Health care leadership and conflict handling

How to Develop Nursing Staff Relationship Conflict Resolving Methods

in Health Care

Facilitative way

Mika Koskinen

A dissertation submitted to the International Management Centres/Revans

University in part fulfilment of the requirements for the degree of Masters of

Business Administration

TABLE OF CONTENTS

1. INTRODUCTION

1.1 General remarks 6

1.1.1 Organization 11

1.2 Aim 12

1.3 Goals 12

1.4 Challenges 13

1.5 Limitations 15

2. PLANNED METHODOLOGY

2.1 Way of working 17

2.1.1 Research Planning 18

2.1.2 Literature Review Planning 22

2.2 Organisation review 23

2.3 Management overview 25

3. LITERATURE REVIEW

3.1 Execution 26

3.2 Conflicts 26

3.3 What kind of methods are there to 30

resolve conflicts

3.3.1 Leadership as a method 33

3.3.2 Organizational change as a method 37

3.3.3 Summary of Literature Review 41

4. RESEARCH

4.1 Execution 48

4.2 Research Results 50

4.3 Research Summary 57

5. SUMMARY OF RESEARCH AND LITERATURE 63

REVIEW

6. GENERATION, EVALUATION AND SELECTION OF OPTIONS

6.1 Options 67

6.2 Choosing Options 69

7. ACTION PLAN 73

Appendix I Budget and Schedule for the Action Plan 76

Appendix II Ten Essential Processes of a Facilitative Leader 78

Appendix III The Group Effectiveness Model 79

Appendix IV Trust and Organizational Learning 80

Appendix V Rapport from Tykkyläinen 81

Appendix VI Interview Minutes 83

Appendix VII Cover Letter for the HUS Questionnaire 85

Appendix VIII HUS Questionnaire 86

Appendix IX Cover Letter for the HUS Questionnaire in Finnish 87

Appendix X HUS Questionnaire in Finnish 88

Appendix XI Questions and Answers of IY/MBA Questionnaire 89

Appendix XII HUS Questionnaire Answers 96

Appendix XIII HRM Strategy in HUS 100

Appendix XIV Labour Process Theory 102

Appendix XV Basic Mediation Styles 103

Appendix XVI Innovation Challenges 104

Appendix XVII Intractable Identity Conflict Resolution Model 105

Appendix XVIII Roles of a Player 106

Appendix XIX TEKES Wellness and Health 107

Appendix XX HUS in a Business Environment 108

Appendix XXI DUTCH Model 109

Appendix XXII Plan Against Harassment 111

Appendix XXIII Conflict Assessment 112

Appendix XXIV References 113

Appendix XXV Glossary 118

List of figures and tables

Figure 1. Leadership principles and structures 7

Figure 2. Major conflict categories 10

Figure 3. Knowledge and trust in an organization context 14

Figure 4. Patient care is both the target and value that runs throughout

health care organization although the ultimate decisions are made by clinicians 23

Figure 5. Hierarchy suggestion of the leaderships based on learning 33

Figure 6. Summary of factors in a conflict situation 62

Figure 7. A suggestion of minimizing conflicts 71

Table 1. Main sources 21

Table 2. Conflict Prevention by IY/MBA 51

Table 3.Conflict Solving by IY/MBA 52

Table 4. Answering frequencies of the questionnaires 53

Key Words

Health care, KIBS, conflict management, relationship conflict, strategy, diversity

1. Introduction

1.1 General remarks

Working environments have, along with the developments of societies of all

mankind, become an ever changing prototypes and playgrounds of

development.1,2,3

There is a tendency of blaming individuals for the errors we

all have made: a cultural blindness to systems and processes when undesirable

outcomes happen.4 Evolution however, hasn’t been able to adapt to that move

with equal speed and this causes disturbances in our minds and organizational

structures.2,5

Hospitals differ from other organizations as what comes to

conflicts and there are many publications to support that.6,7,8,9

I’ve worked with

health care directly and indirectly for over twenty years, out of which the last six

mainly in consulting. I’ve grown accustomed to the different aspects of the

branch while working in the Helsinki University Central Hospital twenty-three

years ago for two years and after that at the same premises, parallel to my main

job, during eleven years. Eighteen years ago I did my diploma on public health

care marketing and I’ve been working as a consultant and facilitator for five

years. For approx. a year ago, we started to plan for a research plan of which

this dissertation work is the first phase after the planning period.

I presume, out of my experience, that one of the “evolutionary” gaps lies in

between organizational structures and processes. Some evidence exists to spoke

for that.10

For ex. Collins D. describes, that changes happen all the time and

organizations must make structural changes for ex. in a form of Business

Process Reorganization (BPR). The organizations of our time are designed to

reflect the old paradigm of business practice, and to automate the processes

1 Lucey J. Management Services Vol. 52, no.4 (Winter 2008), p.11

2 Handy C. Leader to Leader, Vol. 2002, No. 24 (April 2002), p.29-33

3 Riely J et al. National Productivity Review Vol.18, No. 3 (Summer 1999), p.63-68

4 Smith L. Journal of Innovative Management Vol. 12, no.3(Spring 2007), p.44

5 Engdahl R. Organization Development Change Vol. 23, No. 2 (Summer 2005), p.50-61

6 Porter-O’Grady T. Health Care Manage Review, Vol. 29(4), 2004, p.278-283

7 Nelson W. et al. Journal of Health care Management, Vol. 53, January/February 2008, p.41-53

8 Slomka J. Hastings Center Report, March-April 2005, p.45-46

9 Dreachling J. et al. Health Care Executive Nov/Dec 2006, p.9

10 Busby S.J. International Journal of Production Reseach Vol.31, No. 9 (September 1993), p.2183

doesn’t help.11,12

A standpoint of function might be created, but the processes

don’t usually follow the same borders, rather live their own lives.

Processes and leadership doesn’t exclude, but complement each others. In order

to be able to create processes, one has to lead the building of them. The

building of leadership processes are to be taken care of by the peer reviews,

where peers are from different process levels including the management. Some

kind of leadership processes lead to developments, that carry further and some

only to a short living victory. The leaders affect their subordinates through

their own interactions and organization’s culture.13

Already in 1982 Arthur

Turner pronounced:”Prescriptive consulting is telling clients what to do,

facilitative consulting is helping them to do it for themselves. Clearly demand

for the latter is increasing” 14

Figure 1. Leadership principles and structures in organizations (non human=systems,norms)

was processes work without constant leadership (source: author)

Collins D. Strategic Change Vol. 11 (2002), p.81-93 12

Ringhouse B et al. Health Forum Journal (March/April 1999), p.33-37 13

Chen L. Journal of American Academy of Business, Cambridge, Sep2004, Vol. 5 Issue 1/2, p432

*where L=leadership models, M=management models and O=organization models 14

Turner A. Harvard Business Review Vol.60, no.5 (September –October 1982), p.120-129

Management

Leadership

Authority Position

HRM HR Systems

Non-human/non

existant

Processes

Relationship conflicts in this dissertation are controversies in a scale from

differences to battles/riots in between nursing staff at Hospital District of

Helsinki and Uusimaa (HUS) and of different occupations. I use the term

conflict as Havansi, to be a controversy, that has a juridical element at least so

much, that is might “materialize” to overcome the in 2005 mediation law 3§

restricted mediation barrier – in other words to legalize. He describes three

main types of resolution: order from a third party authority,

recommendation/mediation result from a third party or resolution by the parties

themselves.15

Disputes are legalized conflicts and they may also have their

origin from one person, bad leadership or structures and/or processes. The third

party finds or moderates some of the following “resolution sources”: resolution

by law (text/interpretation), or when no law exist “according to the habits of the

land” or by “right and economical” (ex aequo et bono) or non-legalized other

methods than mentioned above.16

At this level of consciousness, we deal with

either unconscious individual driven conflicts or conflicts that have already

come up to the surface (later stage).

Facilitation in nutshell means ways to avoid unilateral control in

communications and management and a way to solve differences by

empowering and engaging people to take responsibilities for their own as well

as organizational actions and decisions. Leadership is an important – but not

sole factor – in generating or prohibiting and dealing with conflicts. Conflicts

should be everybody’s concern. Facilitative leadership makes this possible.

The structures – facilities and working environments – and decisions facilitation

are key ingredients of facilitative leadership. The opposite is evaluative

leadership, which gives credits and punishments and creates win-loose

situations.

