Conflict management for pharmacy managers: part one

One of the most commonly stated reasons for avoiding management in pharmacy is a desire to avoid conflict^​1​. Many people feel they lack the skills or temperament to manage it, resolve it or successfully negotiate an acceptable outcome^​2,3​. Conflict management skills can, however, be learned and improved^​4​.

This is the first in a short series of articles looking at conflict management in pharmacy that will examine the early warning signs of conflict and the strategies of de-escalation and conflict management. Part two of this series will highlight the negotiation and mediation skills managers can call on to help resolve conflict. This article has been adapted from Management, Leadership and Entrepreneurship in Pharmacy, published by Pharmaceutical Press in 2023.

What is conflict?

Conflict can be described as “a stated disagreement between two or more parties, based on a situation where the parties believe they have incompatible goals or objectives”^​5​. An alternative way of viewing conflict is as an intellectual disagreement coupled with emotional involvement^​6​. From this perspective, conflict involves both a cognitive and an emotional component. Simple intellectual disagreement can be stimulating and enjoyable for some people — sparring in a debate when you don’t have any particular investment in the outcome can lead to witty exchanges. However, for many people, conflict becomes troublesome when they have a personal interest in the situation or outcome, or where the result of the conflict could be perceived as emotionally damaging or threatening. The intersection of intellectual disagreement and emotional investment is often why conflict can be difficult to manage^​7​.

Why conflict is so challenging

A common trigger for conflict is the feeling of being disrespected by the other person. Our emotional response to being overlooked or diminished by another person is strong and visceral^​8​.

Emotion and cognition are interconnected components of our central nervous systems — this parallel processing can sometimes lead to us feeling overwhelmed during conflict^​9​. Human beings are literally hardwired to experience emotion prior to engaging cognitively with a situation. Sensory inputs — from sight, sound, taste, touch and smell — first route through a part of the brain called the amygdala, which sometimes is referred to as the ‘reptilian brain’^​10​. The amygdala is also thought to be the centre for most primal human emotion. At one point in human evolution, there may have been a strong survival advantage to this wiring, responding emotionally to stimuli engaged a fight-or-flight response — quickly and without cognitive burden — which may have prevented us from harm. Today, this hardwiring can lead to problems when our stimuli are more interpersonal in nature^​11​. 

Cognitive processing of external stimuli is slightly time delayed by approximately 0.3 seconds compared with emotional processing, which means we feel before we think. Consequently, people can sometimes respond in disproportionate, inappropriate or unhelpful ways^​9,10​. Effective conflict management requires an awareness of the emotion–cognition connection and finding ways to manage the 0.3 second delay between emotional and cognitive processing.

Managerial challenges in conflict management

An important principle of conflict management is accepting that conflict is inevitable^​12​. Accepting this and actively looking for signs, symptoms and early warning indicators are essential tasks for successful managers. Managers must be prepared to diffuse small disagreements to prevent them from escalating into open conflict. Disagreements are frequently easier to address and resolve before they escalate. At this stage, gentle humour, compromise, explanations or agreeing to disagree may be sufficient to prevent escalation.

Early warning signs of conflict

Managers need to be familiar with the early warning signs of brewing conflict and attempt to diffuse the situation before escalation. Such warning signs include:

• Changes in body language: Body language is an important non-verbal cue that can help us gain an insight into the way people feel about each other and a situation. ‘Closed’ body language (e.g. folding of arms, avoidance of direct eye contact, tense or pursed lips, rapid blinking, heavy sighs) may indicate a heightened emotional state. Body language is difficult to fake or hide, so if an individual says everything is fine, but their body language is not consistent with their verbal statements, this can be an important clue that something is amiss^​13​;
• Changes in behaviour: Unexplained or unexpected behavioural or affective changes can be another clue that conflict is in the air. Formerly relaxed and jovial colleagues who suddenly go quiet, or who spend more time than normal at their desk away from others, may be stewing or fuming about something;
• Emergence of new alliances or cliques within a team: During times of disagreement, typical social interaction patterns may start to shift as people seek allies who reinforce their own beliefs. New cliques and alliances can be a sign of trouble;
• Verbal cues: Brewing conflict may be reflected through the use of unusually strong words to describe inconsequential events. Unusually, formal wording could be because each word is being carefully selected so the person has control of their feelings;
• Lack of bandwidth to manage slightly unexpected events: A lack of tolerance for others’ small mistakes can be an important clue of conflict problems ahead. When a person who is usually open to staying a few minutes late to tidy up the day’s work suddenly goes home on the dot and leaves unfinished business, it may be that they’ve exhausted their cognitive and emotional capacity — they have no bandwidth left and problems can easily escalate;
• Unusual sick time or absences: Unexplained or suspicious sick time and absences can indicate someone feels they need to stay away from work for their own mental health and wellbeing. At this point, workplace productivity and morale will be adversely affected, and open conflict becomes more likely.

