1. Planning, Management and Leadership for Health IT
Welcome to Planning, Management and Leadership for Health IT, Conflict Resolution. This is lecture B, Managing Conflict.
Conflict Resolution
Lecture b Managing Conflict
This material Comp18_Unit8 was developed by The University of Alabama Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000023

2. Managing Conflict Learning Objectives
Study various styles for handling conflict
Review ways to promote positive conflict in a group
The objectives for this lecture, Managing Conflict, are to study Thomas and Kilmann’s five styles of conflict handling and to review ways for promoting positive conflict within a group.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

3. Conflict Management: Handling Conflict
Thomas and Kilmann
Five Conflict-Handling Modes
Two dimensions:
Assertiveness
Individual seeks to satisfy own concerns
Cooperativeness
Individual seeks to satisfy others’ concerns
Source: (Schaubhut, 2007)
Thomas and Kilmann provide us with five conflict-handling modes. Such modes can assist in responding or coping with conflict situations and can also be viewed as traits that individuals habitually use to confront and deal with conflict situations.
The five conflict handing modes occur within two major dimensions:
The first dimension, assertiveness, is when an individual seeks to satisfy his or her own concerns.
The second, cooperativeness, is when an individual seeks to satisfy others’ concerns.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

4. Conflict Management: Handling Conflict
Thomas and Kilmann’s Five Conflict-Handling Classifications:
Competition (assertive – uncooperative)
Avoidance (unassertive – uncooperative)
Compromise (middle ground)
Accommodation (unassertive – cooperative)
Collaboration (assertive – cooperative)
Thomas and Kilmann’s five conflict handing classifications are as follows:
Competition, or a competing style for handling conflicts, is assertive and uncooperative. Avoidance is unassertive and uncooperative. Compromise represents the middle ground. Accommodation is unassertive and cooperative. And finally, Collaboration is both assertive and cooperative.
On the next few slides, we will take a look at what each of these conflict handling classifications means.
Again, assertive indicates that an individual is seeking to attain his or her own concerns. Cooperativeness indicates that an individual is looking to satisfy the concerns of others.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

5. Thomas and Kilmann Conflict Handling Styles
The figure on this slide, representing Thomas and Kilmann’s conflict handing styles, illustrates the five conflict handing classifications with respect to the dimensions of Assertiveness on the vertical axis and Cooperativeness on the horizontal axis.
Take a look at the figure. In the upper left corner we see Competing. This style combines assertive and uncooperative behaviors. It signifies a “win-lose” response to conflict. An individual employing this style of conflict handling seeks to achieve his or her objective at all costs. According to Rahim, such a style disregards any needs, concerns, or desires of the other party. The competing style is suitable for conflicts that are insignificant or for urgent situations that require fast and decisive action. It is also useful for executing upper management’s policies and strategies.
In a clinical setting, physicians are quite used to being the leaders and there may be differences between their views and those of the IT staff or between different clinicians. Therefore, this type of conflict handling can and will happen with certain individuals. To level the playing field for these situations it is very important when implementing clinical systems to appoint a physician champion and to involve him or her in decision making processes.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

6. Thomas and Kilmann Conflict Handling Styles
Moving to the upper right side of the graph, we find the collaborating style. This style embodies assertive and cooperative behaviors. It signifies a “win-win” approach to a conflict. Participants seek to address the concerns of all parties, behave cooperatively, and seek to achieve a favorable result for all involved. The focus of this style is not on accommodating the needs and expectations of all parties, but on illuminating differences to help solve problems and achieve the goals of all involved. Healthcare delivery requires the input of many departments and areas to be effective. HIT at its best seeks the solution that optimizes the delivery process as a whole, while also addressing departmental concerns. You can be assured that collaboration, while not always easy, is a vital part if HIT implementation. It takes longer to accomplish, requires the payment of more blood, sweat and tears, but it is at the core of what is required for effective use of HIT.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

7. Thomas and Kilmann Conflict Handling Styles
In the bottom left corner of the graph we find the avoiding style. This style combines both unassertive and uncooperative modes. The party or individual may be aware of a conflict, but chooses to overlook it and to avoid others who may be a party to it. This is also called passive aggressive behavior. There will be times that people seek to avoid change by ignoring your request for their assistance. You must be prepared to go up the ladder to department heads and executives when needed to get the input of a person practicing avoidance.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

8. Thomas and Kilmann Conflict Handling Styles
Right in the middle is the compromising style. This style is a “middle-ground” conflict resolution behavior. The compromising approach results in neither a “win-win” nor a “lose-lose” situation. Both sides in this approach give something up to accept a less-than-completely-satisfying result. Compromise will often be practiced in HIT. Many times vendor solutions will accomplish most of the needed functions but not all. It is important to remember that many of the systems we implement are “works in progress” and are never fully complete but are always being updated and refined. Compromise, therefore, is needed to move forward progressively and realize the benefits that a good but not totally perfect, solution can provide.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