Conflicts in an organization are found in humans and systems and they are

categorised into intra-individual, between individuals, processes and systems,

Havansi E. Conflict Management Vaihtoehtoista Riidanratkaisua vai Vaihtoehtoista Konfliktinratkaisua

(Alternative Dispute Resolution or Alternative Conflict Resolution) , edited by Lindfors H. Gummerus

Kirjapaino Oy,Saarijärvi 2005, p. 10 16

ibid. p.11

but also as hot (human) and cold (processes, systems) and according to the

circumstances for ex. health care conflict or inside/outside –conflicts or public-

private or formal-informal or rational-non-rational17

If the mechanism of conflicts is taken into account, one could divide the

conflicts into individual, organizational and inter-organizational. Researchers

argue that the commonest reaction of the organism to a conflict situation is to

look for a way out of the dilemma18

. This might thus turn out to build

innovative systems for dilemmas or then not, in which case the dilemma might

get worse.

The different leadership types look like having corresponding tooling factors in

mediation:

Transactional leader – cognitive mediation

Transformational leader – transformative mediation

Values-based leadership – could be almost any, but mostly humanistic, narrative

and transformative (this is however evaluative)

Charismatic leader (value based) – same as above, but in a preventive sense

Facilitative leadership – mediation should be at its best (non-evaluative)

(based on own observations and different mediation models, see Appendix

Kolb D. et al. Journal of Organizational Behavior, Vol. 13 (1992), p.320 (the three latter ones)

March J. et al. Organizations, Blackwell Publishers, second edition, 1993, p.132-133

Figure 2. Major conflict categories (source: author taken from different ones)

Everyone knows from our own working experience, that conflicts exist (also in

hospital working environment)19

. The personnel responsible (according to their

own due diligence of human resource) for the planning of disturbing behaviour

handling in HUS have said, that this has been a prolonged process that has been

going on forever20

. According to Deutsch, conflicts exist where ever

incompatible activities occur.21

The challenge is thus, to resolve these kinds of

behaviours that disturb the working environment.

Heuristics is an often used method for problem, and hence, conflict solving.

Most of the conflicts are resolved by references to regulations and/or by passive

waiting. Secondly, they are taken care of by the persons themselves and/or with

the help of a supervisor if a third party is consulted - sometimes (about in 5% of

the cases of third party consultancy)22

by the internal health care professionals

or ombudsman of working safety. A leader should be able to engage people

and to make them achieve goals together by the help of information and

for ex. Haraway D.et al. Hospital topics Vol. 83, No. 4 (Fall 2005), p. 16 20

Personal discussion with Cenita Blomqvist, 30.3.2009. 21

Deutsch M. The Resolution of Conflict Yale University Press, New Haven (1978) 22

Jameson J. Conflict Resolution Quarterly (2001), Vol. 19 no.2, p.177

Conflicts

Relational (hot)

Others

Task (cold)

Systems

Process

experience (capacity and ability) transferred to a sustainable change of

behaviour in a complex world of organizations.

1.1.1 Organization

HUS takes care of the primary and special health care services of an area in

Uusimaa municipality (Helsinki, Espoo, Hyvinkää, Lohja, Länsi-Uusimaa,

Porvoo and Vantaa health care districts), which has about 1,7 million

inhabitants. They employ some 21 000 people in 20 hospitals. They have one

CEO and the management is taken care of a central administration, called Group

Administration and Administration of Supportive and Special Service Areas

and an Executive Board of 15 members23

There are two ongoing projects concerning also this dissertation of conflict

management, namely leadership reorganization and harassment management.

Working community mediation was done there by my colleague, the report of

which is in Appendix V. It was a case where three from the same clinic had

been bullied. They reached an agreement, but a lot of criticism was heard.

HUS would like to see new tools to handle conflicts. They have seen an

increasing amount of conflicts in their own working atmosphere survey and the

interviewed confirmed that observation. They said, that constant organization

changes (smaller than BPR) have been going on since 80’s and two years ago

was a new strategy for eight consecutive years started. No changes, that could

disturb the results are ongoing, according to them, although the leadership plan

is going on parallel to the survey.

Some nationwide projects for occupational health care are ongoing

simultaneously. There is a National Action Plan to Deduce Health Inequalities,

which has managing stress at work, induction and guidance to work as a

foundation tasks on its program. They have an equality program for the years

2008-2011 as well (MSAH 2008:21). The government has also started a

program for renewing the municipal and service structures (law 169/2007) and

gender and salary equality programs (law 609/1986; more in the pages of

http://www.hus.fi/default.asp?path=59,404,4024,5796, 27.3.2009

ministry of social affairs and health:

http://www.stm.fi/en/occupational_safety/wellbeing).

The continuous plans are also listed at the end of the MSAH 2006:8)24

According to the rapports and the HRM managers, these shouldn’t bias the

results of this dissertation work.

1.2 Aim

To find ways to minimize and handle conflict situations with non-juridical

methods. A whole organization can suffer, when system-, process-, between

personnel or individual conflicts arises and they cannot be totally avoided.

There are many reasons for these conflicts and, however, many other reasons for

a suffering organization. The causality would be nice to know, but since other

disturbing factors are always present, we have to be satisfied with the ones

revealed in the literature review and asymptotically come as close as possible.

1.3 Goals

The present way of working doesn’t help in minimizing the conflict situations.

The goal is to find a new way of working with conflicts, that doesn’t jeopardize

the present methods, but helps to turn around the increasing trend of conflict

cases.

http://www.stm.fi/c/document_library/get_file?folderId=28707&name=DLFE-3949.pdf, 15.5.2009

1.4 Challenges

The dissertation questions are:

What could be done to prevent conflicts to happen?

What could be done to conflicts?

How to manage the conflict solutions in organization?

With what methods are the conflicts solved?

Leadership is a must, especially with a group of people targeting to a goal. A

group of people brings another need into the picture, namely organizations and

thus hierarchy, which means that procedural and distributive justices have to be

agreed upon tasks leading to the targets and goals. “Managers appear to be a

major source of the behaviours that are presented as bulliers (Rayner 1997,

Einarsen 1996) which is not surprising as it is felt by many that bullying is

linked to power relationships (Adams 1992, Bassman 1992, Ashford 1994,

Crawford 1997)25

”. Conflicts don’t vanish, rather pop up, when managers try to

avoid them.26

Management teams need to discuss about how to manage `the

self´, conversations and relationships. These kind of teams can built cooling

systems at the individual, team and organizational levels over time. These

practices can be learned.27

It is not going to be easy to make a fully proven

(significant correlations between the parameters of causalities) case that some

type of leadership or organization structure works better than others on long

term and with certain type of situations and people. The understandings of

management development are diverse and the temptation is to follow this up

with a set of recommendations as to how these understandings might “inform

practice”. This is highly problematical. 28

There is for ex. no universally agreed

social network theory to begin with29

Cooper C. et al.(Edited) Well-Being in Organizations, John Wiley & Sons Ltd (2001), p. 71 26

Edmonson A. et al. Californian Management Review Vol. 41, No 1 (Fall 2006), p.7-8 27

ibid. p.25 28

Maby C. et al. Management and Leadership Development (2008) , Sage Publications, p.228 29

Kildurff M. et al. Social Networks and Organizations, Sage Publications Ltd (2003), p.64

If different stages of organization, leadership and management development

claim different approaches, the managers should be aspiring. Many methods in

place already (Appendixes 11-VI,XI-XVIII,XXI-XXIII), prevent or minimize

conflict situations. To get through the hierarchy in any big (bigger than SME)

organization, is challenging and they don’t have a good system in place to do

that in HUS. They don’t exactly know what is causing the problem and what to

do with it.30

The non-linearity of knowledge and trust, that you see in Figure 3

below, shows that it is a continuous process and depends on other things like

values as well.

Figure 3. Knowledge and trust in an organization context. Conflicts can happen anywhere

here. The direction of the arrow doesn’t have to be only clockwise. (source: author)

personal interview with Cenita Blomqvist, working safety manager, HUS 127.4.2009

Knowledge

Revenue Relations

Understanding and trust

1.5. Limitations

Law is not the predominant mode of social control in organizations.31

dissertation includes only, what I call outside of court room conflict resolution

methods (see glossary) and in-house conflict handling. This doesn’t exclude any

kind of conflicts, although task conflicts are outside of the scope of this

dissertation by definition. Most often, they don’t exclude access to juridical

methods, if either part of the conflict or dispute wants to do so. The juridical

methods could be categorized into juridical and half-juridical (juridical methods

might also include alternative dispute resolution and half-juridical methods).