The warning signs listed here are some of the more common ones. There are, of course, others, some of which are unique to individuals. Managers need to be mindful of these signs and not simply ignore them and hope they go away. Proactive identification of conflict warning signs can help us to manage our own emotional responses if we are involved in the conflict directly or provide a trigger to intervene and de-escalate conflict involving other parties.

De-escalating conflict

It is usually more helpful to prevent conflict from escalating into the open in the first place. The objective of de-escalation is to disentangle emotional involvement from intellectual disagreement. There are a number of strategies available to managers: 

• Move to a private area to discuss: Addressing a problem in public, with others listening or observing, can be interpreted as a sign of disrespect and can further escalate emotional entanglement. Separating parties and providing private spaces for discussion is essential for de-escalation;
• Respect personal space and boundaries: A well-intentioned gesture to place an arm around a shoulder, or to reach out and touch a forearm, can be misinterpreted as threatening to someone in a heightened emotional state;
• Be mindful of power dynamics transmitted through body language: When conflict is escalating, small things such as height differences can be distorted out of proportion. Ensure one person does not ‘loom’ over another, which could amplify threat perception. Being seated at a table can provide both physical space and distance, as well as make it easier to establish equitable eye-to-eye contact;
• Try to engage the cognitive rather than the emotional: It may be tempting to say things such as ‘How is everyone feeling right now?’ but reinforcing emotion over cognition can be counterproductive. Instead, emphasise what people are thinking and why they are behaving in a certain way to engage cognitive processes that will help contain emotional responses;
• Be mindful of non-verbal cues: Keep your tone of voice and body language neutral to help calm others. Be conscious of your personal ‘tells’: non-verbal cues that one has little control over but that reflect internal feelings vividly to others. This is particularly important if the other party is being directly hostile, challenging or belligerent. Learning to control non-verbal cues is an indirect but powerful form of learning to control emotional responses. Where anger is met with calmness, anger is more likely to dissipate;
• Learn to ignore provocation: Regrettably, abusive language and slurs can be part of the emotional response that is generated by conflict. Not engaging directly with provocation can be very challenging, particularly where slurs are of a highly personal nature and targeting — for example, an individual’s culture, race, religion, sexual orientation or gender identity. Such slurs are an attempt to wield power by dehumanising the other individual;
• Use words effectively: Though it may be difficult, using empathy during conflict can be a disarming and effective tactic. Effective techniques include summarising, paraphrasing, empathy statements, open-ended questions to encourage dialogue and attentive engagement in conversation.

Safety

De-escalation techniques, such as those listed above, should only be attempted where physical and psychological safety is reasonably certain. Conflict management techniques must always take a back seat to safety concerns. In addition, conflict management in potentially dangerous situations must be balanced with procedures around contacting police, security personnel, or others trained to deal with such situations. Be careful and stay safe.

Conflict management and resolution

As already noted above, the objective of de-escalation is to disentangle emotional involvement from intellectual disagreement. Once individuals have greater self-control over their cognitive and emotional selves, it becomes possible to shift towards conflict management and, ultimately, some form of acceptable resolution.

Conflict management is built upon skills such as listening, root-cause analysis, effective communication and prioritising. It also requires significant cognitive bandwidth and engagement. Conflict management has some golden rules.

Rule 1: Talking is essential

Dialogue is essential in conflict management. Attempts to manage conflict through email or pre-recorded phone messages are generally less effective than face-to-face dialogue. Physical presence sends a strong signal that compromise is possible and that person-to-person connections will be part of the solution.

Rule 2: Emphasise behaviour and events, not personalities

Conflict management is essentially a problem-solving process — clearly define ‘what is the problem we are trying to solve here?’ This can help focus attention away from personalities and on to the concrete issues that are at the heart of the intellectual disagreement, which is an essential first step in resolving the conflict.

Rule 3: Establish ground rules for discussion that give everyone uninterrupted time and space to speak

It is critical that the people involved are given sufficient time to tell their stories and share their perspectives on the problem, without interruption or intimidation. Before even starting this discussion, clearly establish the ground rules and work collaboratively to enforce it. Part of this strategy involves a commitment from everyone to listen and to control emotional responses to statements that are made.

Rule 4: Start by finding ‘low-hanging fruit’

Searching for points on which everyone already agrees can help establish a tone of compromise and collegiality, making difficult discussions less fraught. For example, most pharmacists can agree that keeping patients safe is a priority, even if the way this is achieved may be a point of disagreement.

Rule 5: Acknowledge that not all disagreements will be addressed in one conversation

Defining realistic priorities for an initial conversation will be important. Not everything will be solved in a single discussion. Shifting from the low-hanging fruit of agreement to the most essential priorities for right now — and sticking with this — is important.

