I would say that for any nonphysician to challenge a physician has the whole episode laced with pitfalls. For a nurse, a therapist, a pharmacist, a social worker, a nutritionist, an occupational therapist to challenge a physician is up there with losing a job or getting a divorce—very stressful. And I can say personally as a nurse that in my more formative years that was something that you would try to avoid at all costs.
Because of the intensity of interaction among groups involved in highly interdependent work processes, conflicts tend to be common. Organizational theorists have shown that conflicts are more likely to occur in the presence of high levels of task interdependence or high levels of diversity among participants.103 However, conflict is not all bad. Conflicts can provide a way to articulate and accommodate multiple points of view, each of which has the potential to add value to the work process. For example, Karen Jehn demonstrated that conflict can improve performance when it takes place in a group that values task-related conflict but that unresolved conflicts cause relationships to deteriorate and hinder performance over time.104 In addition, efforts to resolve conflicts provide opportunities for building a shared understanding of the work process among participants who may not understand one another's perspectives, thus strengthening the relationships through which coordination occurs.105
There are substantial differences between individuals and their abilities to engage in conflict resolution: Some have the capabilities and resources that enable them to resolve conflicts effectively, whereas others do not.106 However, organizations should not accept these disparities as a given. They can act to increase their employees' ability to resolve conflicts by designing conflict resolution processes for that purpose. Those processes can take many different forms, but they have the common characteristic of providing opportunities for building a shared understanding of the work process among participants who may not understand one another's perspectives.107 Because conflicts often span functional boundaries, these conflict resolution processes must do the same.
Conflict resolution is especially important in healthcare settings. Conflicts among care providers are common, driven by the intensity of interactions among the care provider functions involved in patient care, the critical nature of the outcomes, differences in training and perspectives, and increasing awareness of time and cost pressures. Some conflicts were seen as desirable because they provided a way to articulate and accommodate multiple points of view, each with the potential to add value to the work process. Case managers typically were expected to take a hard line on resource utilization, for example, whereas doctors and nurses were expected to push back to assure high quality care for their patients. Unresolved conflicts, however, had the effect of hindering communication and weakening relationships over time.
Each of the nine hospitals we studied had some kind of grievance process to resolve conflicts between workers and their supervisors. According ...