I restrict the interview work to HRM managers at HUS, where one

representative of nursing staff was from an acute clinic. For comparison

reasons, the literature review and research include other disciplines as well.

The focus being in the conflict handling, when conflicts already exist, restricts

areas like causes of them. Causes like change and leadership are also cures and

conflict handling occasions one can work with, which is why they are given

attention to. This limits the practical usability of this work as well as the

practical measures, which could be directed to a different handling of the

conflicts dependent on the different causes of them. We focus on the

relationship conflicts, whatever reasons, causes or sources they might have. This

is why I chose to limit the methods to non-juridical and facilitative.

Kolb D. et al. Journal of Organizational Behavior, Vol. 13 (1992), p.318

2. Planned methodology

2.1 Way of working

The whole HUS was chosen to represent the title subject, because of the

working and conflict handling experiences I had. They were so many in so

many different places, that an interview would have taken too long and to pick

up some representatives here and there would not be a representative sample of

the whole organization. Interviews are planned at the later stage, when we know

more about the survey. IY/MBA were chosen to represent a control group,

again, because I have had contact with them and hence the contacts made the job

easier. I could have interviewed them, but an interview by me, whom they

know, would not have been reliable and an interview by anybody wouldn’t give

us reliable results either, since the delicate matter is better to get unanimously.

A survey is more standardized than an interview, which makes it more suitable

for bigger samples. The two personal interviews were about experiences about

conflict management methods.

The interviews are done before the questionnaires, so as to able for adaptations

to the situations found in them. Only the group interview was recorded in

minutes. The others (Pehrman, Laitinen) were done through phone and

documented after they were finished. The IY/MBA questionnaire was

distributed through Survey Monkey® ASP-software over the Internet and the

HUS with Webropol® through their intranet. The questions were formulated so,

that it would reveal the methods by which the conflicts are solved now – not

what methods there might be for solving conflicts. By concentrating to those

methods that we know are working or not, is the point. On the other hand, I

didn’t want to rule new developments out totally, so there were open questions

one could use for that. Literature review might be able to shed some light in the

methods coming up in the future.

Literature review articles were first selected with the help of search words (see

2.1.2) and then according to the interesting subject, author or reference articles

and books on the areas that were interesting under those search terms found

from the primary selection. The methods are taken from the Saunders book

“Research Methods of Business Students”. From the previous experience I

knew about the Change Laboratory program in place of some Finnish Central

Hospitals and about SOPU (mediate by talking, sovittele puhumalla in finnish)

in use at Valio Oyj.

To be able to show the dependences and causalities with the literature research

and to do a research that could show the same in HUS and maybe something of

conflicts severity for the organization is planned in this work. To be able to do

these, claims a broad literature review and a selection of a sample, where people

have faced conflicts and want to do something to them.

2.1.1 Research Planning

An exploratory and partly explanatory survey was planned to nursing staff in

HUS and to a consultant company Itsenäiset Yrittäjät Oy (IY)/MBA students

from my own group. Both IY and MBA got a short presentation about the

conflict handling plan before the questionnaire. The presentation was about

conflict handling in general terms, not about health care. This way, I didn’t

have to explain the circumstances in the cover letter. The HUS form was

different, because of the continuance of that work, where as the others are

dropped off after this dissertation. There were some additional questions in the

HUS formula as well. Only HRM managers and CEO at HUS got a presentation

of the plan before the questionnaire and they were asked not to participate in it.

Approximately (not the same wording and choices) same questions were about:

how long a working career have you had

have you resolved a conflict yourself

how should the conflicts be solved (oneself/management/employees’

health care, working safety or a 3rd

party)

is there any good coming out of the conflicts

The questions were formulated together with a focus group of five of the same

administrative chiefs, with whom I did a descriptive interview about the present

situation (contextual data). The mixed method interview revealed straight away,

that there are conflicts in every group of workers and leaders and they have

already started planning for a new instruction booklet about bulling as well as a

plan to restructure the leadership. I could thus plan the questions to rely on that

The choice of unstructured, “disguise”, group interview was supported by the

short time left for the interview of HUS staff due to an in-house plan that

interrupted everything else at the administrative level of operations for two

months time. It was also supported by the size of the group and the aspects to

explore in conflict handling (being a broad view of their own work, conflict

frequencies and multiple types as well as the professionalism of the

participants). The way the interview was structured (non-interviewer dependent

and not informed to the participants) suits the facilitative way of working and

would hence open the access to sent the questionnaire more easily, than for the

interviewer to take the control. It also increases the reliability, when the

interviewer don’t steer it by asking linear questions. A method to come closer to

the workable certainty was used, which uses same kinds of questions than

mediation: circular and reflective. Due to the delay and already stated plans to

cope with it, the HUS HR group wanted to take part in every step of the way. It

is known, and studied in HUS, that hospital working environments in general

have a high conflict frequency so the literature research and the questionnaire

and interview is planned to take methods and new ways of handling conflicts

into consideration. Therefore most of the questions are of qualitative nature to

support the dissertation question of how to develop a method for conflict.

I needed additional background information (in addition to the Juha

Tykkyläinen’s report, Elke Suomi’s thesis, internet, media and my own

experiences from years ago and during the short planning period of the work

with Working Safety Fund and HUS), so an interview before designing the

questions for the questionnaire was scheduled. A group interview has the

advantage of recovering many points of view.32

The topic stays: conflicts and

Saunders M. et al. Reseach Methods for Business Students, Pearson Educated Ltd., Harlow (2007) fourth

edition, p. 339

their handling; no bias to take into consideration. I also interviewed the two

professionals who had experience on the Change Laboratory™ method HUS is

thinking of using.

The motivation for doing a qualitative research interview is threefold.

Firstly, there are many leaders, who seldom take the time to answer to a

large number of questions – in this case, those participating in the

interview, were even asked not to. Secondly, we need to do a lot of open

questions due to the explanatory approach. Thirdly, we would like to

know the causality and reasoning for their decisions.33

These antecedents

of a task, when given for ex. to a mediator, are clear in their simple

message, but leaves a lot outside of the scope: suitability to strategy and

vision, non-tangible and tangible resources recovery, cultural and other

challenges.

The questionnaire was planned so, that these research questions got answers as

well as the HUS plan a base for needs in conflict handling. The group

interviewees, the leading head doctor of HUS and communication director read

through it. It was sent via intranet to reach the whole personnel and the results

gathered the same way as for the IY/MBA group i.e. Sunday and the first three

working days of the week.

The preliminary, ”disguise” interview was meant to give a picture of the conflict

management in HUS and their thoughts of how to deal with it. While the

unstructured interview would reveal things about the situation without a goal

and minimized pressure, the structured would focus it more to the findings from

the unstructured. I used a mixed model of Interventive Questioning, an action

learning method a consulting company and a researcher had been using in the

Danish Lego. On the other hand, I was letting the participants steer the dialogue

as much as possible. Interventive Questioning uses four types of questions to

work through the problem and paradox to a workable certainty:

1) Linear questioning planned to reveal a more precise problem (didn’t use –

already a known situation of too high a conflict frequency)

ibid, p.310-328

2) Circular questioning to accentuate the intricacy of issues

3) Reflexive questioning to spur double-loop learning

4) Strategic questioning to get to the workable certainty

This was planned to help the hospital staff to go beyond their problems and

paradoxes. It became obvious from the first interview and the literature, that the

middle management was sensing anxiety and defensiveness, which is common

when implementing a change.34

The structure, actions and plans that HUS has, and is going to take, are taken

from the updated internet homepages35

, thesis work of Suomi E. and human

resource manager’s interviews. Here, the environment is built on the idea that

an argument of the characteristics of knowledge could predict the structure of an

organization36

. It is also stated, that organizational design would enhance

strategy.37

Thus, the organization structure is or should adapt to strategy and

knowledge characteristics. Both strategy and organization have been changed a

couple of years back.

IY/MBA

A questionnaire was prepared for these groups I’ve worked with. It was

sent to a consulting company Valmennustalo Itsensäylittäjät Oy

(Traineer’s House Self Overcomers Ltd, author’s translation) and MBA

students from my MBA course. By doing so, I might be able to get

manager’s and/or supervisor’s view with this questionnaire (this was not

separated from the HUS nursing staff – we only separate employees doing

patient work). The HUS staff will both openly comment on the foreman

position in conflicts and whether they have been using their help in

conflicts or managed them themselves.

