Growing with Conflict

It should go without saying that as the health system changes over the next decade, it will produce considerable conflict. At the macro level, the broad sweep of the change means doing more with less. Such a change is always a prescription for tension. And if this process involves changing the ways we organize and deliver health care to get a better, less expensive process, rather than just cutting budgets, then it will involve adapting and adjusting to a new paradigm for health care. Any time you stomp around on someone’s long held revealed truth, conflict is always a byproduct. So if your leadership is hitting the mark of significance, you will know because you will notice the steam around you.

Managing the conflict is the best any leader might hope for. Here are few considerations that every leader needs to be mindful of as steps to managing conflict in the best manner.

First, when conflict arises, it will appear that the other person or institution is being unreasonable and the fault all lies on one side: theirs. This is the best way to make the situation worsen. All conflicts involve a two-way set of responsibilities. Forgetting this reality is a good way for escalation to get out of hand early on. Many conflicts usually revolve around the fact that mechanisms we normally use to keep the tension in a positive dynamic have gotten out of sync. The mechanism for peaceful coexistence in health care for the past fifty years has been a growing bundle of cash that washed around to make the system work smoothly and hid the need for more sophisticated ways of working through the tensions and conflicts of a large, complex system. As some of the resources for this mechanism will be under new pressure, the elements of the system--professions, groups, hospitals, payers, purchasers, and consumers--will need to create new ways to manage and mediate the inevitable conflicts. The first step will always be that everyone is responsible for the conflict.

Next, it will be essential that leaders understand and chart the common ground that impacts every stakeholder. Our current system has not called the stakeholders together with either market accountability or a public sensibility of commonwealth and responsibility. Rather, it has isolated them in market-insensitive silos that consistently fail to actually serve the broad public need instead of the parochial interest of the incumbents. This narrow perspective and market failure is the best explanation of how smart, well trained and intentioned individuals can act in a way that produces a culture that results in thousands of avoidable deaths and costs fully one-third more per person than any other nation. The situation is reminiscent of the title of Reinhold Niebuhr’s book, Moral Man and Immoral Society. Good women and men, working hard, trying to do their best in a system that simply is not set up to serve the efficient needs of a well functioning market or the public goods of well designed public policy. Leaders in every health care sector will struggle with the challenge of seeing and advocating for the common ground. It is not easy to escape the habit of the paradigm, particularly when it has worked so well for so long; at least for the incumbents. To espouse something new means, in part, to question the old; and that cuts against training, experience, material interests and, ultimately self-identity. But of course we will not move the system forward without just such espousals. Articulating these visions in the context of a common ground will be a skill every leader will call upon day in and day out for the foreseeable future. Without such an understanding the nation’s health care system will fall in on itself much as we are now witnessing daily in Washington as incommensurable differences are pushed together for resolution without coherence or context capable of getting to our common interests.

This all sounds so rational. Why don’t we always understand a conflict in its two-way nature and if something brings us into conflict, it is probably because it is important to us both; and we should affirm the common ground. One of the problems is that before we can get to the mindful discussion, recognize our mutual interests and resolve what we can to make some part work better, we are undone by the emotionality that is always just below the surface and ready to explode our best intentions. Some of the older notions of the “limbic” system or “reptilian” brain have lost favor with neuroscience’s understanding of brain functioning, but most of us cannot escape the reality that William James pointed out, that emotions were not always accessible to reason, but vigilant in the service of action. We cannot remove the functioning of our amygdala, but leaders can learn to experience the physical signals that an emotional reaction usually produces. These triggers let us know that we are about to let fight or flight rule the current encounter. If the consequences of a brawl or running away don’t seem to be the best way to improve on the situation, then it is time to struggle to let reason once again rule.

Much of our leadership work around conflict over the past twenty years has been based in a construct that balances a focus on task with a concern for feelings. Ralph Kilmann and Ken Thomas have adapted this managerial grid into their conflict inventory and the accompanying five conflict styles: avoiding, accommodating, competing, compromising, and collaborating. These styles though reductionist are characteristic of most of the conflicts that emerge in our world. It is asking a lot of a leader to be able to step away from the urge to let emotions flow, but if some perspective can be achieved, then the conflict styles model can work. In a moment of rational consideration, the leader can think about the long-term consequences of the conflict and what she desires as a possible outcome. At this point six considerations need to be checked through. They are simple and straight forward, but they are at the heart of doing a better job with conflict. They are worth a quick review here in the form of the questions the leaders might ask.

  • Power – Who has the power? Is it formal or informal? How will I use my power in this conflict? Will I give up or gain power in this possible conflict?
  • Quality – Is there a “technically correct” thing to do in this situation? Who is right in this conflict? Is it even possible to know right in this situation or is it all opinion?
  • Importance – How important is this to me? Why? How important is it to them? Do I really understand why it seems important to them?
  • Time – How much time do we have to resolve this conflict? Is the clock running? Will we know more if we take time? Is knowing more worth it? Is my sense of time demands real or just part of my style?
  • Relationship – Is this a long time relationship? How do I value it? Does this conflict have the potential of harming this relationship? Could the way we resolve this improve the relationship?
  • Buy-in – How much engagement do I need of the others to go forward? Will I lose interest if we don’t account for some of my concerns?

Bringing some balance to conflict using this framework is a challenge, but the alternative of starting with reason and letting emotion take us where it will only produces harder problems to solve. No one does these steps with mindfulness or grace every time, least of not me. But the framework can help bring some discipline to the process.

Conflicts are incredibly complex. The mark of most leaders comes from how they handle the moments of conflict. It is time that we develop the skills to be the best we can be in the challenging times ahead.