Rule 6: Develop a plan to keep talking

Successful conflict management requires multiple conversations over time, which requires planning and scheduling. Do not leave it to informal ‘you’ll sort it all out later, right?’ methods. Instead, formalise the process of ongoing discussion so parties are clear with respect to the next steps and objectives.

Rule 7: Celebrate accomplishments

Find ways to celebrate when even small compromises and successes are achieved. This kind of positive reinforcement can be energising and support further success. Part of this celebration can involve other bystanders who are not actually part of the conflict itself but who may have been peripherally or indirectly affected by it. Highlighting this kind of team-based spirit and collaboration can help build the interpersonal connections that can prevent problems in the future.

Structured approaches to conflict resolution

The ‘Thomas–Kilmann Conflict Mode Instrument’ (TKI) proposes the existence of different conflict management styles: collaboration, competition, avoidance, accommodation and compromise^​14​. Each style has unique strengths and weaknesses — there is no ‘right’ or ‘best’ conflict management style. Instead, understanding how we instinctively respond to conflict can help increase awareness of better options. Being aware that others also have their own, often different, style can help us to respond more appropriately. 

The TKI lists five conflict management styles.

1. Collaboration

Collaborative conflict resolution involves a combination of both assertiveness and cooperation. The goal being to identify solutions that fully satisfy everyone involved, optimising outcomes while minimising negative emotional responses. It is important when the maintenance and nurturing of a long-term relationship with other parties is as important as successful resolution of the conflict itself. Collaboration also requires a give-and-take spirit and the ability to see a situation from other people’s perspectives.

2. Competition

Competitive conflict resolution generally involves an assertive personality type who are somewhat uncooperative and willing to pursue personal objectives at another person’s expense. In this situation, the outcome is more important than the maintenance and nurturing of the relationship. It may be a useful conflict resolution style in some cases — for example, when dealing with another organisation where a long-term relationship is not necessary or desired — but should generally not be used by colleagues within an organisation who will likely need to keep working together and have some form of positive relationship. The competing style is high-risk, high reward. Even in the most competitive settings, there may be times in the future where an overly competitive conflict resolution style can result in unanticipated blow-back.

3. Avoidance

Avoidance is characterised by both unassertive and uncooperative behaviours, which usually takes the appearance of chronic distancing or sidestepping of difficult situations. There will be times where avoidance is the best conflict resolution style — for example, where threats of violence or intimidation are in place. Where safety is a concern, avoidance is appropriate, so long as it is framed in the context of postponement rather than completely ignoring a situation. In other circumstances, where the actual substance of the conflict is not particularly grave or concerning, such as a colleague who once in a while makes personal phone calls during work hours, avoidance may be a reasonable first pathway for conflict resolution. It’s simply not worth engaging at this point. Should ‘once in while’ become ‘all the time’, then it may be appropriate to revisit avoidance as an approach.

4. Accommodation

The opposite of competition, accommodation involves conflict resolution akin to ‘caving in’ and simply accepting the other’s point of view and demands. While this may take on the appearance of being self-sacrificing and generous of spirit, accommodation runs the risk of looking weak and causing resentment. Accommodation is most likely to occur when the ongoing quality of the relationship between individuals is more important than the actual outcome. Importantly, if accommodation becomes a default conflict resolution approach or style, this can start to breed internalised resentment and anger, which may ultimately explode at an inopportune moment.

5. Compromise

Compromises involve quick, reasonable and mutually agreed upon solutions that only partially satisfy both parties and involves a balance of assertiveness and cooperativeness. Compromise is usually best used when the outcome is not critical and there is a time pressure involved. However, by definition, compromises mean that no one is actually truly satisfied with the outcome, so compromises can sometimes mean the conflict re-emerges later in an amplified manner.

The TKI is a commercially available instrument and training programme that can be useful for managers. There are other models and tools available, including the conflict management scale, which are free to use^​15​.

Conflict resolution can, and should, look different in different situations. Recognising that different people can have different conflict resolution styles — and balancing the importance of the outcome and the importance of a healthy long-term relationship between parties in a conflict — can help you decide how to proceed in difficult situations.

Part 2 of this series will look at the negotiation and mediation skills managers can call on to help resolve conflict.

Conclusion

Conflict is an unavoidable reality in the pharmacy workplace, and managers need to accept and work with this reality. Managers may themselves be part of a conflict situation or be called upon to find ways of resolving conflict between other parties. In most cases, conflict is a function of both intellectual disagreement and emotional involvement, which is an amalgam of thinking and feeling.

Strategies to remove or reduce emotional entanglement allow for better problem-solving and are an important part of conflict de-escalation. Conflict management and resolution are functions of both communication skills and emotional intelligence. Self-awareness and self-reflection can support the development of skills with respect to dealing with conflict.