Communication and Conflict

Management in Health Policy

Presented by :Shaimaa Shamoun
Supervised by :Prof. Fathieh Abu-Moghli
 Outlines
Definition of conflict
key characteristics of conflict
Types of conflict
Thomas-Kilmann conflict model
The Process of Conversations
Communication skills need to resolve conflict
Two paths of engagement in conflict management
Intentional Inquiry
Conclusion and Summary
 Objectives
At the end of this presentation, PHD nursing student will be to:

Describe key Illustrate the

Define a conflict characteristics of
conflict types of conflict

Recognize how Discuss the Explore the

Thomas-Kilmann process to engage
conflict escalates conflict model in conversations

Apply effective Clarify Adapt methods

communication communication for engagement of
skills in these models LEAPS for conflict
conversations conflict resolution management
 Introduction

Conflict: to struggle, clash,

be incompatible. (Oxford Dictionary, n.d.)

Senge (1990) identified

conflict as a place of
possibility where we will
find opportunities for
creativity and innovation.
Relationship between Communication and Conflict

Why the learning of conflict management is important?

Participating in health policymaking requires
learning of conflict management skills and
applying specific communication to resolve it.
• Is It A conflict is
Healthy
Relationships?
Is it A conflict is Healthy in Relationships

Respect Creative
Acknowledging diversity
, thinking
and offer new &
of opinion
understanding alternative
differences solutions

Lesson learns
from conflict
 key Characteristics of Conflict
Experiencing strongly held
The issues are considered significant
differences of opinion, we believe
to at least one of the parties
there is obviously a right and a
wrong answer
There is a perception of an
incompatible difference or From our perspective, it is
threat obvious that we are right

When experiencing threat,

we move to defend ideas The other person is
obviously wrong.

The best defense is a good offense” My job to fix this by convincing

attacking the other person and their you that “I am right and you are
ideas increases the level of threat wrong.
 The 9/6 Perspective

The fact that the other

side’s perspective
needs to be heard and
listened to as their life
experience and culture
may differ from our
own.
Types of Conflict and Ramifications to Challenge
Bernard Mayer (2009) describes the six faces of conflict :

Low impact: The issue is not particularly significant or critical.

Latent: The conflict remains latent until something exposes it like topic of
religion and politics at social gatherings.

Transient: Occur within a time frame for engagement and resolution of the
dispute.

Representative: Almost all conflict is. Filing of a contract grievance is

representative of a deeper breakdown in a relationship between a supervisor
and a direct report.

Stubborn: Conflict has become complex, challenging, and resistant to

resolution.Resolution may be reach if handle well

Enduring: deeply rooted in structures, systems, identity, and values. Ongoing

engagement is required, to reach agreements that allow for forward movement
 Conflict Escalation Tornado

It demonstrates how conflict can

quickly escalate out of control.

By observing and listening to

individuals in dispute.

It is often possible to determine

where they are in the escalation
process and anticipate what
might occur next.
“Conflict Escalation Tornado,” by the 
Dispute Resolution Office, Ministry of Justice (Government of Saskatc
hewan)
, redesigned by JVDW Designs, is licensed under a 
CC BY 4.0 International License.
 The Process of Conversations

• Complex conversations require a process that

provides time for thought, reflection, and
structure that is inclusive, productive, and
innovative.
 The Process of Conversations
The four stages of the Process of Conversations:

Moving from
Preparing to Initiating the Increasing
inquiry and
mutual
participate conversation understanding
advocacy to
action
 Phase I: Preparing to Participate
• Preparing for a complex conversation, there are three
objectives to consider:

Decide who you are committed to being in this

process

Align what you are doing with who you are

committed to being.

Support others to prepare to engage

effectively
 Questions Support This level of Preparation
 Who is the conversation calling me to be?
 Why am I being invited to participate?
 Who am I representing?
 What are my own personal positions, philosophies, aims,
intents, limits, and interests related to the issues?
 What biases and blind spots might get in the way?
 Can you commit to self-reflection, awareness, and
honesty ?
 What is the situation calling you to do?
 Are you comfortable with the role you are taking?
 What will be most challenging?
 What kind of conversation do you want to have?
 Conversational Structures
•Used to influence •Used to divide •A discussion us
in a way that is to investigate t
honest and up a fixed truth of a theo
compelling resource. opinion
Persuasive Distributive Dialectic
conversation conversation conversation

