems, hence team members’ views and goals should
be valued to support team-based delivery of care. In order to
manage successfully certain factors must be taken into account,
such as type of conflict, management style, conflict style and
overall approach (Thomas and Kilmann, 1974; Pondy, 1992; Ellis
and Abbott, 2011; Barr and Dowding, 2012).
An agreed solution equals resolution, where all parties see
themselves as winners; a positive consequence.When approached
positively conflict can promote an opportunity for growth in the
clinical team, this can be constructive if there is a balance, as too
much negatively affects performance and compromises patient
care (Barr and Dowding, 2012; Sullivan and Garland, 2013).
Shared problem solving cultivates a climate of mutual respect and
motivation to find mutually satisfactory agreements, this is
beneficial for trust, satisfaction and fairness, facilitating better
outcomes for the team and for patients (Posthuma, 2011).
Conclusion
There are legal, professional and ethical responsibilities to
deliver the best standard of patient-centred care, hence conflict
must be managed and utilised positively as failure to do so puts
patient safety, care and satisfaction in jeopardy (Johansen,
2012; Nursing and Midwifery Council, 2015). Clinical
governance within organisations is in place to ensure risk is
managed, therefore risk such as conflict must be regulated, or
managed, to minimise near misses or serious adverse events
involving patient care (Marquis and Huston, 2014).
Professional development for nurses and nurse managers, via
reflective practice, can enhance or develop conflict management
styles (Johansen, 2012). Considerate management fosters an
environment that minimises precursory conditions for future
conflicts and organisational stasis (Marquis and Huston, 2014).
Even the best functioning teams will encounter conflict. If it is
managed well it can be a positive transforming force for change
and a conduit for innovation, growth and productivity (McConnon
and McConnon, 2010). Conflict management and positive
resolution encourages mutual role respect among nurses and the
wider healthcare team, advocates the wellbeing of team members,
facilitates optimum team function and ultimately promotes the
delivery of high-quality care to patients. BJN
Declaration of interest: none
Aston L, Wakefield J, McGowan R (2010) The Student Nurse Guide to
© 2017 MA Healthcare Ltd
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Conflict Improve Team Performance? A Review of Evidence and
Framework for Future Research. Acad Manage Proc January 2013.
doi: https://dx.doi. org/10.5465/AMBPP.2013.17093abstract
British Journal of Nursing, 2017, Vol 26, No 2
PROFESSIONAL ISSUES
KEY POINTS
■■ Conflict is inevitable within healthcare teams
■■ Poorly managed conflict impacts negatively upon staff and,
importantly, patient care
■■ Allteam members are responsible for promoting resolution
and implementing shared problem solving
■■ Nurse managers with reputable leadership qualities will foster
beneficial conflict resolution and promote team function and harmony
■■ In the dynamic area of health care, change should be expected, and
any manifest conflict used as a driving force for positive change
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