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CONFLICT MANAGEMENT AND RESOLUTIONS IN HEALTH INSTITUTION IN NIGERIA: A STUDY OF IMO STATE UNIVERSITY TEACHING HOSPITAL (IMSUTH) AND FEDERAL MEDICAL CENTRE (FMC) UMUAHIA

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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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