Recommendation 1.1

Organizations identify and take action to prevent/mitigate factors contributing to conflict, for example:

• effects of shift work
• team composition and size
• workload and staffing
• manager span of control
• level of staff involvement in decision-making and provision of care
• resource allocation
• diversity in the workplace
• physical space

Recommendation 1.2

Organizations support the systems and processes that minimize conflict, promote team functioning, value diversity and enact a culture of inclusiveness. Common attributes that exist between and among Health-care professionals include:

• educational background
• work values
• ethnicity and culture
• age
• roles and responsibilities
• power
• scope of practice
• gender

Recommendation 1.3

Organizations implement a regular assessment, which may include quality indicators, to identify the types and outcomes (short-term and long-term) of conflict among nurses, physicians and other Health-care professionals. Assessment data is used to develop and implement both action and communication plans for the organization.

Recommendation 1.4

Organizations implement and sustain evidence-based strategies that support/enable leaders to foster selfawareness, possess emotional intelligence, competencies and utilize conflict management principles.

Recommendation 1.5

Organizations ensure all employees, physicians, and volunteers have the knowledge and competencies related to conflict management by:

• Providing ongoing mandatory skills-based education regarding cooperative or active style of managing and mitigating conflict, clear communication, effective team building through transformational leadership practices, and the promotion of mastery of emotional intelligence skills
• Ensuring education is accessible to shift workers
• Supporting changes in staff behaviour by using a comprehensive educational approach for different levels (e.g., individuals, teams, organization) tailored to specific settings and target groups. This includes implementing mechanism for refresher courses and/or regular updates
• Being congruent with the competencies frameworks for leaders (e.g. LEADS in Caring Environment Framework) and interprofessional practice (e.g. Canadian Interprofessional Health Collaborative, A National Interprofessional Competency Framework).

Recommendation 1.6

Organizations provide internal and/or external third party assistance (e.g. spiritual care, ethicists, safe workplace advocate, and professional practice specialists/consultants) to offer productive support, shared decision-making, and/or manage/mitigate conflict.

Recommendation 1.7

Organizations commit to the sustained use of cooperative or active conflict management styles (e.g., integrating and compromising), clear communication (e.g., crucial/learning conversations) and transformational leadership practices to create healthy work environments by:

• Ensuring all leaders, future and present, acquire leadership competencies in the management of conflict
• Adopting recruitment processes that assess conflict management capabilities
• Recognizing individuals, leaders and managers who demonstrate active management styles
• Implementing a formal mentorship program for managers and point-of-care leaders
• Meeting the College of Nurses of Ontario Nursing Practice Standards (2009) for nurses in an administrator role
• Requiring managers to demonstrate accountability for effective conflict management styles, clear communication and transformational leadership

Recommendation 1.8

Organizations evaluate the feasibility and effectiveness of the strategies, standards and policies of conflict management.

Recommendation 1.9

Organizations ensure multi-faceted and comprehensive structures, processes, and supportive policies (e.g. Universal Code of Conduct and Respect in the Workplace) are in place. Organizations should support those in leadership roles to apply organizational policies and processes that exist to recognize, assess, monitor, manage and mitigate conflict.

Recommendation 1.10

Organizations value, promote, enable and role model a culture that recognizes, prevents, mitigates and manages conflict, while enhancing the positive outcomes by:

• Developing structures and processes to foster effective intra- and interprofessional collaborative relationships
• Utilizing a professional practice model that supports practice accountability, autonomy, reflection, self-awareness and decision-authority related to the work environment and patient/client care
• Promoting professional autonomy and decision-making
• Implementing and sustaining effective staffing and workload practices
• Ensuring a climate of appreciation, trust and respect
• Including resources in orientation sessions
• Utilizing a variety of tools such as education, media campaigns and performance review processes

Recommendation 1.11

For interprofessional collaborative practice, organizational supports are provided to address conflict in a constructive manner by:

• Valuing the potential positive outcomes of conflict
• Identifying common situations that are likely to lead to disagreements or conflicts, including role ambiguity, power gradients and differences in approaches to patient/client care goals
• Establishing a safe environment in which to express diverse opinions and viewpoints regardless of outcome
• Establishing consistency and clarity about role expectations among Health-care professionals

Recommendation 2.1

Nurses and Health-care teams acknowledge that conflict is normal and seek to understand through self-reflective practice how their behaviours, values, beliefs, philosophies and perceptions affect relationships with others, and how the behaviour of others influence conflict by:

• Identifying personal behaviours and/or attitudes that may have contributed to conflict, and strive to alter this behaviour
• Acknowledging and understanding their personal conflict management style
• Developing conflict resolution skills by taking advantage of education offered. Where education is not offered, the individual should bring this need to the attention of their manager/director
• Understanding the importance of emotional intelligence, lived experiences and their relationship to conflict

Recommendation 2.2

Nurses and Health-care teams contribute to a culture that supports the management and mitigation of conflict by:

• Seeking resolutions when necessary through counseling (employee assistance programs), accessing support (occupational health) and education offered in their organizations or settings
• Utilizing problem-solving techniques
• Acknowledging and discussing the issue at forums such as staff meetings
• Demonstrating accountability for their actions, and commitment to managing and mitigating conflict
• Actively and constructively participating in their Health-care team initiatives
• Being accountable for, and respectful in the manner in which they communicate to patients/clients, families and members of the Health-care team
• Seeking opportunities and assuming the responsibility for sharing knowledge and best practices in nursing and health care

Recommendation 2.3

Nurses, Health-care teams and Health-care professionals:

• Acknowledge that conflict is addressed in different ways, depending on the relationship of the person one is having conflict with
• Understand how they uniquely contribute to the client’s experience of health or illness and the delivery of Health-care services, in addition to facilitating the paramount importance of improving health outcomes, which is guided by the philosophy of patient/client-centered care
• Understand and respect the roles, scope of practice and accountability of all members of the Health-care team

Recommendation 2.4

Nurses and Health-care teams practice and collaborate with team members in a manner that fosters respect and trust by:

• Ensuring open communication related to the provision of patient/client care and other work related activities
• Setting clear and objective goals for patient/client care
• Utilizing processes for conflict resolution and problem-solving
• Participating in a decision-making process that is open and transparent
• Being an active, engaged member of the Health-care team while demonstrating respect and professionalism
• Contributing to a positive team morale
• Understanding that the work environment is in part constructed by each member of the team
• Supporting each individual team member working to their own full scope of practice

Recommendation 2.5

Individuals contribute to the development of clear processes, strategies, tools and structures that promote the management and mitigation of conflict with emphasis on:

• Open, honest and transparent communication
• Constructive and supportive feedback
• Clear goals and objectives that foster professionalism, respect and trust

Recommendation 2.6

Individual nurses and Health-care teams actively participate in education to achieve a constructive approach to the management and mitigation of conflict.

Recommendation 2.7

Consult organizational and professional guidelines, policies and procedures related to the management and mitigation of conflict by:

• Seeking support
• Obtaining information
• Providing support to others

Recommendation 2.8

Utilize management tools/strategies for management and mitigation of conflict such as the following:

• Listen empathetically and responsively
• Allow the other person to express their concern
• Search beneath the surface for hidden meanings
• Acknowledge if you are at fault and reframe emotions
• Separate what matters and what gets in the way
• Learn from difficult behaviours
• Lead and coach for transformation
• Negotiate collaboratively to resolve an issue