Organizational Conflict Causes and Resolution Style among First Line Manager and Hospital Administration

Introduction

Conflict is a common issue in our everyday lives. Caused by disagreement in goals, motivations, or actions between two parties that can be real or only perceived to exist, conflict is seen as a perceived incongruity of interests. Whether it results due to a difference of opinions, harsh words or direct action to solve competing goals, conflict has the potential to occur in many domains of our lives. Conflict is considered to be the normal and inevitable consequence of social and organizational life (1,2).

Furthermore, conflict is a fact of human lives and if they are able to understand it and its impact on work effectiveness, they can make conflict useful and use them to achieve better results. Every organization encounters conflicts on a daily basis. The conflict cannot be avoided, but it is possible to manage them in a way that people recognize conflict symptoms in time. Thus, it is necessary to continuously track the organizational signals which point to their existence. As well as, everyone has to deal with conflict both in the workplace and personal lives (3).

Conflict is a situation where there is a disagreement between parties. It connotes a stressful, unhappy, distressing, depressing, annoying and frustrating state of affairs. Also, conflict occur because individuals have different perceptions, beliefs and goals; as well conflict is inevitable when managers are making important decisions as they would face opposing pressures from different sources (4,5).

Also, conflict between people are caused for several reasons, some of which include incompatible goals, different values and beliefs, ambiguity and role conflict, problems of communications resulting from confusion or refusal to cooperate, ambiguous rules, authority conflict, inconsistent evaluation and reward system, job stress, task conflict, and deficiency of information system, etc.; which in turn can affect the managers and staff’s satisfaction (6, 7).

Managing conflict in the workplace is a time-consuming but it is necessary task for the nurse and physician leader. Conflict may range from disagreements to major controversies that may lead to litigation or violence. Conflict has an adverse effect on productivity, morale, and patient care. Also, it may result in high employee turnover and certainly limit staff contributions and impede efficiency (7, 8).

The workplace conflicts in the healthcare environment tend to be far more complicated because in hospital one would interact with different human resources with diversity, including physicians, nurses, managers and personnel’s from same or other departments. However, some time nurses are working under difficult and stressful situation which can lead to negative interpersonal relationship with other co-workers, and they are so busy in their work to reflect upon and to resolve it (8, 9).

As a result, patient care will be compromised and organization would lose its productivity. Health care professionals, who understand each other’s roles and can work effectively together, have been shown to provide higher quality care. Hence, to achieve desire out comes in patient care, it is essential to have good interpersonal relationship in terms of cooperation, collaboration, listen, and respect the values or positions of each other. It is usually observed in our context that physicians showing dominancy and lack of acceptance of role of nurses are the root causes of interpersonal conflict in health care settings (10, 11).

Conflict management is a complex process, which demands time and energy. Thus, managing conflict and ultimately resolved it, is critical to the effective functioning of the organization and its ability to creatively move forward. The management and the subordinates must be concerned and devoted to resolving conflict among coworkers by being willing to listen and to find accurate solutions (12, 13).

Interpersonal conflicts can be handled with various styles of behavior; there are five styles of resolve conflict avoiding, accommodating, compromising, competing, and collaboration. The person who has avoiding style neglects the conflict or denies the availability of conflict. One seeks for neither own concerns nor others’. In this mode, one prefers to evade an issue or put it off until later (Unassertive and uncooperative) (14, 15).

Accommodating style had to overlook own concerns to satisfy those concerns of others. It is a form of selfless generosity that followed by yielding to others’ wishes when one would prefer not to do (Unassertive and cooperative). Compromising style seek for a mutually acceptable solution that satisfy both parties partially via addressing some concerns of both parties and neglecting others by exchanging concessions and finding a middle-ground position (Moderately assertive and moderately cooperative) (14, 15).

