Special Feature
Conflict in System of Care: Is it an Issue?
Why Talk About Conflict?
The University of South Florida, under contract with ORC-MACRO, recently completely a review of conflict in local system of care sites. In this study, conflict was defined as “tension between team members due to real or perceived differences”1. The results suggest that conflict is a common occurrence across sites. Why, when the focus of systems of care is on collaboration, would conflict be so prevalent?
The existence of tension between team members should not be too surprising, since developing systems of care inevitably involves organizations and individuals with differing agendas, missions, funding sources and expectations. Effective system integration requires an alignment of potentially competing values, cultures and practices. Even greater potential for conflict surrounds the push for system partners to share power and decision-making.
Along with the potential for conflict between agencies, individuals and cultures respond differently to conflict. When conflict emerges, some individuals tend to seek immediate compromise or try to accommodate to the needs of others, while others are uncomfortable with conflict and will avoid disagreements if at all possible. Others focus on the possibility of finding a win-win solution, and are willing to stay with the conflict as long as needed to make everyone happy. Still others find conflict and competition to be stimulating, and enjoy a discussion where people express different opinions and propose competing solutions. No conflict style is inherently better than others, and each has a role to play in effective group functioning. However, according to Thomas and Kilman (1974) certain individual styles such as competing and avoiding can appear uncooperative and tend to weaken group relationships, while collaborating and accommodating styles help build relationships2. Being aware of individual conflict styles can be very helpful in getting a new collaboration off the ground.
Different intercultural conflict styles also may create confusion and tension among partners. While most individuals of northern European decent are comfortable with a direct discussion style, they are usually emotionally restrained. Eastern cultures such as the Chinese, while also restrained emotionally, tend to express disagreement indirectly. In fact, it is often considered rude in Eastern cultures to express one’s own needs or beliefs directly. In contrast, Eastern European and Middle Eastern cultures tend to be emotionally expressive. People from these cultures may be seen by members of more emotionally restrained cultures as aggressive or even hostile when they are simply expressing disagreement in their own cultural style.
While conflict is a normal and inevitable outcome of trying to make dramatic changes in the way people think and act; it can be uncomfortable, painful, and even scary. As a result, people may choose not to address conflict directly—especially if they see it as at odds with their mandate to develop collaboration. However, conflict that is not identified and addressed often affects the entire group—if not immediately, then at some later point in time.
Conflicts that are not addressed may be temporarily forgotten, but they rarely disappear. Unresolved conflicts may be carried forward by individuals as suppressed emotional feelings and/or become embedded in the collective historical memory of the group. By the time the suppressed feelings emerge again, their original source may not be recognizable. For example, some system of care sites may have a hard time getting started not due to any conflict between the individuals involved, but because of previous failed collaborative attempts.
In addition, conflict is often traumatizing. In talking about conflict, many system partners identify their experience as traumatic and emotionally scarring, especially when their experience is not validated. Unrecognized historical conflicts in systems of care may also stem from specific traumatic events. For example, a child death may affect the entire community and create blame between agencies. Years later, some relatively minor conflict between agencies may unwittingly reenact this trauma, often with a level of emotion that is disproportionate to the current conflict.
Conflict can also be a motivating energy that stimulates change. Conflict can highlight different strengths and perspectives by the different stakeholders. Through surfacing differing opinions, existing problems can be identified. Conflict can motivate people to make change, identify historical differences, and lead to healing. If conflict is to be a positive stimulus for change, however, it needs to be consciously identified, analyzed and worked with, not ignored.
What Did The Study Show?
To assess the experience of SOC sites with conflict, a needs assessment instrument was mailed to 86 currently funded sites. Project Directors were asked to distribute to their board members. The instrument examined demographic characteristics, respondents’ experience with conflict, the effects of conflict on the governing board and on the functioning of the system of care, and strategies used to address conflict. Responses were received from 218 board members at 44 sites. Family members (20%) and mental health specialists (15%) were the most common respondents, although there was also good representation from juvenile justice (8%), child welfare (7%), and other child serving agencies (10%).
Results indicated that conflict was a common occurrence at all sites. Conflict was reported in all 10 domains, ranked below from most to least common:
- Prior history
- Incompatible or overlapping goals
- Communication issues
- Overlapping authority
- Status inconsistencies
- Interpersonal relationships
- System of care issues
- Decision-making
- Incompatible rewards
- Scarce resources
Over half of all respondents reported conflict in three areas—prior history, incompatible or overlapping goals, and communication. Conflicts over authority and status were also common. Two-thirds of all respondents noted that signs of conflict were apparent during governing board meetings.
