Managing Conflict

Conflict arises between individuals when there are differences in perceived goals, aims, and values. Despite differences in perspectives and values, workers should continue to conduct themselves in a positive manner. Specifically, workers should ensure interactions with clients are fair, just, humane, and equitable.

When conflict arises, clients may find it difficult to share their perspectives due to power imbalances between the client and worker (Bomhof-Roordink et al., 2019). Despite being well-informed and having sufficient knowledge about their support needs, clients may feel that their knowledge is undervalued as they may perceive the worker as the ‘expert’ who should have the final decision. Hence, this hinders the client’s ability to participate meaningfully in decision making and conflict resolution.

Power imbalances can be addressed by using person-centred care which encourages workers to use the client’s lived experience as an important source of information when making decisions. In the context of managing conflict, patient centred care would involve the worker taking the time to understand the client’s concerns and values as it is the client themselves that has the best understanding of their current situation. Workers should also include clients when making decisions surrounding conflict resolution. This can be done through workers encouraging client’s share input on the type of support they wish to have.

Person-centred care ensures that the client’s perspectives and choices are central to the process of decision making around their own care. It encourages workers to respect the client’s right to self-determination and empowers clients to make decisions based on their persona values and interests.

Accordingly, this reduces power imbalances between workers and clients, thus ensuring fair, just, humane, and equitable interactions.

Principles for Effective Communication

To ensure effective interactions and problem solving with clients, workers should ensure that they are practising effective communication. The following principles and strategies should be considered by workers when approaching conflict and problem-solving with clients.

Active Listening and Empathy

Active listening and demonstrating empathy to clients are important principles of effective communication. Active listening involves listening with full attention to what the other person is saying. Active listening is associated with empathy, which is defined as the ability to recognise, understand, and share another individual’s experience. In line with person-centred care, demonstrating active listening and empathy was found to be associated with better client communication and clients feeling more enabled to make decisions surrounding their care (Hayley et al., 2017).

While managing conflict, workers should actively listen to the client’s perspective. From there, workers can determine the reason for the conflict and empathise with the difficulties faced by the client. Accordingly, this signals to the client that the worker is willing to listen and support the client through their concerns, thus improving client interactions. Once the client has felt heard and understood, the worker may start problem solving with the client.

Using Clear and Simple Language

When communicating with clients, workers should use clear and simple language. Workers should avoid using medical terms or jargon that may be difficult for a layperson to understand or ensure these terms are clearly explained to the client. This helps to prevent confusion and removes the barrier of client’s not understanding the decision-making process surrounding the support provided. Hence, the use of clear and simple language fosters effective interactions and problem solving, while empowering clients by allowing them to take part in the decision-making processes surrounding their care.

Non-verbal Language

Another principle of effective communication involves being mindful of non-verbal behaviour. Non-verbal behaviour generally refers to body language and facial expression. Observing the client’s non-verbal behaviour allows workers to make more informed decisions about how to communicate with the client. Workers may gain important information about the client’s emotional state through observing non-verbal behaviour. For example, restless movements in the hands could indicate nervousness.

Although non-verbal behaviour is an important source of information, there is a risk of misinterpreting the behaviour. For example, while eye twitching could indicate frustration in some people, it could also indicate that the person is feeling tired. Hence, workers should clarify their observations through verbal communication.

Cultural Competency

...refers to the ability to work and communicate effectively with culturally linguistic diverse clients

With healthcare settings becoming more culturally diverse, cultural competency is an important requirement. Cultural competency refers to the ability to work and communicate effectively with culturally and linguistically diverse clients (Alizadeh & Chavan, 2015). Cultural competency consists of three components. These components are cultural awareness, cultural knowledge, and cultural skills.

Cultural awareness refers to an individual’s own awareness of their own views, biases, and prejudices. As previously discussed, workers should practise self-reflection on how their personal culture may influence their interactions with clients. This allows workers to be more sensitive about cultural differences and avoid acting based on assumptions.

Cultural knowledge refers to efforts made to learn information on different cultures. Workers should strive to gain knowledge of cultural practices and customs of clients as their impacts of client behaviour. Building on cultural knowledge, cultural skills refer to the behavioural component of cultural competency where individuals can interact effectively with culturally different people.

Adapting Communication Style and Language to Accommodate Different Cultures

To be culturally competent, workers should adapt their communications style and language to accommodate different cultural values and practices. This encompasses both verbal and non-verbal communication.

Verbal and Non-Verbal Communication

Effective verbal communication in the context of culturally competent care involves the use of preferred language, dialect, and greetings (Purnell, 2018). This may involve engaging further support from an interpreter or translator depending on the organisation’s scope of services. Verbal communication also includes the contextual use of language. In addition to voice volume, tone and intonation, contextual use of language also includes one’s willingness to share thoughts and feelings and degree of formality. Adapting these factors to accommodate for cultural differences would allow workers to establish rapport with clients.