•Used to put the •Used to create

parts together entirely new
into a whole. possibilities
Integrative Generative
conversation conversation
Questions Useful in Preparing for a Conversation
Around Policy

Focus is on
What is procedural
prompting this preparation. If
conversation? the process
Why are we
engaging at this feels fair and
time? Who is inclusive, then
asking for this the outcome is
conversation? more
acceptable.
A fair & Inclusive Procedural Preperation
is Dependent on a Number of Factors

What is What is your How will you What is the

What authority level of structure of
your do you bring? organize to
responsibility your work?
relationship Can you commit
and/or
complete the
convene a
to this the organization work? given
you represent? accountability conceptual
issue? information
? meeting
Conclusion of Phase I

• Phase I prepares participants to

think through psychological,
substantive, procedural issues and
clarify what they mean for their
participation.

• Participants in this phase have

prepared to engage in conversation
by building shared expectations.
Entering into the Conversation
Metaphor
 Phase II: Entering Into the Conversation
• 1.Creating a safe space 2. Increasing trust in
Objectives the process and the people
• 3. Including all of the voices.

• Consider your relationships to those in the conversation

Relationships
and those external to it, the issues, and your own
capacity to remain honest and compassionate in the face
of diversity.

Intention
• Be intentional about the environment and the
process.

Confidential •Determine whether the process is confidential? If it is not , who will be informed and how will they be informed?

Parameters •Clarify potential parameters such as time and expected outcome

Phase II: Entering Into the Conversation
• Define the principles to guide the
conversation called ground rules shared
expectations about
Principles participation ,behaviors ,logistics (how often
you meet and where), and communication.
• .

• Clarify the purpose of the conversation.

understand the problem, various points of
Purpose view, ?Making decisions? Debating
alternatives?

• Manage your tone. You can model the

conversational structure.
Tone
• Work to include all of the voices with
respect,so others are likely to follow.

• How will decisions be made: decision are

Decisions made by group ,group are engagment in
decision making .
Phase III: Increasing Mutual Understanding
Everyone has to be willing to share their information,
ideas, knowledge, and narrative, as well as understand
the same from others.

 The objectives of increasing mutual understanding are:

Create a Clarify
Support shared outcome
group underst s with
dialogue to
create anding sufficient
deeper of issues detail to
shared prepare
understandi and
ng of the desired for
challenge outcom impleme
es. ntation
Factors Increase Mutual Understanding

Balance inquiry and advocacy. willing to

explore other perspectives as well as
promote apoint of view

Be familiar with typical decision-making

patterns and possibilities

Build trust & ask Good questions (intentional ,

purposeful, come from curiosity, cause the
participants to ponder)
 Phase IV: From Inquiry to Action; Moving Forward

Guiding questions for moving to action:

 To what extent are we on the same page?
Are you stuck?
Has the proposed solution been reality tested?
What are the details?
 Is there a plan for accountability ? Indicators of
success help in making decisions to stay the
course or to make corrections.
When do you opt out?
 Critical Communication Skills
Relate to Conflict Management .

Listening for Shared Understanding

Asserting for Shared Understanding

Differentiating Fact and Interpretation

Inquiring for Shared Understanding

Intentional Inquiry: Asking Questions in Service of a

Conversation of Shared Learning
 A-Listening for Shared Understanding

 This level of listening and

responding is driven by a
deep commitment to :
 Understanding
 learning
 Collaboration
 Mutual purpose
 Mutual respect
 Shared learning.
 Fundamental Things Needed to Do in a
Conversation Committed toMutual Purpose

Understand the Jointly clarify

perspective by Share your and understand
understanding perspective by where Create options
objectives, understanding everyone that, will meet
needs, and objectives, shares interests both your
interests needs, and and separate shared and
around the interests interests, not individual
issue held by around the necessarily interests.
the other issue opposed to
person(s). each other
 Why the
listening is
critical ?
 Reasons that listening is Critical
1-Listening to the other person lets them know if they have been heard.

2-Listening & responding helps to clarify if what heard is, what was intended.

3-It facilitates the others' ability to share what is most important to them.

4-Effective listening can defuse emotion and provide feedback.

5-Listening encourages the group to slow the conversation down.