9. Thomas and Kilmann Conflict Handling Styles
And finally, you can find the accommodating style in the bottom right corner. This style represents a combination of unassertive and cooperative behaviors. This approach is apparent when a party to a conflict places a rival party’s interests above its own. This conciliatory style may be employed by a weaker party or by a party intent on maintaining a positive, long-term relationship with another. In part, because the relationship with clinical clients is so important for effective health IT implementation, accommodation will be something that is required of the HIT professional. It is not uncommon to get pages late at night during implementations, requests to work on holidays, and requirements to work much longer than the standard 40 hours a week. By demonstrating that you are accommodating to clinical staff they will be much more willing to assist with the changes you need from them.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

10. Individual Intentions or Preferences in Conflict Situations
Individual conflict-handling preferences relate to Thomas & Kilmann’s classifications
Collaboration—”win-win”
Competition—inconsequential or quick decisions
Accommodation—enhance long-term relationships
Response to a conflict can change over time
Source: (Schaubhut, 2007)
Thomas and Kilmann’s conflict handling styles provide a menu from which appropriate behaviors can be chosen based on a given circumstance. For example, the collaborative, that is assertive and cooperative, approach to dealing with conflict is generally advocated as it results in a “win-win” that allows both sides to reach a most favorable outcome. However, the competitive approach, assertive-uncooperative, can be appropriate for conflict situations that are inconsequential or in need of quick, decisive action. Alternatively, an accommodating style that is unassertive and cooperative can be appropriate when a party seeks to continue and enhance a positive, long-term relationship with another. How an individual responds to a particular conflict can change and evolve over time.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

11. Individual Intentions or Preferences in Conflict Situations
Innate preferences for handling conflict
Enduring response traits or dispositions for dealing with conflict
Correspond to Thomas and Kilmann’s conflict handling styles
Source: (Sternberg & Soriano, 1984)
Interestingly, research reveals that individuals have certain innate preferences for handling conflict and that these correspond to Thomas and Kilmann’s conflict handling styles.
Sternberg and Soriano suggest that it may be more fitting to think of the five conflict handling styles as relatively enduring conflict response traits or preferences as opposed to alternative choice behaviors people can choose to best match a particular conflict. In other words, when faced with a conflict, some people will prefer to win, others will be obliging, others will want to ignore the conflict, others will choose to lose a little if they win some, and yet others will seek to come up with the most favorable result for all.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

12. Conflict Intensity Continuum
Overt efforts to destroy the other party
Aggressive physical attacks
Threats and ultimatums
Assertive verbal attacks
Overt questioning and challenging of others
Minor disagreements and misunderstandings
No conflict
Source: (Robbins & Judge, 2007, p. 512)
It is important to remember that not all conflicts are the same in terms of their intensity. Robbins and Judge present a Conflict Intensity Continuum that ranges from no conflict at one extreme to overt efforts to destroy an adversary at the other. You will empathize with this latter approach at times in your HIT career, but please try to avoid indulging in this approach to resolving conflicts!
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

13. Conflict Intensity Continuum
Overt efforts to destroy the other party
Aggressive physical attacks
Threats and ultimatums
Assertive verbal attacks
Source: (Robbins & Judge, 2007, p. 512)
Be prepared to receive threats and ultimatums. An example would be a very impatient chair of the emergency department wanting a software vendor to customize some functionality in an emergency department system. When told that the vendor will require time and the solutions must be tested, the physician asked the vendor, “Do you like your job?” The chair had to be told that the vendor liked his job and wanted the solution as much as he did, but that things take time in order to be done correctly.
Unfortunately, assertive verbal attacks will frequently occur in conflict situations. You should be like a duck: let the water – or attack – roll off your back. In your mind, sing the nursery rhyme, “Sticks and stones may break my bones...” Retaliation is not effective in dealing with these, you must stay entrenched in the rational and reasonable high ground and not indulge in retaliatory attacks.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

14. Conflict Intensity Continuum
Overt efforts to destroy the other party
Aggressive physical attacks
Threats and ultimatums
Assertive verbal attacks
Overt questioning and challenging of others
Minor disagreements and misunderstandings
No conflict
Source: (Robbins & Judge, 2007, p. 512)
Sometimes conflict occurs in the form of overt questioning. When (not if) this happens to you it is important to answer what is known factually and not speculate. If you do not know the answer, write down the question and tell the person asking that you will do some research and follow up with them on it later.
Minor disagreements and misunderstandings will comprise about 30-40% of your working hours in HIT. Whereas conflicts at the upper end of the continuum tend to be uniformly negative or dysfunctional, conflicts occupying the lower levels of the continuum are generally positive or functional.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