Lüscher L. et al. Academy of Management Journal Vol. 51, No. 2 (2008), p.221-240 35

http://www.hus.fi and subsequent pages, 3.5.2009 36

Birkinshaw J. et al. Organization Science ; Vol. 13, No 3, May-June 2002, p. 274-289 37

Lowell B.et al. McKinsey Quarterly Issue 2 (2007)

Information

sources

What kind What

information

How gained Relevance

Table 1. Main sources of information

Tykkyläinen^= Member of the same workplace mediation group as I. Mediated with Zotow

in HUS conflict

HUS* = Same group as HUS “disguise” interview plus head doctor and communication

director

Pehrman**= Doctors thesis work, that I have taken part into. He works for Valio Oyj and has

developed SOPU (sopimalla ja puhumalla paras=best to agree and talk) method which is used

in Valio Oyj

HUS Qual./Quant. Conflict Survey Main research

source

IY/MBA Qual./Quant. Conflict Survey Management/control

Tykkyläinen^ Qual. Mediation Interview Optional method

HUS Qual. Planning Interview

meeting

Survey planning

HUS* Qual. Situational Interview over

General information

and survey planning

Laitinen Qual. Situational Interview over

phone and

experience

Change

Laboratory™

Pehrman** Qual./Quant. Situational Interview and

experience

Mediation and

Change

Laboratory™

Suomi Qual./Quant. HRM Thesis work Main target

Vartia Qual./Quant. HUS/Conflict Literature Main research target

EBSCO Qual./Quant. Literature IP Main literature

source

Tenttu Qual./Quant. Literature IP, Books Whole dissert.

DOAJ Qual./Quant. Literature IP Non-mainstream

Research area

FinnWell Qual./Quant. Literature IP Health Care

TERTTU Qual./Quant. Literature IP Health Care

MSAH Qual./Quant. Literature IP Health Care

2.1.2 Literature Review Planning

Some 100 peer review papers were written about mediation (as title) before

1980 and approximately 1200 after that according to EBSCO and some 17 000

and 19 000 according to Google Scholar respectively (but not as title and peer

reviewed). I chose the year 1978 as the last to be taken with. Tenttu and DOAJ

databases and some referenced (here at least one time) books serve as a basis

points for this dissertation for peer reviewed, scientific journal articles with

conflict, relationship, facilitative leadership, health care and organization

structure as well as all of their combinations as search words. The internet

pages used are not peer reviewed to my knowledge. I’ve also had all of the

referenced books in my possession. I read the reports from The Research

Programme for Health Services Research (=Terveydenhuoltotutkimuksen

tutkimusohjelma, TERTTU)38

and FinnWell (two major ongoing plans - the

former the one the continuance of which this dissertation work hopes to be part

of through the Working Safety Fund). One of the five weaknesses according to

the MSAH rapport mentioned earlier, was the lack of good practices in

psychosocial issues.39

Search words in addition to the title words and the ones mentioned above are:

Other conflict expressions and connotations: Conflict free, Conflict less,

Bullying, Harassment, Dispute, Disagreement, Argument

Other leading connotations: Leadership

Other facilitative connotations: Evaluative

Other solving expressions: Resolution, Restoration, Conciliation, Prevention

The time period of 1978-2009 was also chosen based on literature coverage

(with a couple of exceptions for books). In 1978 Argyris et al. published their

book “Organizational Learning”, Burns his “Leadership” and at the same time

another to be published book started its voyage: in 1990 Senge P. published the

learning organization article (and the book “The Fifth Discipline”) and last but

http://www.uta.fi/laitokset/tsph/terttu/ohjelmamuistio/to_rahoitus.html (15.5.2009) 39

http://www.stm.fi/c/document_library/get_file?folderId=28707&name=DLFE-3949.pdf, (15.5.2009), p.75

not least Schwarz R. published the “Skilled Facilitator” in 199440

- the same

time 1994 Möller described the term employeeship the first time41

. The method

should be facilitative , so I searched through the EBSCO database for mediation.

All the more so, evaluative methods had been used at HUS and they wanted

something new.

I took only peer reviewed, scientific journal articles with, that had the search

terms as titles, abstract or subject terms to begin with and to get a picture of the

proceedings during the whole time period. I didn’t want to use non-peer-

reviewed articles, since peer reviewed add objectivity. I work and follow

(work, volunteer job and read) these branches also through other than peer

reviewed, scientific articles, however. The interviews with the HRM people

from HUS add to the sources and are also increasing the reliability and validity

in form of a bigger sample and concentrated experience on conflict

management. They, if someone, should be aware of the recent proceedings,

since it is their job and they are constantly (like at the present time) reviewing

their processes on conflict handling and leadership. Suomi’s thesis on HRM

shows this (see Appendix XIII). It is part of their strategy and a statement of

values that they take care of the working atmosphere.

2.2 Organizational Review

Health care has a special need for organizing itself efficiently – as it has both an

ambulatory and non-ambulatory work. Time limits the possibilities to lead and

manage these kinds of systems. They are often financed or at least partly

supported by government treasury. The customer’s value is often the most

valuable – life. Almost the whole staff is highly trained and educated and could

thus be described as an expert organization. HUS has a centralized background

and is trying to decentralize and to defractionize decision powers – special area

CEOs and HRM strategy being examples of that. The ultimate decisions lay in

the hands of the clinicians on patient’s treatments and the decisions on personnel

in the hands of department head nurses. The administrative leadership is run by

Senge P. Sloan Management Review Vol. 32, No. 1 (Fall 1990), p.7-23 41

Møller C. Empowermant in Organizations, Vol. 2 , No. 2 (1994),p.4-13

clinicians, but there is a tendency to replace at least some of them with

professional leaders.

Leadership powers, or should we say rights in this case, are thus diversified

Figure 4. Patient care is both the target and value that runs throughout the health

care organization although the ultimate decisions are made by clinicians (source:

author)

with the exception of the ultimate patient care that lies in the hands of treating

clinicians. This creates an overlap both in patient care and the staffing and

administration for the good of the patient care. The budget runs in 1.4 milliard

Euros and staff in 21 000. It consists of five district hospitals and one central

hospital within a serviced area of some two million inhabitants.

Patients Staff Adminstration

2.3 Management Overview

Management in HUS is divided like in a corporate to centralized administrative

processes and to special divisions of specialities for the rest. This has been

according to the media the biggest source of trouble. My own findings42

support

this: in 1991 management was not mentioned in media at all and by the 2008

the situation was changed to a constant debate.

The metrics used are based on economical measures. A working atmosphere

survey is taken almost annually (not always so) as well as some quality

measures. The performance of personnel is not measured directly. The

innovativeness, conflict handling, problem solving and social capabilities are not

monitored. Operative efficiency and development should be the key entities, but

they are only indirectly measured (capacity of treating patients and the length of

surgical queues). The automation and IT should at large be used for controlling,

cost calculations and streamlining the processes to help managing the

production and customer operations.43

I look at the leadership and management the same way as Roger Herman.

Leaders are those, who people want to follow and have as their leaders.

Facilitative leadership, according to him, is about assuring and

understanding of objectives, providing resources, coaching, teaching,

encouraging, measuring and giving objective feed-back. 44

Still, managerial skills are needed and they significantly influence the

performance of the firm45

Koskinen M. Diploma in marketing, Marketing Intitute (1991) 43

Lewis L. et al. Journal of Computer Information Systems (Summer 2004) p,16-26 44

Herman R. Employment Relations Today (Winter 2000), p. 73-82 45

Barth H Journal of Small Business Management; Vol. 41, No. 2 (2003). p. 141

3. Literature review

3.1 Execution

Literary review was done by the help of the advanced search possibilities

provided by the service providers, and after they were gathered to one file,

the search engines provided by the Windows® Office programs. The

abstracts, conclusions and discussions of each paper were read through at

least once to get an overview of the subject for the interviews,

questionnaires and literature review. A written rapport by Tykkyläinen

(Appendix V) about a mediation in HUS was included as well as thesis

about HRM in HUS (Appendix XIII) were used. As planned in

Organizational and Management Overview, leadership, which is missing

now, lead to the inclusion of them into the methods of conflict

management both in Literature Review and Research.