Competing style seeks for own concerns at the expense of others’ concerns by using all appropriate power to win the position and defend something that is believed to be correct (Assertive and uncooperative).  The collaborative style pursuit of all concerns of both parties through a solution that satisfy both parties completely as a result of parties collaboration to address all underlying concerns and attempts to find alternatives to satisfy all of them (Assertive and cooperative) (15, 16).

Significance of the Study

Nursing is a profession based on collaborative relationships between nurses and others. When two or more people view issues from different perspectives, these relationships resulting in conflict. Conflict that was managed effectively by first line nurse managers can lead to personal and organizational growth. If conflict is not managed effectively, it can hinder a nurse's ability to provide high quality nursing care and escalate to violence. Therefore conflict has an adverse effect on productivity, morale, and patient care; it may result in high employee turnover and certainly limit staff contributions in participation in decisions and impede efficiency.

Moreover, during working  in Minia University hospitals it has been observed that multiple problems related to conflicts occur between in the top level (directors of nursing services) with middle level (supervisors) and first level ( head nurses) and in the other side hospital administrative. Therefore, it is important to assess the causes of conflict among organizational staff and resolution style among first line manager and hospital administration.

Aim of the study

  The aim of the current study is to identify organizational conflict causes and resolution style among first line manager and hospital administration.

Research questions:

• What are the causes of organizational conflict among first line managers and hospital administrative?

• What are the organizational conflict resolution style among first line manager and hospital administrative?

Subjects& Methods

Research design

A descriptive correlation research design was used to achieve the aim of the present study and answer the research question.

Subjects:

The subject of this study was included convenient sample of the available first line manager (140 included nurses and physicians) and administrative authority (16 included nurses and physicians) at time of data collection.     

Study settings:

The study was carried out at Minia University Hospitals, at Minia City, Egypt. The study was conducted over two months during year 2017.

Tools of data collection:

Data was collect through the utilization of two tools as follows:

Tool No I: it included two parts

Part I: Personal Data sheet; it included age, sex, marital status, level of education, current department, current position, years of experience, and years of experience of current position.

Part II: Organizational Conflict Causes Questionnaire

This tool developed by Hasani et al. (2014) (17) and was adopted by researcher to measure first line managers and hospital administrative response opinions about conflict causes. It consist of 13 items with three point Likert scale ranged as (agree = 3, neutral = 2, and disagree =1). The higher score, the higher agreement about causes of conflict

Tool No II: Organizational Conflict Resolution Styles Scale

Developed by Grace (2012) (18) and was adopted by researcher to measure first line managers and hospital administrative responses opinions about Conflict resolution styles. It consist of 25 items with three point Likert scale ranged as (agree = 3, neutral = 2, and disagree =1). This tool was divided by the researcher into five styles as follow: collaborating style included (5) items; competing style included (6) items; avoiding style included (5) items; accommodating style included (4) items; and compromising style included (5) items. The higher score of style score, the higher dominant style of participants. 

Validity of the tools:

A jury of 5 experts in the field of nursing administration field has been submitted with tools to determine its applicability and content validity. Necessary modification was done.

Reliability of the tool:

Reliability of the tools was performed to confirm consistency of tools. The internal consistency measured to identify the extent to which the items of the tools measured what is intended to measure. Also, the tools were tested for internal reliability by using Cronbach' alpha test (α=0.89 for tool I, and α =0.88 for tool II).

Study procedure:

• A written approval to carry out the study was obtained from faculty of nursing dean and ethical committee
• A written approval to carry out the study was obtained from the hospital directors and from nursing directors after explaining the aim of the study.
• After getting approval the investigator explained purpose, nature, and significance of the study for the director of nursing services, supervisors, head nurses, resident physicians and hospital administrative.
• Work schedule of supervisors, head nurses, resident physicians was obtained, to estimate time for data collection, the time consumed to fill the questionnaire was between 20 to 30 minutes.
• According to the plan of time schedule, the questionnaires were collected from them during their break time.
• Data collection was done during morning and afternoon shifts and lasted for two months during year 2017.

