HCS 321 Week 3 Conflict Management and Collaboration Example

The Emergency Department Says the Beds Are Ready, the Medical Unit Says They Are Not: Managing a Handoff Conflict Through Collaboration Instead of Blame

[Student Name]

University of Phoenix

HCS/321: Business Communication for Health Care Managers

Week 3 Assignment

[Instructor Name]

[Date]

The hospital, its units and the figures are composites written for a model paper; research findings and models come from the sources listed.

On a Tuesday morning, the director of nursing at a composite 250-bed hospital received two emails. The emergency department manager wrote that admitted patients were waiting an average of four hours for beds on the medical unit and that the unit "never picks up the phone." The medical unit manager wrote that the emergency department sent patients "before rooms were clean and without report." Both were partly right. What follows is the director's analysis of the dispute and the collaborative process she used to settle it.

Positions and Interests

Each manager's position was that the other unit was the problem. Beneath the positions were interests. The emergency department wanted to free beds for new arrivals and protect patients from long waits in hallways. The medical unit wanted time to prepare rooms, safe staffing for arrivals and a proper handoff. Both wanted safe care and less friction. Seeing the shared interest in safety changed the conversation from who is slow to how both units could get patients to the right bed safely.

Why the Conflict Keeps Returning

Kim et al. (2017), in a scoping review of health care conflict, grouped its causes into individual factors, such as stress and personal styles; interpersonal factors, such as communication problems and power differences; and organizational factors, such as workload, unclear roles and competing goals. This conflict fit all three levels. Staff in both units were exhausted. They communicated mainly through a bed board and occasional terse phone calls. And the units were measured differently: the emergency department on time to admission, the medical unit on patient falls and nurse overtime.

The Structural Core

The hospital had no shared definition of when a bed was ready. Housekeeping marked a room clean; the unit considered it ready only when a nurse was free to receive the patient. The two units were using the same word for different things.

The Five Modes

Kilmann and Thomas (1977) described five conflict-handling modes along two dimensions: assertiveness, pursuing one's own concerns, and cooperativeness, pursuing the other's. High on assertiveness but low on cooperation lies competing; the reverse is accommodating. Low on both is avoiding, high on both is collaborating, and compromising falls between them.

Choosing an Approach

Avoiding would let delays continue. Competing, with the director ruling for one side, would leave the other resentful and the definition problem unsolved. Compromising, such as splitting the difference on wait times, would treat a design problem as a bargaining problem. Collaboration fits because the issue matters to patient safety, both units hold information the other lacks and the relationship must last.

Preparing for the Meeting

The director met each manager separately first to hear their concerns without the other present and to ask what a good outcome would look like. She asked each to bring two charge nurses and a week of data on arrivals and room turnover.

Opening the Joint Meeting

The director opened by stating the shared goal: every admitted patient in the right bed, safely, as soon as possible. She set ground rules: describe events, not people; one speaker at a time; and no decisions until everyone has spoken.

Working Through the Data

The data showed that most delays happened in the four hours after 3 p.m., when the medical unit was discharging patients and changing shifts. Rooms were often clean by 4 p.m. but nurses were occupied with discharges. Emergency department nurses were calling report at shift change, when no one could take it.

Options Generated Together

The group listed options before judging any: a discharge lounge to free rooms earlier, a defined bed-ready status requiring a clean room and an assigned nurse, a short handoff call rather than a faxed report, a float nurse for arrivals in the afternoon peak and a pause on transfers during the 30 minutes around shift change.

The Agreement

The units agreed on four changes. A bed is ready when the room is clean and a nurse is assigned, shown on the bed board. Report is a five-minute phone call using a structured format such as SBAR (Leonard et al., 2004) within 30 minutes of the bed being ready. No transfers from 6:45 to 7:15 p.m. except in emergencies. A float nurse will support afternoon arrivals for a 60-day trial.

Communication Rules

Charge nurses will call each other directly rather than escalate by email. Disagreements about a specific patient go to the house supervisor in real time. Each manager will explain the agreement at her unit's huddles in the same words, using a one-page summary both signed.

Shared Measures

Both units will now see the same measures: time from bed request to bed ready, time from bed ready to patient arrival and the number of arrivals without report. The director will review them with both managers every two weeks.

Repairing the Relationship

The two managers agreed to walk each other's units during the afternoon peak once a month. Seeing the other unit's workload firsthand reduces the assumptions that fed the conflict.

Results After 60 Days

Average time from bed request to arrival fell from four hours to two hours and ten minutes. Arrivals without report dropped from 14 a week to two. Neither unit's fall rate rose. The float nurse position was made permanent.

What Could Have Gone Wrong

Had the director simply told the medical unit to accept patients faster, the unit would likely have complied on paper while taking report later or leaving rooms unprepared, and the next complaint would have come from patients. Had she told the emergency department to wait, boarding in hallways would have grown. Imposed answers would have settled the argument without solving the problem.

Lessons for Managers

Look beneath positions to interests. Look for structural causes before blaming personalities. Use shared data. Choose collaboration when the issue is important and the relationship ongoing, and write down the agreement with measures.

Conclusion

A conflict framed as one unit's failure turned out to be a shared design problem. By diagnosing its causes, choosing collaboration and leading a structured conversation, the director helped two units agree on definitions, communication and measures that shortened waits and improved safety.

References

Kilmann, R. H., & Thomas, K. W. (1977). Developing a forced-choice measure of conflict-handling behavior: The "MODE" instrument. Educational and Psychological Measurement, 37(2), 309-325. https://doi.org/10.1177/001316447703700204

Kim, S., Bochatay, N., Relyea-Chew, A., Buttrick, E., Amdahl, C., Kim, L., Frans, E., Mossanen, M., Khandekar, A., Fehr, R., & Lee, Y.-M. (2017). Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review. Journal of Interprofessional Care, 31(3), 282-290. https://doi.org/10.1080/13561820.2016.1272558

Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Suppl. 1), i85-i90. https://doi.org/10.1136/qshc.2004.010033