WK.5: Power, Politics, and Conflict

Introduction to Health Services Management

• Professor: Dr. Reshma Prashad, PhD, MHI, PMP, CPHIMS, CCMP, ITIL

Learning Outcomes

• Understanding Power: Comprehend what power is, how and where to identify it, and its manifestation within health care organizations.

• Conflict Management Focus: Emphasize the crucial role of conflict management in handling both power and politics effectively.

• Importance of Power and Politics: Recognize the essential and necessary functions that power and politics play in ensuring organizations and workers perform effectively.

What is Power and Where Does It Come From?

• Definition of Power: Power is the control one group possesses over another's behavior.

  • It frequently involves coercion, which refers to the application of subtle influence dynamics to accomplish desired objectives.

  • It necessitates two or more parties engaging in continuous interaction.

• Three Major Sources of Power within Organizations:

  • Structural: Power derived from the formal organizational structure, roles, and hierarchy.

  • Cultural: Power stemming from the shared values, norms, traditions, and beliefs prevalent within the organization.

  • Knowledge-based: Power originating from unique expertise, information, or specialized skills held by individuals or groups.

Key Power Relationships in Health Care Organizations

• Physician-Patient Relationship:

  • Traditionally, physicians commanded significant authority over patients. However, this dynamic is currently undergoing a shift towards more shared decision-making.

• Physician-Nurse Relationship:

  • Physicians typically exert direct influence over nursing work assignments, compensation, and employment status.

• Physician-Administrator Relationship:

  • The presence of dual hierarchies (medical and administrative) often creates tensions and ambiguities, as both groups stake claims to power.

The Political Nature of Power

• Health care organizations are inherently very political due to the presence of several distinct and powerful stakeholder groups.

• Negative Aspect of Politics: Politics can be inefficient, as it often requires individuals and groups to devote valuable time and resources towards self-interests rather than collective organizational goals.

• Positive Aspect of Politics: Politics also plays a positive and critical role in organizations by encouraging different groups and individuals to share power, fostering collaboration and compromise.

The Abuse of Power in Health Care Organizations

• Definition of Power Abuse: This refers to the utilization of power in ways that are generally considered unacceptable, primarily serving self-interest rather than the organization's best interests.

• Two Main Reasons for Power Abuse:

  • Advancement of personal ends: Pursuing individual benefits at the expense of customers, shareholders, or employees.

  • Advancement of organizational ends: While seemingly positive, this can also be a form of abuse when organizational goals are pursued through unethical or harmful means, which can be difficult to discern.

• Negative Fallout from Power Abuse by Managers:

  • Loss of trust among employees and stakeholders.

  • Uncertainty regarding goal achievement, leading to decreased productivity.

  • Significant harm to the organization's reputation.

Trust, Fairness, and Transparency in Preventing Power Abuse

• Steps to Guard Against the Abuse of Power:

  • Structuring Communication Networks: Implementing systems that foster greater transparency in communication throughout the organization.

  • Utilizing Boards of Directors and Advisory Groups: Establishing these bodies to act as counterbalances to unchecked managerial authority, providing oversight and guidance.

  • Creating a Strong Code of Ethics: Developing and enforcing a comprehensive set of ethical guidelines that govern behavior and decision-making.

  • Designing Appropriate Appraisal Systems: Implementing fair and objective performance evaluation systems that reward ethical conduct and discourage power abuse.

  • Emphasizing Personal Integrity: Fostering a culture where personal integrity and ethical behavior are highly valued and promoted among all personnel.

Power as a Key Source of Conflict

• Conflict associated with power and politics primarily stems from two circumstances:

  • Differing Perspectives and Agendas: Parties hold distinct viewpoints, ideas, or intentions and are determined to advance their own.

  • Unequal Access to Power: Interdependent parties draw upon different sources of power or have unequal opportunities to acquire or exert power.

• Conflict Management: This refers to how parties approach, deal with, and ultimately resolve disagreements or disputes.

Types of Conflict

• Task Conflict:

  • Involves differences among parties in understanding and executing tasks.

  • Challenge: The primary difficulty lies in understanding and reconciling individual viewpoints and approaches to the task.

• Relationship Conflict:

  • Pertains to disagreements regarding an inherent characteristic of the other party.

  • Causes: Examples include differing interpersonal styles, personality clashes, or perceived intrinsic traits.

  • Challenge: The main difficulty is navigating and managing heightened emotions that typically accompany such conflicts.

The Negative Side of Emotions

• When individuals perceive a threat, their thinking patterns often become rigid or inflexible, hindering open-mindedness.

• Heightened emotions typically result in a decreased ability to cognitively process information, evaluate various ideas, or identify possible solutions effectively.

• Emotional Contagion: This phenomenon occurs when emotions are involuntarily transmitted from one party to another, potentially escalating the emotional intensity of a situation.

Common Mistakes in Thinking About Conflict

• A significant error negotiators frequently make when approaching conflict is failing to plan or thoroughly think through the conflict before attempting to address it.

• Components of an Effective Plan for Negotiation:

  • A clear description of one's own interests or needs.

  • Consideration of possible positions or offers that could be made.

  • Specific goals regarding the desired positions for the negotiation outcome.

  • Identification of possible tactics to employ in achieving those goals.

Common Mistakes in Managing Relationships

• Not Thinking About the Other Party:

  • Reciprocity: The inherent tendency for individuals to exchange equivalent levels of goods, services, or behaviors with others. Failing to consider this can harm relationships.

• Adding Up Personal Not Collective Gain:

  • Cognitively Active: The act of being consciously focused on the interests and positions of all parties involved in a negotiation, not just one's own, for mutual benefit.

• Failing to Trust:

  • Self-Fulfilling Prophecy: A psychological phenomenon where one's beliefs about another person influence that person's behavior in a way that ultimately supports and confirms the initial belief.

Key Conflict Management Strategies

• Conflict strategies are characterized by different approaches to value, which represents the combined benefits achieved among all parties in a negotiated agreement.

• Most Common Strategies for Engaging Another Party and Seeking Resolution:

  • Compromising: Seeking a middle ground where both parties make some concessions.

  • Competing: Prioritizing one's own interests and striving to win at the expense of the other party.

  • Collaborating: Working together to find a solution that fully satisfies the concerns of all parties, often requiring creativity and mutual understanding.

Tactics to Acquire More Information

• Do Research: Systematically gather objective data and relevant background information pertinent to the conflict or negotiation.

• Ask Questions: Employ specific and well-formulated questions to uncover crucial information about the other party's interests, needs, and positions in a negotiation.

• Find Common Ground: Engage in behaviors or discussions that help multiple parties identify shared goals, interests, or values, which can facilitate agreement.

Tactics to Influence the Other Party

• Make a strong opening offer: Setting an ambitious but justifiable initial proposal can anchor the negotiation.

• Use objective criteria: Referencing external standards, data, or precedents to justify proposals and decisions.

• Form a coalition: Partnering with other parties who share similar interests to increase bargaining power.

• Use BATNA / Power of walk-away: Clearly understanding one's Best Alternative to a Negotiated Agreement and being willing to disengage if a satisfactory outcome isn't reached.

• Plan concessions: Strategically determining in advance what concessions can be made, when, and under what conditions.