6-The ideas that people share are not only

conveyed by their choice of words but equally
by body language, tone of voice and
Facial expression
 B-Asserting for Shared Understanding
Is this context safe, and is this a safe person with whom to share my
needs, thoughts, and ideas.

We engage in a cost-benefit analysis, calculating the risks of sharing and

the potential benefits of putting ideas.
Asking the question, “Should you share?”, “How do you share in a way
that will make it easy for the others to hear, understand, and respond?

Move from either/or thinking to both/and thinking .

either/or:become polarized around the notion
both/and thinking :inclusive ,explain multiple perspective.

Both what you say and how you say it are critical.
Looking formaintain conversation that is safe and supports exploration of
the issues.
C-Differentiating Fact and Interpretation

What is the
differences
between a fact
and an
interpretation?
 C-Differentiating Fact and Interpretation
When preparing to share your perspective it may be useful to reflect on the
following questions:

What is the current situation? What can you state with certainty?

• Facts

What does the situation mean to you? Individually? Collectively?

• Interpretation

What are you working to accomplish in this situation? Individually? Collectively?

•Individual and collective purpose

 D-Differentiating Fact and Interpretation
• The critical consideration is in the how of
sharing.
Start by sharing the data As a hunch,not become a
and/or facts that are fact .remains open to
informing your perspective alternate interpretations

The most critical is

Describe specific events
sharing your
or behaviors that you
interpretation as a hunch.
have observed

Identify what you can observe Add your interpretation of

without judgment what these behaviors mean
to you
 Inquiring for Shared Understanding

An essential skill for achieving

deeper, shared understanding of
an issue is the ability to ask
good questions.

Will we ask questions in service of

divergent thinking or convergent
thinking?

Will the questions expand shared

understanding of the issue or
will look for quick solution ?
Divergent thinking

Increase the depth and breadth of

understanding of issue

Focus on increasing awareness of alternatives

Eencourage open discussion to gather diverse

viewpoints
 Intentional Inquiry: Asking Questions in Service
of a Conversation of Shared Learning
 Marilee Adams (2004), introduces a strategy she calls Question
Thinking.
 It as a “system of tools using questions for better results in almost
anything you do” (Adams, 2004, p. 18).
 “Questions drive results” Adams distinguished between two paths
of engagement, referred to as the Learner Path and the Judger
Path.
 Two Paths of Engagement
The options of Judgers Path and Judger Path:
Learners Path are a choice: What is wrong with them?
What is wrong with me?
Who are you committed to
Why are they so stupid?
being in the conversation? How do I fix this?
 What is the nature of the
challenge?
Is quick decisive action called for? Learner Path :
What happened?
 Would it be wise to slow down
What is useful?
and explore the challenge more What do I want?
completely? What can I learn?
 What choice is most in line What is the other person
with your intentions? thinking, feeling, needing,?
 Examples of Intentional Inquiry Questions
Broadening questions Provide a range of response options. Tell me more about that

Clarifying questions Clarify what is unclear or potentially misunderstood. What do

you mean when you say the situation is unsafe

Explaining questions Invite a person to share their line of reasoning or thought

process. how did you reach that conclusion?

Exploring questions Designed to get at what is most important about an issue.

What do you most need us to understand that you do not
think we currently understand?

Challenging questions Explore apparent inconsistencies in what is being said. Please

help me understand.

Brainstorming Generate ideas or options. What options have you considered?

Consequential Focus attention on the ramifications of a potential course of

action.How this decision impact the patients?

Intentional Inquiry asking questions with purpose in mind to seek greater

understanding of the issue
 Summary
Conflict is inevitable, especially for leaders& policy
makers.

 Managing conflict is not something to be feared;

rather, it is something that can be learned and
practiced. It just takes time.

Change the way you think about disagreements,

and how you behave during conflict.
Be willing to listen, engage directly,
and collaboratively with others.
 Conclusion
 Engaging in politics and policymaking require complex and
challenging conversations that often include conflict.

 To be effective in these conversations requires an

understanding of conflict, identifying it when it emerges.

 Create mutual understanding using the communication skills

of listening, asserting, and inquiring .
 Create mutual understanding lead to move forward
effectively in advancing health policy and being influential in
politics related to health care delivery.
 References
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Submissions to a Consultation on a Draft WHO Tool". International Journal of Health Policy
& Management, 11(2).
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