ABSTRACT
This study was undertaken to examine conflict management and resolutions in health institutions in Nigeria using Imo State University Teaching Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia as study area. Data for the study was collected from the Imo State University Teaching Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia, Abia state. The total populations of 6,200 workers are in the services of the sampled two health institutions payroll voucher, 2014.The senior staff which has entire population of 2,886 was sampled. The study employed both primary and secondary sources of data. The primary sources of data include questionnaire and interview while the secondary data was obtained from internet, textbooks, journals, past student’s dissertations and other relevant studies .A normal confidence level of 95% and error tolerance of 5% were used while sample size was determined by using Taro Yamane’s formular. To ensure the validity of the instruments applied in this work, the researcher ensured that the appropriate measurement was followed. A proper structuring of the questionnaire and the conduct of a pre-test of every question contained in the questionnaire were carried out to ensure that they are valid. Descriptive statistics, T-tests and correlation analysis was adopted for the analysis. The study found that the major cause of organisational conflicts is sharing of limited resources. Employees always compete for the scarce resources. Therefore it`s the prime responsibility of the management to ensure that the available scarce resources are utilized properly for the benefit of the organisation and other stakeholders. This approach to a certain degree will minimize chances of conflicts arising in organisation. Employee`s performance evaluation criteria should be clearly stated and communicated to all employees. Employees should be evaluated impartially considering the performance standard set. Therefore, to avoid the situation of conflicts to arise in organisations related to performance evaluation, the standards set by management should be specific, measurable, achievable and realistic and should have time limit (SMART).
TABLE OF CONTENTS
Title
page i
Declaration ii
Certification iii
Dedication iv
Acknowledgements v
List of
tables vi
List of
figures vii
Abstract
viii
CHAPTER 1: INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of the Problem 4
1.3 Research Objectives 5
1.4 Research Questions 5
1.5 Research Hypotheses 6
1.6
Significance of the Study 7
1.7 Scope
of the Study 7
1.8 Definition
of Terms 8
CHAPTER
2: REVIEW OF RELATED LITERATURE
2.1 Conceptual
Review 9
2.1.1 The
concept of conflict 9
2.2.1 Conflict dynamics (process)
11
2.2.2 Types
of conflict in institutions 14
2.2.3 Sources of conflict in
institutions 17
2.2.4 Conflict consequences
(outcomes) 20
2.2.5 Cross-cultural variation in
conflict sources and outcomes 22
2.3 Perspectives of Conflict 24
2.3.1 The traditionalist
perspective 24
2.3.2 The behaviouralist (human
relations) perspective 25
2.3.3 The interactionist
perspective 26
2.4 Theories of Conflicts 26
2.4.1 Interdependence theory 27
2.4.2 Social identity theory 28
2.4.3 Socio-cognitive conflict
theory 29
2.5 Conflict Management
Systems 29
2.5.1 Conflict management 31
2.6 Conflict Management Styles 33
2.6.1 Competition 34
2.6.2 Collaboration 35
2.6.3 Compromise 36
2.6.4 Accommodation 38
2.6.5 Avoidance 38
2.6.6 Managing conflict through stimulation
40
2.6.7 Restructure the institution
40
2.6.7 Introduce new individuals
into the institution 40
2.6.8 Stimulate competition in
the institution 41
2.6.9 Introduce programmed
conflict 41
2.6.10 Use of communication 42
2.6.11 Change the culture of the
institution 43
2.6.12 Cross-cultural variation in
conflict management 43
2.7 Approaches to Conflict
Management in Health Care Institutions 44
2.8 Empirical Review of
Conflict in Health Care Institutions 48
2.9 Theoretical Framework 50
2.9.1 Deutsch’s theory of cooperation
and competition 50
2.9.2 The dual concern model (DCM)
51
2.9.3 The interest-right-power
(IRP) theory 52
2.9.4 Application of theoretical
framework 54
2.10 Gap in Literature Review 54
CHAPTER 3:
RESEARCH METHODOLOGY
3.1 Research
Design 56
3.2 Population
of the Study 56
3.3 Sources
of Data Collection 57
3.4 Sample and Sampling Technique 57
3.4 Sampling
Procedure 58
3.5 Administration
of Research Instrument 59
3.6 Validity of the Research
Instrument 59
3.7.
