A Systems Approach to Resolving OR Conflict - operating room

AORN Journal, March, 1999 by Tess Pape

Conflict is an inevitable part of today's health care environment. Close teamwork, rapid decisions, and confined quarters all are factors that set the stage for conflict in the OR. In addition--because the OR does not operate in a vacuum--conflict can occur if good relationships are not maintained between the OR and other hospital departments.

Ignored conflict can lead to mistakes as individuals lose their ability to communicate effectively. When conflict between other departments and the OR continues, employees may withhold information, be slow to deliver patient care supplies, or not respond effectively when needed. If not addressed, conflict can escalate, prevent progress, and reduce productivity. Consequently, as coordination of efforts within the OR decrease, patient care is jeopardized, and both patients and personnel become dissatisfied.

Many of these conflicts, however, are manageable when issues are clearly defined and effectively articulated.(1) Resolutions to organizational conflict can be constructive or destructive, depending on the approach.(2) A team-oriented systems approach can be a constructive way to resolve conflict within health care institutions and improve outcomes--an important concern in today's health care market.

WHEN CONFLICT OCCURS

Due to the fast-paced, highly technical nature of OR work, stress and its resulting conflict are common. Conflict occurs when actual or perceived differences exist or when there is a lack of clarity between two or more parties regarding task accomplishment, ideas, interests, or values.(3) The way organizations resolve conflict often reflects their ability to balance concerns about relationships (eg, among OR team members and other departments) with concerns about outcomes (eg, patient safety).(4)

REACTIONS TO CONFLICT

The initial reaction to conflict often is influenced by emotion rather than intellect.(5) Identifying the exact cause, therefore, may solve the real problem but do little to resolve the perceived problem.(6) For example, M. Jones, RN, became angry when there were no large suction canisters ready for the next procedure. Without knowing all the facts, she blamed the authorized purchaser (AP). The actual cause of the problem was related to a recent increase in the canisters' cost, which led the hospital to investigate other vendors. In the meantime, M. Jones was unaware that provisions were in place to use a different suction device, and she felt frustrated with the AP because the canisters were unavailable. Had she been aware of the actual cause of the problem (ie, canister cost and the decision to change vendors), she would not have become angry about the perceived problem (ie, lack of effort by the AP).

Overt or covert reactions. Expressed behavior can be either overt or covert. Overt action initially may take the form of aggression, competition, or arguments. Covert action may be reflected in scapegoating or blaming, avoidance, or apathy.(7) These less extreme reactions may result in a person's retreat from the individual involved in the conflict, stress-related illnesses, absences from work, or--as in M. Jones' case--anger toward oneself or others.

Severe reactions. Many nurses have difficulty handling conflict and the emotions it creates.(8) In a more severe response to conflict, a nurse may withdraw, leave his or her job, change shifts or assigned areas, or eventually leave nursing. This reaction reflects either the nurse's lack of concern for the outcome or an avoidance of hostility and the stress it brings.(9)

TEACHING CONFLICT RESOLUTION

As interdependence and coordination of efforts among groups increase, so does the potential for conflict.(10) For example, coordination of many functions is necessary between the radiology department and the OR. Any problems with scheduling personnel or equipment have the potential to cause friction. Yet, limitations exist when circumstances prevent problems from being understood (Table 1). At these times, education about conflict resolution techniques, coupled with group autonomy, is vital.

Table 1

LIMITATIONS ON CONFLICT RESOLUTION

When there is a lack of understanding of the real nature of the problem.

When it is difficult to determine how to proceed.

When bureaucratic rules exist for dealing with the other side.

When there is a lack of knowledge regarding how to supervise resolution.

When there are no plans to educate personnel about conflict management.

NOTE

(1.) C A Maher, "A systems approach to managing conflict in orthopaedic nursing," Orthopaedic Nursing 10 (May/June 199]) 35-44.

IMPORTANCE OF COLLABORATION

Collaboration is the most effective method of conflict resolution, and it results in a mutual commitment to chosen solutions.(11) Collaboration involves health care personnel taking an open, insightful look at the issues and available resolutions.(12) It encourages a win-win situation because all parties work together to find mutually satisfying solutions. Such cooperative agreement brings participants closer and teaches employees that working together can help them achieve personal and departmental goals. Furthermore, through collaboration, employees reduce stress and improve interpersonal communications.