3.2 Conflicts

Why conflicts should be resolved

A lot of publications on the differences in conflict handling and methods in

health care and others have been published. 46,47,48,49

Simply put:”

Health care is a particularly humanistic environment, requiring higher levels of

relationship and functional interaction between and among the members of the

work community. The opportunity for conflict is accelerated by increased

intensity of interaction and human communication50

”. Conflicts are a source of

frictions in organizations.51

A study says that 30-42% of management times go

to conflict handling.52

Also salesmen take a hit of 1/6th

of their working time

going to conflict solving.53

Staff time loss of 20% has been reported in a health

Porter-O’Grady T. Health Care Manage Review, Vol. 29(4), 2004, p.278-283 47

Nelson W. et al. Journal of Health care Management, Vol. 53, January/February 2008, p.41-53 48

Slomka J. Hastings Center Report, March-April 2005, p.45-46 49

Dreachling J. et al. Health care Executive Nov/Dec 2006, p.9 50

Porter-O’Grady T. Health Care Manage Review, Vol. 29(4), 2004, p.283

Murtha B. Fairfield County Business Journal (2005), p.42 53

Bradford K. et al. Journal of Personal Selling & Sales Management Vol. XXIX, No. 1 (winter 2009), p.33

care publication.54

Also taken from health care, conflict produces organizational

stress and reduced well-being, helplessness and flight behavior.55

Not that I’m

concentrating on the drawbacks, rather exploring the predominant conflict issues

at large (more about it in for ex. Conflict Dialogue, Kellett P, 2006).

As for ex. Jameson states, mediation is not a broadly used conflict handling

method. According to him, the biggest hindrance is prejudice on its

functioning.56

. Another study mentions another likely explanation to be that

solving problems belongs to the role of the manager and they are not ready to

give up the responsibility to their subordinates57

. Mediation is also not generally

used to solve problems in Finland.58

It probably should, since Finland tops the

European Union countries of workplace bullying.59

According to a survey done

by The Finnish Forum for Mediation, Switzerland has used working community

mediation actively. They have some 30 private practitioners for that.60

The benefits of conflict handling for health care are well documented: better and

positive working environment that supports conflict discussions and reduces

stress61

, diminished, conflict related health problems62

, growing pre-social

behaviors63

as well as less occurrences of aggressive behaviors64

. The opposite

also applies generally to changes within relations in an organization (they are a

source of psychological morbidity, early retirement, increased job strain,

sickness absenteeism and injuries).65

The same has been shown about the

negative correlation of relationship conflicts on “employees’ attitudinal

Miller M. et al. The Physician Executive (July-August 1999), p.46 55

De Dreu et al European Journal of Work and Organizational Psychology Vol. 14, No.2 (2005), p113 56

Jameson J. Conflict Resolution Quarterly, Vol. 19, No.2, Winter 2001 57

Kolb D.M. et al. Negotiation Journal, Vol. 1, 1985, p. 379-388 58

Pehrman T. Valio Manager of development and training, preliminary results from his thesis work 59

Publication of the Ministry of Social Affairs and Health, Occupational Safety and Health Strategy, Follow-up

Report 1998-2007, Helsinki (2008), p. 19 60

Pehrman T. Valio Manager of development and training, preliminary results from his thesis work 61

Murphy L Trends in Organizational Behavior, Vol. Z,1995, p.1-14 and Haraway D. et al. Hospital Topics,

Vol. 83(4), Fall 2005, p. 11-17 62

Stokols D, Hostility, Coping and Health, Washington, DC:APA, 1992, p. 65-76 and McGabe D. Corporate

Nonunion Complaint Procedures and Systems, Praeger, New York,1988 and Shapiro D, Justice in the

Workplace, Hillsdale NJ, Erbaum, 1988, p.51-78 and Shapiro DL et al. Journal of Personality and Social

Psychology, Vol. 65, 1993, p.1167-77 63

Greenberg L. et al. Organizational Behavior, Wiley, New York, Vol. 3, 1996,p.49-64 ja Domenici K et al.

Mediation, Waveland Press, 2001 64

Greenberg L., Justice in The Workplace, Justice in the Workplace, Hillsdale NJ, Erbaum, 1993, p.79-103 ja

Shapiro D. et al. The Legalistic Organization, Sage, Thousand Oaks CA, 1994, p. 303-06 65

Saksvik P. et al. Work & Stress Vol. 21, No. 3 (July-September 2007), p.244

responses, such as satisfaction and commitment, employees’ psychological well-

being and affective acceptance of group decisions and further more they

increase group members’ stress and anxiety and job tension”66

Task to relationship conflicts

The same paper (Gamero) states with a help of a meta-analysis, that this doesn’t

apply to task conflicts, which have been shown to have negative, no effect or

even to have some positive effects on job satisfaction with group’s decisions and

a desire to stay in the group. They conclude that relational conflicts have more

negative effect than task conflict on job satisfaction. Further, some evidence was

found, that the task to relationship conversion happens, when a biased

information processing or self-fulfilling prophecy triggers it. This is more

pronounced, when the issues are serious and there is a potential of great personal

gain or loss. So, the negative effect of task conflict might be due to a

hidden/unnoticed transformation to a relational conflict. This task conflict effect

has been shown in a clinical medical department of 182 members67

. Their own

analysis showed that this applies for a team as well: a relationship conflict

mediates the positive relationship between task conflict and team tension and

negative relationship on team enthusiasm. Social interaction was shown to

moderate this so, that when it is high, the relationship is weakened and when

low enhanced.68

Relationship conflicts are shown to mediate the effects of value

diversity, which decreases satisfaction, intent to remain and commitment to the

group.69

De Dreu found that when constructive conflict management and

integrative negotiation yielded high joint value in the short run - innovativeness

decreased in the long run.70

However, it is not easy to distinguish between task

and behavior (read relationship conflicts) conflicts. Task conflicts increase

performance and behavior conflicts, central to bullying, decrease it.71

might help to differentiate them.

Gamero N. et al. Journal of Occupational and Organizational Psychology Vol. 81(2008), p. 50 67

ibid. p.50-51 68

ibid. p. 53-64 69

Jehn K. et al. Administrative Science Quarterly Vol.44 (1999), p.741 70

De Dreu C. Journal of Organizational Behavior Vol. 29 (2008), p. 7 71

Cooper C. et al.(Edited) Well-Being in Organizations, John Wiley & Sons Ltd (2001), p. 71

Bullying

The strongest predictors of bullying were found to be role stressors, social

climate and leadership behavior72

. Another group studying managers in teams

found that:”substantial conflicts erupt in management teams, dysfunctional

group dynamics followed by frustration and flawed decisions may be the rule

rather than the exception. Clearly, realizing the promise of teamwork at the top

requires finding ways to help management teams deal constructively with tough

conflicts”73

. They didn’t find silencing to work, but found that relationship

conflict handling could be learned. They argued, that organizations with

relationship conflict perform weaker, that those without. It might also be that

this is due to co-occurrence of task and relationship conflicts.74

I found two studies about bullying among municipal workers in Finland.

The other states that: “Bullying differs from ordinary ‘conflict’ since there

is generally a victim-perpetrator configuration, such that the person on

the receiving end feels unable to defend him or herself successfully. It is an

accumulation of many ‘minor’ acts amounting to a pattern of systematic

maltreatment”75

. The other paper found, that 10,1% of the ones, that

answered to their questionnaire (n=949) suffered from bullying. Envy, a

weak superior, competition for tasks or advancement and competition for

the supervisor’s favor and approval, were the most common reasons. Also

features in the functioning of the work unit were listed: poor information

flow, an authoritative way of settling differences of opinion, lack of

mutual conversations about the task and goals of the work unit and

insufficient possibilities to influence matter concerning oneself.76

A meta-analyze came into a conclusion, that 13 different studies have

resulted in a moderate and positive correlation between conflicts at work

and psychosomatic complaints. They also found studies of work place

Hauge L. et al. Work &Stress Vol. 21, No. 3 (July-September 2007), p. 224 73

Edmonson A. et al. Californian Management Review Vol. 41, No 1 (Fall 2006), p.6 74

ibid. p. 29,citing Jehn and Amason in Journal of Applied Psychology 85/1 (February 2000) 75

Salin D. Scandinavian Journal of Management (2008) doi:10.1016/j.scaman 2008.04.004, 18.06.2008. 76

Vartia M. European Journal of Work and Organizational Psychology Vol. 5, No. 2 (1996), p. 203

conflicts to correlate with anxiety, frustration and burnout.77

There have

also been contradictory findings about bullying. Einarsen states, that

bullying cannot simply be explained in terms of the personality traits of

those involved or of the situation78

3.3 What kind of methods are there to resolve the conflicts

Most often, the methods of choice are passive, like waiting for the problem

to solve itself avoiding contacts or prioritizing something else. “Each

source of conflict suggests a different approach, which ranges from

avoidance strategies, such as solution, cover-up, resignation, and

withdrawal, to engagement through negotiation, arbitration, and

compromise. Whatever the character of the conflict, it usually has three

primary components: emotions, verbal content, and procedure.”79 Kolb is

suggesting almost similar methods: self-help (force, vengeance),

avoidance (withdrawing from the relationship), “lumping it” (tolerance the

situation without public comment), negotiation, and the involvement of

third parties as mediators, arbitrators, and/or adjudicators.80

In Knowledge Intensive Business Services (KIBS), like HUS, we learn

through knowledge assets that have a paradoxal aspect: they must be

codified if they are to become an asset but once this happens, they lose

value. A mainstream definition of knowledge is the capacity to act and of

organization, that they are taken to be learning, knowledge-generating

systems of individuals interacting with each other in group/social contexts.