On the other hand, non-verbal communication involves eye contact, gestures, the use of touch, facial expressions, and body language. Non-verbal communication also varies across cultures. For example, while eye contact may signal to another person that you are listening to them, other cultures may perceive this as impolite. Given the variance in how verbal and non-verbal behaviours may be perceived across cultures, workers should demonstrate a willingness to understand and adapt to these differences. Furthermore, workers should continue to demonstrate cultural competency by practicing self-reflection and furthering their knowledge on different cultures.

Cultural differences in Decision Making

Although workers are encouraged to involve clients in the decision-making process, there may be cultural differences in the client’s desire to participate in decision making. It was found that clients ethnic racial minority groups appraised their decision-making process less positively than Caucasian clients (Hawley & Morris, 2017). For example, clients may believe that healthcare workers are “supposed” to make decisions and “tell them what to do” when it comes to treatment or support plans. To address cultural differences in the decision-making process, it is recommended that workers explain the benefits of shared decision making, while being able to tailor the decision-making behaviours to the client’s preferences.

Identify Potential Causes of Conflict and Acknowledging Emotions

Once conflict has occurred, workers should discuss the cause of conflict with the client. During this discussion, workers should gather information on what the client’s desires, motivations, and goals, as well as what outcomes the client finds undesirable. At this stage, the aim is to understand the client’s perspective rather than imposing one’s own values.

When identifying the cause of conflict, clients may express negative emotions, such as anger or anxiety. Workers should be mindful of the client’s emotions and acknowledge these emotions. This suggests to the client that the worker has heard and understood their feelings and concerns.

Workers may use the techniques “reflecting” and “validating” to acknowledge the client’s emotions.

These techniques are summarised in the table below:

Defusing Responses

The following are techniques and responses workers may use to defuse conflict (Overton & Lowry, 2013):

Mutual Respect and Purpose

Workers should ensure mutual respect and purpose is conveyed to the client while defusing conflict. Workers may use a range of verbal and non-verbal communication skills to show mutual respect to the client. This can be achieved through a calm and neutral tone of voice and neutral expression. This fosters a safe environment where both parties can share their perspectives and work towards a common goal.

Establish a Goal of Joint Problem Solving

Establishing a goal of joint problem solving is another strategy that may be used to defuse conflict. To begin, the worker signals to the client that they will start discussing their perspective or their observations of the client. Workers should share all relevant information and avoid being vague as this may lead to further miscommunication and conflict. The use of “I” statements, such as “I am concerned…” or “ I feel that…”, help communicate the worker’s perspective in a non-threatening manner.

Throughout the discussion, the worker draws attention to points of agreement. Workers may continue to gather the client’s opinions and check in with the client’ understanding. Accordingly, this allows the client and worker to work towards a joint goal of problem solving.

Offering Solutions

During the problem-solving process, the worker and client may offer solutions to resolve the conflict. After several solutions have been created, each person should discuss their preferred solutions. The benefits and limitations of each solution should also be discussed together with the client. The overall goal is to find commonality and acceptable compromise that allow for both people to feel like their needs have been met, thus resolving the conflict.

Once a solution has been agreed on, an action plan that addresses the ``who, what, and when” of resolving the conflict needs to be created. All parties involved in the need to understand their role and responsibility to successfully achieve the solution.

Diverting and Minimising Aggression

If conflict escalates, clients may present with aggressive behaviour, which include abusive language, raising one’s voice, intimidation, threats, and abusive language. Accordingly, negotiation techniques can be used to divert and minimise aggressive behaviour.

Negotiation is a two-way communication process, with the goal of reaching a joint decision. The process of negotiation generally consists of four steps (Lewicki et al., 2021):

Step 1: Identify and Define the Problem

Similar to conflict resolution, negotiation involves both people having a shared understanding of the problem. Hence, the first step of negotiation is to define the problem in a way that is mutually acceptable to both sides. Furthermore, the problem should reflect both individuals' needs and priorities.

When identifying the program, it is also important to develop standards by which potential solutions will be judged by how well that resolve the problem. Workers may consider the following questions:

• How will we know the problem has been solved?
• How will we know that our goal has been attained?
• How would a neutral third party know that our dispute has been settled?
• Is there any legitimate interest or position that remains unaddressed or left out by the outcome?

Step 2: Surface Interests and Needs

Workers should work together with clients to understand each other’s interests and needs. It is important for workers to have a good understanding of their own personal interests and needs.