Reliability of the Research
Instrument 59
3.8 Method
of Data Analysis 60
CHAPTER
4: DATA PRESENTATION ANALYSIS AND DISCUSSION
4.1
Demographic Characteristics of Respondents 61
4.2 Conflict
Management and Resolutions at the Case Institutions 64
4.3 Hypotheses Testing 68
4.3.1 Hypothesis One 71
4.3.2
Hypothesis Two 72
4.3.3
Hypothesis Three 74
4.4 Discussion
of Findings 75
CHAPTER 5: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary 77
5.2
Conclusions 77
5.3 Recommendations 78
References 80
Appendices 89
LIST OF TABLES
3.1
Population distribution of
each of the sampled health institution 56
3.2 Reliability statistics 60
4.1
Respondents as per case study health
institution 61
4.2
Gender composition of respondents 61
4.3
Age distribution of respondents 62
4.4 Education background of respondents 62
4.5
Job position of respondents 63
4.6
Period of employment with
institution 64
4.7 Respondent’s participation in
conflict management and resolution 65
4.8 perceived causes and effect of
conflict 66
4.9 KMO and Bartlett’s test 69
LIST
OF FIGURES
1: the conflict process 13
2: levels of conflict in institutional
behaviour 15
3:
two dimensional taxonomy of conflict handling styles (dual concern model). 34
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND
TO THE STUDY
Conflict
is one of many issues found in any institution, including health institutions
where constant human interaction occurs (Johnson 1994, Yu and Davidhizar 2004).
The potential for conflict to arise in a most health institution setting is
considerably higher due to the complex and frequent interactions among the
nurses and other employees and the variety of roles they play (Waldman, 2007).
Specialization and institutional hierarchy often add to the territorial conflicts
in hospitals (Huber 2000, Swansburg and Swansburg 2002). Although a reasonable
amount of conflict in the form of competition can contribute to a higher level
of performance and a conflict-free work environment is an exception and how
conflict is addressed is of paramount importance (Tomy, 2000). The sources of
conflict among hospital nurses and health care personnel include authority
positions and hierarchy, the ability to work as a team, interpersonal
relationship skills, and the expectations of performing in various roles at
various levels (Kleinman, 2004).
In Nigeria, primary health care is to be provided by Local
Governments, secondary health care by State Governments and tertiary health
care by the Federal Government. In operationalizing this policy, the Federal
Government decided to establish at least one tertiary health institution in
each State of the Nigerian Federation. Federal Medical Centres (FMCs) were
established nationwide in states that do not have Federal University Teaching
Hospitals present. The exception to this rule is Lagos State, which has one
such centre in addition to a Teaching Hospital. The general mandate given to
all the Federal Medical Centres within the framework of the laws establishing
the centres is to provide qualitative, affordable, specialized/tertiary level
hospital care to the citizenry and to ultimately reduce the burden of diseases
within the communities, through provision of prompt and emphatic preventive,
curative and rehabilitative services. The vision that informed the
establishment of 22 Federal Medical Centres nationwide is equitable presence of
the Federal Government in providing tertiary healthcare. It is therefore to see
to meeting all the health needs of the clientele, within the shortest time
frame. The question is; are they actually fulfilling this vision?
In line with the above, conflict that occurs in Nigerian
health institutions are usually between one department with another as a result
of limited resources; union with management; union with government which is
caused by disparity in pay or non implementation of an agreement entered with
the union and the federal government especially with Nigerian Medical
Association (NMA), Joint Health Sector Union (JUHESU), Nigerian Union of Allied
Health Professionals (NUAHP), Medical and Health Workers Union of Nigeria
(MHWUN) and National Association of Nigeria Nurses and Midwives (NANNM.