Individuals and contexts are two distinct phenomenological levels

interacting with each to form the whole system. It is then taken for

granted, that these must be managed. In other words, one has to manage

the individuals, who possess the tacit knowledge.81

People need

knowledge to act and that could be provided by education, which have

De Dreu C. et al European Journal of Work and Organizational Psychology Vol. 14, No.2 (2005), p112

citing Spector and Jex (1998) meta-analysis 78

Cooper C. et al.(Edited) citing Einarsen in Well-Being in Organizations, John Wiley & Sons Ltd (2001), p. 70 79

Arwedson I et al. Work, Vol. 28 (2007), p. 3-11 80

Kolb D. et al. Journal of Organizational Behavior, Vol. 13 (1992), p. 316 citing Black, 1987, Nader&Todd,

1978) 81

Stacey R. Complex Responsive Processes in Organizations, Routledge, New York and London, 2001, p.17-39

been shown to work in conflict resolving. They can benefit (holding at

least during one year follow-up) from even a short conflict resolution

training program.82

This was also supported by a study among nurses in

the U.S.83

Canadians did a three factor conflict resolution trial including

mediation and negotiation training and found out that all three worked

well, but negotiation training (on the top of the rights-based) only, didn’t.84

“Mediation has been advocated as an effective and fair method for

resolving disputes. Studies of mediation in simulated organizational

contexts suggest that people find it fairer and more satisfactory than other,

more controlled forms of intervention (Karambayya and Brett, 1989;

Lewicki and Sheppard, 1985, Sheppard 1984). Despite these desirable

attributes, recent research suggests that managers are not natural

mediators (Kolb, 1989a; Sheppard, 1984).”85

Methods for structure and context

The differences in goals, perceptions and feel for joint decision making are

the key players in intergroup conflicts. There are less perceptual conflicts

in an organization when less external sources of information exist (like in

medical care) and this also impacts the extent of conflict as the source

might be a homogeneous outside group. If we have autonomous

departments rather than decentralized, there will be more perceptual

conflicts. For a prediction one needs an explicit specification not only of

cross relationships, but also of their functional form and the values of their

critical parameters. March et al. came into a conclusion, that in restricted

resources situations the relations between individuals become strictly

competitive and as resources are reduced further, intergroup conflict tends

to increase. 86

Zweibel E.et al. Conflict Resolution Quarterly Vol. 25, No.3 (Spring 2008), p.321-350 83

Haraway D. et al. Hospital topics Vol. 83, No. 4 (Fall 2005), p. 11 84

Bendersky C. Industrial and Labor Relations Review Vol. 60, No.2 (January 2007), p.221 85

Kolb D. et al. Journal of Organizational Behavior, Vol. 13 (1992), p. 316 86

Also, the organizations react to conflicts in four major ways: solving

problems, persuasion, bargaining and “politics”. The disagreements over

goals are fixed in bargaining and less fixed in “politics”, but not in

persuasion or problem solving where there is reliance on information

gathering. On the top of that, persuasion uses testing of sub goals for

common goals and evoking relevant criteria. The use of politics within the

organization solves intergroup conflicts. The difference in the use of

solving conflicts is either on analytic processes in problem solving and

persuasion (individual rather than intergroup conflicts) or on the other

hand bargaining in bargaining and “politics”. One of the problems with

bargaining is acknowledgement and legitimating of heterogeneity of goals

and that it almost necessarily places strains on the status and power

systems in the organization. Therefore an organization will perceive all

conflict as individual rather than intergroup and hence, as problems in

analysis. They argue that neither psychological nor sociological research

has provided assumptions to generate solutions to two person and n-person

cooperative games.87

I also looked for evidence for a theory in social

network for this in other publications used in this dissertation and found

none.88

There is however an Intractable Identity Conflict Resolution

Model (Appendix XVII) that rely on the social and organizational identity

“theories”. A Midwestern hospital conflict with broad consequences was

an example in this study. Physicians couldn’t cope with administration –

characteristics, that could be from HUS as well. The Mode is a four

phases, sequential identity change method.89

Suggestions where to look

for conflict methods are many; like one example: take compromising angle

together with problem solving angle with in all conflict handling90

. These

kinds of methods multiply the amount of methods by using basic methods

and adding something to them.

ibid, p.150-151 88

for ex. Kildurff M. et al. Social Networks and Organizations, Sage Publications Ltd (2003), p.64 89

Fiol C. et al. Academy of Management Review Vol. 34, No. 1 (2009), p.32-55 90

De Dreu C. et al. Journal of Organizational Behavior Vol. 22 (2001), p. 665

3.3.1 Leadership as a method

There are many models for the leaders to follow. The most recent ones entering

this arena have been knowledge based (information management), values based

(part of which is facilitative), coaching and shared managing systems adapted to

many organization models. Knowledge elicitation is a process of assisting

others to generate their own knowledge. 91

By knowledge based leadership, one

does not, hence, refer to the old management style of managing by holding on to

pieces of information and let others pay for it. They all work together for a

better outcome than a single system - or would it be better to find own way

around. The form in this case could look like: L x M x O* = different

possibilities (result is more than the sum of parameters). When different

circumstances and ways to analyze these are taken into account, the job of

finding a right structure in every situation would be a challenge.

As management (for ex. by Kotter) is described to bring order, consistency and

quality, leadership is about preparing the enterprise for change and helping

employees cope as they struggle through it92

; I chose leadership to these

methods of conflict handling.

Dawson R. Developing Knowledge-Based Client Relationships, Butterworth-Heinemann, Boston (2002), p.17 92

Mabey C et al. Management and Leadership Development, Sage Publications Ltd (2008),p.29

Figure 5. Hierarchy suggestion of the leaderships based on learning

organization. (source: author) Visionary and spiritual leaderships might be

included in every one of them (with the exception of Laissez-faire).

Relatively little is found on the interactional effects on job stressors and

bullying. According to a publication from Norwegian researchers

(Einarsen et al.), who has published many papers on conflicts in working

conditions, they found only three - theirs and one from Vartia M. and

Vartia M. et al. They showed, that role conflicts, interpersonal conflicts

and tyrannical and laissez-faire leadership behaviour are strongly related to

bullying. “Support was found for an interactive relationship between

decision authority and role conflict at different levels of laissez-faire

leadership. Hence, bullying is likely to prevail in stressful working

environments characterized by high levels of interpersonal friction and

destructive leadership styles.” They found also, that supervisors role in

intervening and managing stressful situations is particularly prevalent.93

hierarchic system together with responsibility and eagerness to help others

creates a conflict prone combination, in which management have a

Hauge L. et al. Work &Stress Vol. 21, No. 3 (July-September 2007), p. 221

Shared

Facilititative

Coaching

Value-Based

Knowledge-Based, Process-Based

Consultative

Servant

Entrepeneur

Motivational

Authentic

Laissez-faire

significant role.94,95

A lot of evidence speaks for active participation on the

job to be associated with better worker health.96

In the U.S. the Joint Commission of Accreditation of Hospitals has pre-

published standards that require health care organizations to have specific

process to address impaired physician behavior. The leaders

must proactively create high-performance work cultures that enable

talented professionals to realize their full potential, which is limited by

disruptive behavior. This policy is seen as one of the organization-wide

initiatives the administration has to take into account. They have found

that most bullies (72%) are bosses.97

The symptoms of bullying might not all be easy to notice: “verbal or

physical attacks, excluding or isolating from the peer group, taking away

responsibilities or devaluating one’s work and efforts, social isolation and

exclusion exposures to teasing, insulting remarks and ridicule98

”. The

same symptoms mentioned in the publications in the conflict chapter

(3.2.1.). They continue by stating that bullying is not an either-or

phenomenon, but a gradually involving process. The supervisors are

found to be the most frequent perpetrators of bullying, role and

interpersonal conflict and leadership behaviour are the strongest predictors

of bullying99

Role conflict is not only a challenge for leadership. When identities are

implicated in a conflict, the conflict tends to escalate, encompassing an

ever-widening number of issues. Parties then become trapped in an

ongoing conflict spiral from which they have difficulty extricating

themselves.100

Some nine parameters (attributed charisma, idealized

influence, inspiring motivation, intellectual stimulation, individualized

consideration, contingent reward, manage-by-exception passive, manage-

Nelson W. et al. Journal of Health care Management, Vol. 53, January/February 2008, p.41-53 95