15. Results of Conflict Positive or functional conflict can result in:
Better decisions
Improved creativity and innovation
An environment in which group members feel engaged
Self-evaluation and positive change
Functional conflict can lead to:
Improved decisions
Allowing all points of view, including minority views, to be included in key decisions
Positive or functional conflict is productive in that it can lead to better decision making, improved creativity and innovation, and an environment where group members feel engaged and willing to critically evaluate themselves. In HIT, conflict is inevitable. Implementations of new systems always involve a level of change, and working through conflict can be the refining needed to make ideas on processes and systems more effective. Positive conflict encourages all viewpoints, including those of the minority, to be considered and incorporated into key decisions.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

16. Results of Conflict “Groupthink” Role of positive conflict
Team shuts down conflicting ideas
Team begins to think alike
Role of positive conflict
Can reduce “groupthink”
Challenges status quo
Furthers creation of new ideas
Promotes reassessment
Increases probability of response to change
Sources: (Janus , 1972)
(Robbins & Judge, 2007, p )
Groupthink occurs when a group conforms to a point of view or idea without considering viable alternatives. As the researcher Janus argues, groupthink is a ‘phenomenon that occurs when a team shuts down conflicting ideas or alternative points of view. In other words, the team begins to think alike and discounts perspectives that are at odds with that thinking.”
Positive conflict can reduce groupthink. According to Robbins and Judge, positive conflict “… is an antidote for groupthink. It doesn’t allow the group to passively ‘rubber-stamp’ decisions that may be based on weak assumptions, inadequate consideration of relevant alternatives or other debilities. Conflict challenges that status quo and therefore furthers the creation of new ideas, promotes reassessment of group goals and activities, and increases the probability that the group will respond to change.”
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

17. Results of Conflict Negative or dysfunctional conflict:
“Among the more undesirable consequences are a retarding of communication, reductions in group cohesiveness, and subordination of group goals to the primacy of infighting among members. At the extreme, conflict can bring group functioning to a halt and potentially threaten the group’s survival”
Source: (Robbins & Judge, 2007, p )
Read the quote on the slide from Robbins and Judge. As you can see, although positive conflict can lead to improved group decision making and functioning, negative conflict can lead to impaired group decision making.
Negative conflict can also inhibit communication and discussion, reduce cohesiveness, and result in negative and dysfunctional infighting and arguing among members. If intense enough, it can destroy a group.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

18. Promoting Positive Conflict
Add new or relevant information
Reward dissent
Create more diverse and heterogeneous groups
Restructure existing groups to upset the status quo
Include a devil’s advocate
In order to stimulate positive conflict, it is necessary to have some level of dissent that forces people to critically examine their assumptions and beliefs, and to fully consider appropriate options. Techniques for encouraging this include rewarding dissent, creating groups with greater diversity and heterogeneity, and including a “devil’s advocate.” A devil’s advocate takes a position at odds with the one proposed and agreed upon by a group. In doing so, the devil’s advocate attempts to bring others in to an argumentative discourse in order to test the strengths of the original positions, possibly identifying weaknesses in its assumptions, and moving the group to a better and more fully reasoned position.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

19. Conflict Resolution Summary
Definitions of conflict
Transitions in conflict thought over time
Conflict as a positive or negative force
Styles for handling conflict
Promoting positive conflict in a group
This concludes Conflict Resolution.
In summary, we defined conflict and traced how ideas of conflict have changed since the early part of the 20th century. We studied how conflict can be a positive force as well as a negative one. We looked in detail at the various styles that people use for handling conflict. And finally, we examined ways to promote positive conflict in the health information technology arena.
Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b

20. Conflict Resolution Lecture b – References
Janus IL. Victims of groupthink: a psychological study of foreign-policy decisions and fiascoes. Oxford, England: Houghton Mifflin; 1972.
Rahim MA. Managing conflict in organizations, 4th ed. New Brunswick (NJ):Transaction Publishers, 2011.
Robbins SP, Judge TA. Organizational behavior. 12th ed. Upper Saddle River (NJ): Pearson Prentice Hall; 2007.
Schaubhut NA. Technical brief for the Thomas-Kilmann conflict mode instrument: description of the updated normative sample and implications for use. CPP; Available from:
Sternberg RJ, Soriano LJ. Styles of conflict resolution. J Personality and Social Psychology.1984;47(a):
Images
Slide 13: Microsoft clip art; Used with permission from Microsoft.
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Health IT Workforce Curriculum Version 3.0/Spring 2012
Planning, Management and Leadership for Health IT Conflict Resolution Lecture b