Most of these conflicts have affected the smooth operation of Imo State
University Teaching Hospital (IMSUTECH) and Federal Medical Centre (FMC)
Umuahia negatively. During disagreement between management of health
institutions and union which protect the employees, most patients that were
admitted don’t receive adequate medical treatment especially when it has to do
with the medical doctors. Even when it concerns administrative staff, admission
of new patients becomes very difficult since the employee that renders services
for registration of nee patients are not on duty.
The
difference of opinions, aims and interest of the individuals and groups in the health
institutions may breed conflict among the staff, between staff and management,
as well as stakeholders. The uneasy aftermath of this difference may be
monumental disorderliness, confusion and dysfunctional situation or environment
(Nweke, 2001).That notwithstanding, for the health institutions in Nigeria to
carry out their functions very well, management, staff and even students must
be interdependent. The various departments in the institutions must build a
good inter-human relationship in the institution. Amason (1996) averred that
people in Institutions have both personal and role preferences about the
Institutions’ actions and policies. However, conflict arise or result whenever
it is impossible for staff to carry out their desired action, hence, management
and staff in institutions sometimes engage themselves in conflict situation
which in the extreme cases, result in strikes thereby reducing and interrupting
productivity of the staff (Imhabekhai, 2001).
Researchers
believe that functional conflict can turn into emotional conflict if not
managed properly, which in turn disrupts collaborative efforts (Gardner and
Cary, 1999); leads to unprofessional behaviors (Pranulis, Renwanz-Boyle, Kontas
and Hodson, 1995); results in under commitment to the institution (Kroposki,
Murdaugh, Tavakoli and Parsons, 1999); increases
psychological stress (O'Driscoll and Beehr, 2000) and emotional exhaustion (Elloy,
Terpening and Kohls 2001, Peiro, Gonzalez-Roma, Tordera and Manas, 2001); results
in mistreatment of patients (Peiro, Gonzalez-Roma, Tordera and Manas, 2001);
elevates anxiety and work resignation (Kjormo and Halvari, 2002); and decreases
altruistic behaviors (Jex, Adams, Bachrach and Sorenson, 2003). This is only a
short list of negative consequences of poorly managed conflict.
Nevertheless,
some researchers argue that conflict, if treated with wisdom and creativity can
result in positive performance in the institution (Valentine, 1995). Finally,
conflict influences clinical decision-making as much as collaboration and
positive relationships do (Gardner and Cary, 1999).
The
first step for the effective management of conflict would be the recognition of
conflict and its sources from the viewpoints of nurses/caregivers and then
understanding how to moderate and control them according to those viewpoints (Eason
and Brown, 1999, Bartol, Parrish and McSweeney, 2001). Once the conflict and
its source are identified, addressing the conflict would be instrumental in
enhancing professional development and reducing the burnout rate among nurses (Yu
and Davidhizar, 2004).
1.2 STATEMENT OF THE PROBLEM
The
Nigerian health care sector, like any other sector in the country has witnessed
spates of industrial conflict both at local, state and national levels with
various degrees of impact on the population (Ojeme, 2012; Okafor, 2012; Obinna,
2011). Conflict has become a common occurrence in the existence and operations
of health care Institutions in the country, and Imo State University Teaching
Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia are not left out.
These conflicts are often the resultant effects of failure to amicably resolve
perceived grievances/disagreement between different stake-holders in the health
sector. The responses of employees to the dynamics in health care Institutions
sometimes hinder or bring closer the occurrence of conflict (Osabuohien, 2010).
Since the complex structure of health care Institutions creates opportunity for
conflict to occur, the ability of management and employees to handle conflict
is a sin qua non for effective health
care delivery.
With
the ever occurring industrial actions being embarked by health care employees
especially resident doctors in Nigerian public health institutions, it becomes
necessary to know the conflict management practices practiced by the management
of health care institutions in order to avert this ever lingering crisis and
help the suffering masses who are deprived of good Medicare when they are on
strike as these trend becomes worrisome.
More
so, since this incessant strike actions and other forms of conflict occur in
these health institutions, the effects of these conflicts on health care
delivery, the impact of the resolution of these conflicts on public perception
about public hospitals and the roles management hierarchy play in resolving and
managing these conflicts has never been studied. This study therefore becomes
pertinent as it examined these problems from the perception of the managerial
and non-managerial employees of the selected health institutions.