Dreachling J. et al. Health care Executive Nov/Dec 2006, p.9 96

Deutsch S. Labour Studies Journal (Spring 1981), p. 128 97

Martin W. Hospital Topics Vol. 86, No. 3 (Summer 2008), p. 22,26 98

Zapf D. et al. European Journal of Work and Organizational Psychology Vol. 10, No. 4 (2001), p.370 99

Hauge L. et al. Work &Stress Vol. 21, No. 3 (July-September 2007), p. 224, 234 100

Fiol C. et al. Academy of Management Review Vol. 34, No. 1 (2009), p.32

by-exception active and the non-leadership dimension of Laissez-Faire)

were measured for subordinate resilience association. They found the

latter three not to correlate, rather the opposite, and inspiring motivation

not to have a positive effect. The participants were asked a question of

how they managed the situation. Those indicating help from their

managers had better resilience. 101

Facilitative leadership activates the participants to a joint leadership force.

Everyone leads something. One has to carry some strength and means of

intercourse in a facilitative working environment. One of the metaphors

that come into mind is power. “Power within dialogic is seen as relational

and rooted in discursive practices, thus not amendable to being ‘held’ as

possession by any particular individual or group. In contrast, both power

and knowledge within the critical perspective are indeed conceptualized as

possessions. These are possession that can be exploitative in the hands of

dominant but which also have the potential to be emancipatory in the

hands of the oppressed. “102

The relation of management and labour in processes has gained ground

since Braverman’s Labour and Monopoly Capital (1974). Kauppinen T.

has also published a book on a good employee and has thus contributed to

a Finnish view of management labour relations. Critical Disclosure points

out this dualism (for ex. individual/collectivism) and “embrace

‘reflexivity’ which extends the notion of critique to one’s own knowledge

and truth claims. This requires that all those involved in the development

of managers (including managers themselves) be constantly and critically

aware of their own presuppositions, values, motivations and social

positioning.”103

I presume that “all those involved” refer to operational

workforce as well and “social positioning” to all social hierarchies. The

Labour Process Theory (see Appendix XIV) assumes an inherent power

imbalance which creates the structural tendency for antagonism between

Harland L. et al. Journal of Leadership and Organizational Studies Vol. 11, No.2(2005), p.2 102

Mabey C. et al. Management and Leadership Development, Sage Publications Ltd (2008), p. 131 103

ibid. p.127-128

labour and capital. The broad areas of Critical Disclosure to management

development can be divided according to the following broad areas104

• Power, control, resistance and

• Ideology critique

o of specific or ‘micro’ development initiatives

o wider-scale discourses

• Critical management pedagogy

o emancipator action learning

o reflections on attempts to critically educate managers

De Dreu on the other hand has suggested that handling relationship

conflicts in teams are best done by avoidance rather than collaborating or

contending. 105

3.3.2 Organizational Change as a method

There is no one, all-encompassing, broadly accepted theory of

organizational change and there are no agreed guidelines for action by

change agents106,107

. Resistance is not necessarily a result of poorly

managed change implementation; it is merely an expected human

response. On the top of this, good health care organizations (at least in the

U.S.) are found particularly difficult to build108

. If this resistance is

brushed aside as being “irrational”, it can make bad matters worse. The

concept of resistance is by definition synonymous with conflict, and it

implies disagreement either about the change content, the change process,

or both. Through the use of constructive conflict, the employees will be

more adaptable and flexible as they feel more involved during the process.

A sense of active participation and the acceptance of expressing one’s

ibid, p.139 105

De Dreu C. et al. Journal of Organizational Behaviour Vol. 22 (2001), p. 309 106

Dunphy D. Human Relations Vol. 49 (1996), p.541 107

Saksvik P et al. Work & Stress Vol. 21, No. 3 (July-September 2007), p.244 108

Tucker A. et al. California Management Review, Vol. 45 (2), Winter 2005, p.55-71

views imply a feeling of control and influence, and lessen the chances of

feeling victimized and ignored during the change process.109

Stress (could be a cause of change) have also been shown to have a

negative effect on bullying. The researchers conclude by referencing

Leymann (1996) and Zapf &Einarsen (2003), that “if the management of

organizations avoids or neglects its inherent responsibility to adequately

address stressful work conditions, this may be a particularly high risk

situation in terms of the development of bullying at work110

”. Role conflict

and role ambiguity needs to be addressed as soon as possible, since it has

consequences for the change implementation per se, for the work group

and for the individuals.111

Jimmieson et al claim that, if the employees have control and a sense of

prediction and understanding about impending organizational change

implementation, they are more likely to appraise the situation.112

According to Morsing, organizational culture, that encourages constructive

conflicts ,will create an enhanced ability to change. 113

Saksvik concludes

that awareness of norms and diversity, early role clarification, manager

availability and the use of constructive conflicts to cope with change were

indentified in his study to minimize conflicts.114

The less conflicts there

are the more likely the partners are to have confidence for each other in

time.115

Wheatley is recommending free dispersal of knowledge, delegation of

authority, individual empowerment, network of relations and continuous

organic change of the organization.116

ibid, p.255 110

Hauge L. et al. Work &Stress Vol. 21, No. 3 (July-September 2007), p.237 111

Saksvik P et al. Work & Stress Vol. 21, No. 3 (July-September 2007), p.255 112

Jimmieson N. et al. Journal of Occupational Health Psychology Vol. 9 (2004), p.11-27 113

Saksvik P et al. Work & Stress Vol. 21, No. 3 (July-September 2007), p.255 citing Morsing 114

ibid., p.256 115

Bayer S. et al., System Dynamics Review Vol. 22, No. 3, (Fall 2006) 116

Czajkiewics Z. et al. Economics and Organization of Enterprise Vol. 2, No.2 (2008), p.9 citing Whealey

Visionary leadership is called for to motivate professionals in demanding

environments (what they call the edge of chaos=state where complexity

absorption and reduction take place) and overcome reluctance to share

knowledge. Dialogue, as a special form of relating, is to be used as a tool

to develop knowledge.117

Spiritual leadership goes beyond dialogue and

works with facilitating their feelings of completeness and joy working

together.118

These forms of management control are linked to calls for a

shift in organizational design from hierarchical structures to network

organizations consisting of webs of self-managing professionals with

shared interests and common values. These kinds of systems are based on

dual theory:

-Rationalist teleology, which basically holds that the cause of human

action is human motivation expressed in autonomously chosen goals and

means of achieving them, arrived at through rational reasoning expressing

ethical universals

-Formative teleology, which is a systemic theory of causality in which a

system unfolds patterns of behaviour that are already enfolded in its

structure in movement to a mature state that can be known in advance 119

Learning

Action is a choice made on the basis of knowledge and that knowledge is

evaluated in the light of the consequences of the decisions and actions it

leads to. This is a systemic, error-activated notion of learning. 120

Argyris

and Schön made notions of single and double loop learning, which means,

that Model I is a debating mode in which they seek to win and not to lose

and in which they withhold information and is a loop without a loop of

dialogue, which exist in Model II.121

Learning and knowledge creation

becomes shared routines that are stored in the form of culture, social

structure organizational procedures, traditions, habits and norms. This

higher level consists of sets of shared assumption, beliefs and behaviours

which are internalized by individuals as part of their individual mental

models. Stacey calls this mainstream theory of learning (that is a systems

Stacey R. Complex Responsive Processes in Organizations, Routledge, New York and London, 2001, p.25 118

Pawar B. Leadersip&Organization Development Journal Vol. 29, No.6 (2008), p.544 119

Stacey R. Complex Responsive Processes in Organizations, Routledge, New York and London, 2001 120

ibid. 121

Argyris C. Academy of Management Learning and Education Vol. 1, No. 2 (2002), p.206-218

theory). There has been shown, though, that knowledge is also created in

stories a community of practitioners tell each other122

. This has been used

for ex. in Anu Kajamaa’s dissertation in health care professionals at Oulu

University Hospital.

