HCM 5020 Module 3 Workplace Conflict Paper Example

Called In at Three in the Morning: Diagnosing and Leading Through a Conflict Over Overnight Ultrasound

Student Name

Master of Science in Healthcare Management, Thomas Edison State University

HCM-5020: Healthcare Administrator Leadership

Mentor Name

Month Day, Year

Called In at Three in the Morning: Diagnosing and Leading Through a Conflict Over Overnight Ultrasound

In my department at the fictional Monmouth County hospital used throughout these HCM-5020 samples, ultrasound is staffed in house from 7:00 a.m. to 11:00 p.m. Overnight, one of six sonographers takes call from home and must arrive within 45 minutes. Over the past year, overnight call-ins rose from about 40 a month to 70. Sonographers say emergency physicians order scans at night that could wait until morning, such as gallbladder studies in stable patients, and two have resigned citing call burden. Emergency physicians say they order what patients need, that waiting for morning holds patients in crowded hallways, and that some sonographers are slow to come in or argue on the phone. Last month a sonographer and an emergency physician exchanged angry words in front of a patient's family, and both filed complaints. This paper diagnoses the conflict, explains what research says about its effects, and describes how I am leading the two groups through it.

Diagnosing the Type of Conflict

Jehn (1995) distinguished conflict about the work itself, meaning disagreements over what should be done, from relationship conflict, meaning personal friction, tension and dislike. Later work added process conflict, about who does what and how. Naming the kind of conflict is the first step, since a dispute over rules needs a different remedy from a feud between people. This conflict began as a task and process disagreement: which overnight scans are urgent and how quickly sonographers must respond. It has become a relationship conflict. Sonographers now describe some emergency physicians as disrespectful, and some physicians describe sonographers as obstructive. Each new call is read through that history, so even a reasonable request triggers resentment.

De Dreu and Weingart (2003) combined results from 30 studies and found that relationship conflict went with markedly worse team results and less satisfied members, as theory had predicted. Contrary to the common claim that disagreement about tasks is healthy, task conflict was also negatively related to performance and satisfaction, especially for complex work, and it was least harmful when it was not tangled up with relationship conflict. Their findings warn against treating the night-call disagreement as a productive debate. Once task and relationship conflict reinforce each other, as they do here, both performance and morale suffer.

Sources of the Conflict

Almost et al. (2016) reviewed 44 studies of conflict in healthcare teams and found that common sources included role ambiguity, poor work environments, lack of support, poor communication and individual factors such as low emotional intelligence. Each appears here. There is no written definition of which ultrasound studies justify an overnight call-in, so each call is a negotiation. Sonographers carry call on top of full day schedules, with no limit on consecutive calls and no rest time after a night in the hospital. Communication happens by phone between two tired people who have never met in person, without a shared format. The volume increase itself came from a change in emergency practice, more ultrasound for suspected appendicitis in children and for early pregnancy problems, that was never discussed with imaging.

Knowledge and skill differences also matter. The emergency physicians know the clinical stakes of a missed ovarian torsion or ectopic pregnancy; the sonographers know which studies can wait safely and how long each takes at night alone. Neither group has had a reason to learn the other's constraints. Two of the six sonographers are newly certified and less confident handling a disagreement with a physician, which makes the phone call harder for them.

Leading Through the Conflict

My first step was to separate the relationship incident from the task problem. The two people involved in the confrontation met separately with their own leaders, and then together with me and the emergency medical director, to acknowledge what happened in front of the family and agree on how disagreements will be handled in the future. That conversation was not about who was right about the scan.

The task and process problem is being handled jointly. The emergency medical director and I convened a working group of two emergency physicians, two sonographers, an emergency nurse and a radiologist. Using a year of overnight call data, the group is drafting a short list of studies that justify a call-in at any hour, studies that can wait until 7:00 a.m. with a reassessment plan, and a gray zone in which the radiologist on duty decides. The radiologist's role is important: a neutral clinical decision-maker for disputed cases removes the need for sonographers and physicians to argue with each other.

Structural changes address the underlying burden. Call is now capped at two nights in a row, sonographers who come in after 2:00 a.m. may start the next day later without losing pay, and I have requested funding for a seventh sonographer. The two newer sonographers are paired with experienced colleagues for their first ten calls and practice the standard call format with a lead sonographer.

Measuring Progress

Progress will be tracked through three measures over six months: overnight call-ins per month and the share that met the agreed criteria, the median time from order to completed overnight ultrasound for studies on the urgent list, and the number of complaints or safety reports involving conflict between the two groups. I will also ask sonographers and emergency physicians a short set of questions at three and six months about whether they trust the new process.

The working group's draft will go to the emergency department's physician meeting and to a sonographer staff meeting before it takes effect, so that people who were not in the room can question it. Once adopted, the list will sit in the order entry screen, where a physician ordering an overnight ultrasound sees which category the study falls into, and the radiologist's decision in gray-zone cases will be documented so the group can revise the list after three months.

Conclusion

This conflict began as a reasonable disagreement about urgency and became personal because no rule, structure or relationship existed to absorb it. Diagnosing it as tangled task and relationship conflict, tracing it to role ambiguity, workload and poor communication, and responding to each layer separately allowed me to keep leading the department while the conflict was still live. The goal is not to end disagreement about scans but to give it a fair process.

References

Almost, J., Wolff, A. C., Stewart-Pyne, A., McCormick, L. G., Strachan, D., & D'Souza, C. (2016). Managing and mitigating conflict in healthcare teams: An integrative review. Journal of Advanced Nursing, 72(7), 1490-1505. https://doi.org/10.1111/jan.12903

De Dreu, C. K. W., & Weingart, L. R. (2003). Task versus relationship conflict, team performance, and team member satisfaction: A meta-analysis. Journal of Applied Psychology, 88(4), 741-749. https://doi.org/10.1037/0021-9010.88.4.741

Jehn, K. A. (1995). A multimethod examination of the benefits and detriments of intragroup conflict. Administrative Science Quarterly, 40(2), 256-282. https://doi.org/10.2307/2393638