Workers may ask themselves the following questions:

• What do I want from this negotiation?
• Why do I want that?
• Why is that important to me?
• What will achieving that help me do?
• What will happen if I don’t achieve my objective?

Having a good understanding of personal interests allows the worker to better communicate their perspectives to the client.

Similarly, the same questions can be applied to the client when clarifying the client's needs. Asking these questions while being mindful of the client’s verbal and nonverbal behaviour can surface the client’s needs while minimising aggressive behaviour.

Step 3: Generate Alternative Solutions

After the worker and client’s needs have been surfaced, workers may generate alternative solutions with the client. Generating alternative solutions is the creative phase of the negotiation process and the aim of this step is to create a variety of options, rather than evaluating each option. This process is also referred to as brainstorming.

Step 4: Evaluate and Select Alternatives

Once possible solutions have been identified, the worker may move on to evaluating and selecting the appropriate solutions with the client. In this stage, the worker and client discuss the pros and cons of each alternative. At the end of the process, the client and worker should come to an agreement on a preferred solution.

If no options seem to be suitable, this suggests that the problem was not clearly defined or the standards that were decided on earlier are not reasonable or realistic.

Responsibility and Accountability for Behaviour

When managing conflict, negotiation techniques can be further applied to examine cause and effect of the client behaviour, while ensuring appropriate responsibility and accountability. Lewicki et al. (2021) discusses the following techniques may be used to further ensure successful negotiation:

Avoid Personalising the Conflict

Workers should separate their feelings from the conflict or problem. This involves the worker not taking the conflict personally and making judgements about the client. During conflicts, individuals tend to be judgmental and place blame on one another. They might only view their own actions in positive light, while viewing the other’s actions in negative light. This can be avoided using objective language when defining the problem.

Telling the client that they are wrong inhibits the negotiation process and may escalate the conflict to aggression as the client may feel attacked. Alternatively, the worker may take a more objective stance by stating “We are having different viewpoints of the problem.” The language in this statement is objective and allows both parties to approach the problem rather than giving one party the sole ownership of the problem.

Firm Flexibility

Firm flexibility allows workers to be firm with what they want to achieve, while being flexible with how it is achieved. When examining cause and effect of client behaviour, workers should demonstrate firm flexibility. This allows workers to uphold professional boundaries as they resolve conflict.

Workers may send signals of flexibility by expressing willingness to address the client’s concerns and indicate a willingness to change. However, it is also important to reaffirm the professional boundaries using clear statements.

In this section, you have learnt the various steps and techniques that can be carried out during the negotiation process to manage conflict with clients. While managing conflict, it is important that you continue to uphold the principles of effective communication and be aware of cultural differences. These processes highlight the importance of self-awareness in the way we communicate with clients and the need to provide a safe space for clients to share their perspectives.

1. Alizadeh, S., & Chavan, M. (2015). Cultural competence dimensions and outcomes: a systematic review of the literature. Health and Social Care, 24(6), e117-e130. https://doi.org/10.1111/hsc.12293
2. Australian Government. (2020). [Photograph of a group of people standing and having a conversation]. https://www.yourcareer.gov.au/resources/articles/how-to-interact-with-others
3. Bomhof-Roordink, H., Gärtner, F. R., Stiggelbout, A. M., & Pieterse, A. H. (2019). Key components of shared decision making models: a systematic review. BMJ Open, 9(12). http://dx.doi.org/10.1136/bmjopen-2019-031763
4. Hawley, S. T., & Morris, A. M. (2017). Cultural challenges to engaging patients in shared decision making. Patient Education and Counselling, 100(1), 18-24. https://doi.org/10.1016/j.pec.2016.07.008
5. Hayley, B., Heo, S., Wright, P., Barone, C., Rettiganti, M. R., & Anders, M. (2017). Relationships among active listening, self-awareness, empathy, and patient-centered care in associate and baccalaureate degree nursing students. Nursing Plus Open, 3, 11-16. https://doi.org/10.1016/j.npls.2017.05.001
6. Lewicki, R. J., Saunders, D. M., & Barry, B. (2021). Essentials of Negotiation. McGraw-Hill Education.
7. Overton, A. R., & Lowry, A. C. (2013). Conflict management: Difficult conversations with difficult people. Colon and Rectal Surgery, (26), 4. https://doi.org/10.1055/s-0033-1356728
8. Purnell, L. (2018). Cross Cultural Communication: Verbal and Non-verbal communication, interpretation and translation. In M. Douglas, D. Pacquiao, & L. Purnell (Eds.), Global Applications of Culturally Competent Health Care: Guidelines for Practice (pp. 131-142). Springer. https://doi.org/10.1007/978-3-319-69332-3_14