A Conflict Management Scale for Pharmacy

By Austin, Zubin; Gregory, Paul A. et al. | American Journal of Pharmaceutical Education, December 2009 | Go to article overview

A Conflict Management Scale for Pharmacy


Austin, Zubin, Gregory, Paul A., Martin, Craig, American Journal of Pharmaceutical Education


As pharmacists collaborate with physicians, nurses, patients, and others on a more frequent basis, the possibility of interpersonal conflicts developing increases. (1-5) Consequently, understanding the nature of conflict in pharmacy practice and providing pharmacists with skills for managing interpersonal conflict are important from a quality of working life perspective, (6,7) as well as from a human resources (recruitment/retention) (8) perspective. Herzog's definition of conflict is widely accepted: interpersonal conflicts may exist whenever 2 or more individuals interact and disagree. (9) Importantly, interpersonal conflict is frequently identified as an intellectual and/or moral disagreement, coupled with an emotional response from at least 1 of the parties involved. (10)

Much of the literature examining conflict in health care focused on interprofessional conflict (particularly between physicians and nurses). Gerardi noted that un-addressed conflict is a frequent cause of unhealthy nursing workplaces, and suggested educational strategies should be employed to empower nurses to understand and manage conflict rather than simply avoid it, (11) a finding echoed by Fujiwara et al. (12) Among nurses, there were important correlations between conflict management skills and staff morale, burnout, and job satisfaction. An individual's ability to cope with and manage conflict was essential to fostering successful workplace interprofessional and interpersonal interactions. (13) There were similar findings in a study of surgeons. (14)

Skjorshammer described the polarizing nature of most physician-nurse conflicts and the role of professional cultures and stereotypes in exacerbating this polarization. (15) Successful conflict management appears to be built on a foundation of self-reflection, self-awareness, and flexibility. In one study, nurses and physicians actually differed in their perception of when a difference of opinion actually became a conflict, and consequently, what appropriate action was required. (16) In another study of health care practitioners, conflict avoidant behaviors were significant and a major managerial challenge to advancement of interprofessional collaboration. (17)

Individual conflict management styles exist and are relied upon by individuals in managing day-to-day conflict. The Thomas-Kilman Instrument has been widely used as a management training tool to assist individuals in identifying their own conflict style and learning new tactics for managing conflict that may be more successful in different situations. (18) This instrument is built upon a model conceptualizing 5 different conflict management behaviors: avoidance, competition, compromise, accommodation, and collaboration. This model suggests that the collaborative style is superior to the other 4 and focuses on providing individuals who have one of the other styles with strategies to assist them in becoming more collaborative. Herzog used this instrument to examine conflict management styles of nurses, and provided specific behavioral guidelines for managing both patient-nurse and physician-nurse conflicts. (9) In another study, the majority of nurses avoided conflict, with less than 10% actively adopting collaborative conflict resolution behaviors. (19)

Conceptualizing conflict management in terms of individual "styles" (or preferences for use of specific strategies) has provided researchers with unique opportunities to develop models and programs to facilitate practitioner development. A variety of strategies are utilized by community mental health workers, and individual preferences for use of specific strategies appears to be linked to individual conflict management styles. (4,10)

The role of self-reflection in conflict management has also gained prominence. Reflective practice was found to raise self-awareness, and self-awareness provides opportunities for conflict de-escalation. (20) In examining conflicts between patients and physicians, lack of self-awareness on the part of the physician as to the impact of his/her words on the patient was a significant cause of conflict or the escalation of a disagreement into conflict.

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