Family members reported slightly higher levels of conflict than professionals in 9 out of 10 domains (prior history being the exception), although the differences were not statistically significant. Similarly, family members reported the impact of conflict on their systems of care to be slightly more negative than professionals in 9 out of 10 domains (overlapping authority being the exception), although again the differences were not statistically significant.
Conflict appears to have an impact on systems of care in several ways. Overall, the more conflict people reported, the less effective they perceived their system of care to be. Among respondents who reported conflict, those who indicated that conflict had a positive impact rated their systems as being more effective, while those who indicated that conflict had a negative effect rated their systems overall as less effective.
Responses showed that although some sites acknowledge and attempt to deal with conflict when it arises, other sites either fail to acknowledge the conflict (35%) or attempt to handle conflict behind the scenes (31%). Almost a third of all sites (30%) reported no experience with any form of formal or informal conflict management.
What Have We Learned So Far?
Results from the needs assessment indicate that conflict plays a role in developing and implementing effective systems of care. Conflicts arise from a number of factors, including historical, structural and interpersonal factors. Although conflict is inevitable, and may even be a positive factor in changing systems, it may sometimes be difficult to identify and address openly.
One important first step is to create a safe way for team members to acknowledge conflicts that they are experiencing. Based on the work done to date, the study team has developed a simple tool to help facilitate discussion among your board or team about conflict. The Conflict Self-Assessment provides a series of questions to help people take an objective look at how conflict affects their team and how the group handles it. Once people realize that conflict is not necessarily something to be avoided, ways of handling conflicts can be developed that reflect both the nature of the conflict and the needs and preferences of the team members.
There are many strategies to help teams reduce conflict or to address it productively. Some suggestions include:
- Use a neutral facilitator for meetings, especially in the beginning.
- Spend time talking about what the team’s values mean from each team member’s perspective and identify areas of agreement and disagreement.
- Establish ground rules and pre-plan how the group will make decisions and handle differences.
- Consider establishing a formal process for handling disagreements that cannot be easily resolved in group discussion.
- Take time to listen and learn each other’s issues and why there is concern.
- Clarify key points in discussion and assure all issues are addressed.
- Assess your individual conflict management styles and discuss how they affect the functioning of your board.
- Learn basic conflict management skills such as finding common ground, clarifying issues, and tools from the conflict resolution process.
The field of conflict management or conflict transformation has many excellent tools available, including facilitation, conflict style assessments, structured dialogue processes, coaching, mediation, arbitration and partnering. Partnering, a process often used by government and the private sector to build teams for very complex projects, entails developing a mutual commitment by all parties about how they will interact during the course of a collaborative project. Facilitation, dialogue and partnering interventions are particularly well-suited for use during the early, developmental stages of a new site, to identify and address underlying sources of tension prior to conflict emerging. Other methods may be helpful after the group has had some time to function and to see how and where conflicts emerge. Formal methods of conflict resolution such as mediation may only be necessary for conflicts that cannot be resolved through group discussion.
Where Do We Go From Here?
The viability and sustainability of a system of care may depend on how its members acknowledge and handle conflict. Given the pervasiveness and perceived negative impact of conflict, it is important to understand the role conflict plays in system development, and to examine the unique ways individual sites handle differences. Over the next year the research team will work with three sites to learn more about the effects of conflict on collaboration. Through concept mapping, interviews with key stakeholders, focus groups and a review of documents, issues and perceptions of conflict will be surfaced and the sites’ methods of addressing conflict examined. From this in depth study, specific tools and materials will be developed to assist system of care teams to integrate conflict management approaches into their collaborative process. If your site would be interested in participating, please contact Robyn Boustead at Robyn.boustead@dmh.mo.gov or at 573-751-8724.
For more information on this study or about alternative dispute options please visit our Web site at http://mediation.fmhi.usf.edu. If you have a story to share about your experience of conflict while working in a system of care, go to our Web site and post your story. We would love to hear from you! Sources of stories will be completely confidential.
Additional Resources
View the materials and audio playback from the TA Partnership’s Webinar, “When Collaboration Hurts: Ways to Address Conflict in Building Partnerships,” with presenters Robyn Boustead, Patricia Baker and Sheryl Schrepf. These materials are available at http://www.tapartnership.org/learning_opp/conflict_in_SOC.asp.
References
1De Dreu, C., & Van Vianen, A.E.M. (2001) Managing relationship conflict and the effectiveness of organizational teams. Journal of Organizational Behavior. 22(3), 309-328.
2Thomas, K. W. and Kilmann, R. H. (1974) Thomas-Kilmann Conflict Mode Instrument, Xicom, Inc., Tuxedo, NY.