1.3 RESEARCH OBJECTIVES
The
broad objective of this study is to examine conflict management and resolutions
in health institutions in Nigeria using Imo State University Teaching Hospital
(IMSUTH) and Federal Medical Centre (FMC) Umuahia as study area. The specific
objectives are to:
i.
To examine the conflict management
practices in Imo State University Teaching Hospital (IMSUTH) and Federal
Medical Centre (FMC) Umuahia
ii.
To find out the effect of
conflict resolution and management on health care service delivery in Imo State
University Teaching Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia
iii.
To find out the major
factors responsible for causing conflicts in Imo State University Teaching
Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia
iv.
To identify the roles of
health institution management hierarchy on conflict management and resolution
in Imo State University Teaching Hospital (IMSUTH) and Federal Medical Centre
(FMC) Umuahia.
1.4 RESEARCH QUESTIONS
The
study attempt to answer the following research questions:
1. What
conflict management practices are practiced in Imo State University Teaching
Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia?
2. Does conflict resolution and management have
any effect on health care service delivery in Imo State University Teaching
Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia?
3 What
are the major factors responsible for causing conflicts in Imo State University
Teaching Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia?
4 What
role does health institution management hierarchy play in conflict management
and resolution in Imo State University Teaching Hospital (IMSUTH) and Federal
Medical Centre (FMC) Umuahia?
1.5 RESEARCH HYPOTHESES
The
following research hypotheses are formulated in line with the research
objectives and questions to be tested by this study;
HO1:
There are no positive conflict management practices in Imo State University
Teaching Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia.
HO2:
There is no significant effect of conflict resolution and management on health
care service delivery in Imo State University Teaching Hospital (IMSUTH) and
Federal Medical Centre (FMC) Umuahia
HO3:
There is no significant impact of conflict and conflict resolution on the
perception of the general populace within Imo State University Teaching
Hospital (IMSUTH) and Federal Medical Centre (FMC) Umuahia
1.6 SIGNIFICANCE OF THE STUDY
The theoretical significance of this study is that; it
has added to conflict management and resolution body of knowledge thereby
increasing the scope of conflict management in the literature. Another
significance of this study is its contribution to empirical investigations that
would be used by other investigator to support their studies. The methodology
and findings of this study would equip other researchers to draw inferences
from it. However, medical practitioners would benefit from this study by
drawing strategies they can employ to resolve conflicts within their
workplaces. It will also be significant to policy makers in the health sector
by a way of proffering solutions to ways, strategies and approaches they can
adopt in resolving conflicts when they occur. Lastly, postgraduate students in
the department of Industrial Relations and Personnel Management would find this
study useful as it would serve as a reference research project in the future.
1.7 SCOPE OF THE STUDY
The content scope for this research dwells on conflict
management and resolution in health institutions in Nigeria using Imo State
University Teaching Hospital (IMSUTH) and Federal Medical Centre (FMC), Umuahia.
The geographical scope is limited to Imo State University Teaching Hospital (IMSUTH)
and Federal Medical Centre (FMC) Umuahia between 2011 to 2015.
1.8 DEFINITION OF
TERMS
In other to achieve clarity and avoid misconceptions,
an attempt is made here to define some of the terminologies used in this study.
Conflict - refers to some form of friction, disagreement, or discord
arising within a group when the beliefs or actions of one or more members of
the group are either resisted by or unacceptable to one or more members of
another group. Conflict can arise between members of the same group, known as intra group conflict, or it can occur
between members of two or more groups, and involve violence, interpersonal
discord, and psychological tension, known as intergroup conflict.
Conflict management - the process of limiting the negative aspects of conflict while increasing the positive aspects
of conflict. The aim of conflict management is to enhance learning and group outcomes, including
effectiveness or performance in organizational setting as properly managed
conflict can improve group outcomes.
Conflict
resolution – it involves
the reduction, elimination, or termination of all forms and types of conflict
using Competing, Compromising, Collaborating, Avoiding, and Accommodating.
Health institution
– is a public organization that provides health care and other related
services.
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