Ethical Consideration:

A written initial approval was obtained from the Research Ethical Committee of the Faculty of Nursing, Minia University, and then a written approval was obtained from the directors of Minia university hospitals. Consent was obtained from the subjects. Confidentiality was assured to them. Each participant was interviewed individually by the investigator to fulfill the necessary data. Subjects have the right to withdraw from the study without any rational. 

Statistical analysis of data

The collected data of the study tools were categorized, tabulated, analyzed; and data entry were done using SPSS software version 20 (Statistical Package for Social Science). Data were presented using descriptive statistics in the form of frequencies and percentages, mean, standard deviation and chi-square. Tests of significance were performed to test the study hypotheses (i.e. t- test, and ANOVA test).  Pearson correlation analysis was used for assessment of the interrelation among quantitative variables. Statistical significance was considered at p- value ≤ 0.05.

Results:

Table (1): Distribution of the study participant personal data (n=156)

It was noted from table (1) that the about two third (62.5%) of administrative subjects were in age group (36-46), while majority (88.6%) of first line manager were in age group (25-35). Regarding sex, more than two third (68.8%) of administrative subjects were female, and more than half (53.6%) of first line were female. Regarding qualification there were about one third (31.3%) of administrative subjects had doctoral degree, while no one (0%) of first line had doctoral degree. Speaking about marital status the majority (93.8%) of administrators, and the half (50.7%) of first line married.  About years of experiences, half of administrators had (11-21) years and half had (22-32), while about three quarter (72.9%) of first line had (1-10) years of experiences.

Table (2): The frequency distribution by percentage regarding to opinion of the hospital administrative regarding to causes of organizational conflict (N=16)

Table (2) shows that all (100%) of administrative manager agreed that (Lack of cooperation among the staff, Lack of information and dialogue among professionals, and Gossip at the workplace) were the most causes of organizational conflicts. Moreover, the majority of them agree that (Diverging opinions and actions to perform work, Incompatible goals, and Job stresses) causes of organizational conflicts. Also, there were three quarter of them (75%) agreed about causes of conflict.

Table (3): The frequency distribution by percentage regarding to opinion of the first line managers in relation to causes of organizational conflict (N=140)

Table (3) shows from the first line managers perceptions that (Job stresses, Lack of human and material resources, Deficiency in information system, Ambiguous  rules, and Gossip at the workplace) were the most causes of organizational conflict (72.1, 65, 59.3, 58.6, and 55 respectively) . Also, there were about three quarter of them (74.3%) agreed about causes of conflict.

Table (4) the comparison between Hospital Administrative and First Line regarding to Causes of Organizational Conflict (N156)

In table (4) it was noted that mean score regarding causes of conflict among hospital administrative was (33.37+3.59) and among first line manager was (31.10+5.19) with no statistical significance difference between two groups.

Table (5) Distribution by percentage regarding to opinion of the hospital administrative in relation to resolution styles of organizational conflict (N=16)

In table (5) it was noted that all of hospital administrative preferred the collaborative style with mean (13.81=0.83) and there was one quarter (25%) of them had dominant level and (62.5%) had backup level for the accommodating style, and majority of them (81.3%) had the competing style with backup level, while all of them (100%) less use/preferred the avoiding or compromising style.

Table(6) Distribution by percentage regarding to opinion of the first line managers in relation to resolution styles of organizational conflict (N=140)

In table (6) it was noted that there was more than two third (68.6%) of first line manager had the dominant level of the compromising style, and (60%) of them had the avoiding style with dominant level; while majority of them (87.1%) less use the collaboration style.

Table (7) the comparison between Hospital Administrative and First Line regarding to resolution style of Organizational Conflict (N=156)

* p≤0.05 (significant) T-test: P – value based on independent sample t-test,

NS= No Significant difference * Statistical significant difference

In table (7) it was noted that there were highly statistical significance differences for all conflict resolution style between hospital administrative and among first line manager (p=0.000) except the competing style (p=0.488).