Hindrances for our learning tends to hold on to unilateral control,

maximize winning and minimize loss, suppress negative feelings as well

as trying to be as “rational as possible in a situation. 123

A cure for

unilateral control has been found in bilateral control: heedful interrelating

is a missing link between trust and performance124

Boisot things that people are information processors, who pay an

evolutionary price for complexity production, where complexity is an

increase in data.125

Stacey concludes:” that knowledge is the act of

conversing, and learning occurs when ways of talking and therefore

patterns of relationship, change. The knowledge assets of an organization,

then, lie in the pattern of relationships between its members and are

destroyed when those relational patterns are destroyed. This begins to

suggest very different ways of thinking about what it might mean to

‘manage’ knowledge in an organization.”

Olson et al. says, that “every strategy needs different combinations of

organization structures and strategic behaviours for success126

”. The

changes may come from internal- or external sources, but must be

compensated by simultaneous changes in organizational structure. But, as

P.Duncker said: “the core is innovativeness and marketing” and Vargo and

Lusch said:”skill and knowledge is all you need”.

Stacey about Lave, Wenger, 1991,Brown and Duguid, 1991, in Complex Responsive Processes in

Organizations, Routledge, New York and London, 2001, p.36. 123

Argyris C. Reflections Vol. 4, No. 2 (Winter 2002), p.8 124

Biljsma-Frankema K. et al. The Internal Journal of Human Resource Management Vol. 19 No. 1(January

2008), p. 19-20 125

Stacey R. about Boisot M. (1998)Knowledge Assets:Securing Competitive Advantage in the Knowledge

Economy, Oxford University Press, Oxford in Complex Responsive Processes in Organizations, Routledge, New

York and London, 2001, p.22. 126

Olson E. et al. Journal of Marketing; Vol. 69 (2005), p. 49

There are two ways of making up the knowledge management strategy,

namely codification and personalization. When codification is used,

technocratization is the only way to structure the organization.127

personalization is used, one can also use centralization, which means, that

decentralization needs decentralization of knowledge management. HUS

uses codification, but is not technocratizised (and cannot be, authors note).

One could add that this applies to mediation as well. The mediators use

this, when they steer the dialog into affective or fact based.

Of the organization studies the 7-S’ are applied here. When making the decision

to intervene in conflict resolving:

1. Strategy

2. Structure

3. Systems

4. Skills

5. Staff

6. Style

7. Super ordinate goals128

are to be taken care of, since task conflict can be used for the benefit of the

organization and some are better to discuss through some to neglect.

When the cultures collide, one should also compare some of these key

characteristics and avoid resistance and challenges in change management by

taking these into account proactively. If the cultural differences are big and

products are complex, one should have trust and flexibility as a goal and stay

away from process control, which is counterproductive.129

Right kind of

control, on the other hand, might be beneficial. Diversity in a sense of

demographical and cultural differences and powers to foster innovation and

problem solving, has been shown to benefit organizations130

, but to be one of the

greatest challenges as well131,132,133

. Jehn has recently revealed some of the

mysteries in conflicting results on diversity:” It is the diversity associated with

Liao Y-S. International Journal of Management Vol. 24, number 1 (March 2007), s.53-60 128

Pascale et al. McKinsey 1981 129

Solberg C. Journal of International Marketing Vol. 16, Number 3 (2008), s.57-83 130

Orlando R. et al. The International Journal of Human Resource Management; Vol. 17 (2006), p.2091-2109 131

Bryce D. Harvard Business Review (May 2007), 87-92 132

Pascale et al. McKinsey 1981 133

Fiol C. Academy of Management Review Vol. 221, no.4 (1996),p.1012-1021

values, and not social category that causes the biggest problems in and has the

greatest potential for enhancing both workgroup performance and morale134

Conflicts tend to silence people and measurements have to be taken, if

innovation is needed. The cultural differences by nature take more resources

than homogeneous structures, but there is a lot to gain. It can very well be that

diversity is the only and the most important activity parameter on this century135

The same researchers that pointed out the problems that developments

bring into organizations came up to the conclusion, that we should “see

through the dominant Discourse/discourses to which we are exposed to

and might thus be able to reflexively form a personal and subjective

judgement as to where we stand on the issues this rises” 136

De Dreu and others have recently pointed out, that the positive effects of

conflicts that could take place in narrow circumstances in organization are

easily outperformed by the negative ones.137

They also found in a study of

27 partly-autonomous teams, that collaborating and cooperating works

with task conflicts whereas relationship conflicts are better to leave as they

3.3.3 Summary of Literature Review

Relationship conflicts hurt commitment, satisfaction, psychological well-

being, acceptance of group decisions and are a source of stress, anxiety

and tension. The meditative effect might be moderate or high. It is

mediated through value differences among other things. Help from

leaders are needed to fix roles and leadership challenges to avoid value

diversities. Silencing conflicts didn’t work, although it is mentioned (for

ex. by Arwedson and De Dreu) as one of the conflict management

methods (among negotiation, arbitration and compromise – Kolb adds self

help and some other third parties). The origin might be also task conflicts

turning to relationship conflicts while left unattended. A Finnish study

Jehn K. et al. Administrative Science Quarterly Vol.44 (1999), p.758 135

Wheeler M. Harvard Business Review (March 2005) p.S1-S6 136

Maby C. et al. Management and Leadership Development (2008) , Sage Publications, p.228 137

De Dreu C. et al. Journal of Organizational Behavior Vol. 22 (2001), p. 309-328

revealed this to be a problem in HUS138

. They had weak superiors,

competition, poor information flow, authoritative way of working, lack of

communication on mutual visions and they could influence matters

concerning oneself. Psychosomatic complains are shown to correlate with

conflicts.

Heedful interrelating is proposed to be a missing link between trust and

performance139

. The demand of control is elementary to an organization

and among others Merton, Sleznick and Gouldner has made models of it.

Merton emphasizes rule as a response to the demand for control and

Selznick delegation of authority and Gouldner the use of general and

impersonal rules regulating work procedures in part of the response to the

demand for control from the top hierarchy.140

It has also been found that

control (felt by the study population) is a mediator of psychological

ownership to a job and an organization and there is a positive correlation

in between them. 141

Further, a narrow managerial span of control

(MSOC) positively correlates to gender diversity142

providing further

evidence of heed as a missing link between trust and performance.

Recently in German a research group claimed, that in leader-member –

relation, the member “needs” support to feel the well-being at job.143

sort of control was also used in a longitudinal study in a health care setting

of elderly care, were 188 workers answered a questionnaire on a

transformational leadership environment. A positive effect on their well-

being was found, when leadership had a feed-back loop to help the

employees to perceive their work in a transformative manner.144

Vartia M. European Journal of Work and Organizational Psychology Vol. 5, No. 2 (1996) 139

Biljsma-Frankema K. et al. The Internal Journal of Human Resource Management Vol. 19 No. 1(January

2008), p. 19-20 140

March J. et al. Organizations, Blackwell Publishers, second edition, 1993, p.55-63 141

Pierce J. et al. Journal of Social Psychology Vol.144, No. 5 (2004), p.507 142

Richard O. et al. International Journal of Human resource Management Vol. 17, No. 12 (December 2006),

p.2102 143

Schyns B. et al. Leadership & Organization Development Journal Vol. 29, No. 7 (2008),p.631-646 144

Nielsen K. et al. Work & Stress, Vol. 22, No. 1 (January-March 2008), p.28

Framework of facilitative leadership:145

Valuable information

Free and informed choice

Internal commitment

Compassion

This becomes reality:

Test assumptions and inferences

Share all relevant information

Use specific examples and agree what important words mean

Explain your reasoning and intent

Focus on interests not positions

Combine advocacy and inquiry

Jointly design steps and ways to test disagreements

Discuss undiscussable questions

Use decision making rules that generates the commitment needed146

The change and conflict (resistance) antecedents resemble each other,

which suggest that they are related. Change becomes easier when these

above mentioned facilitative methods are in use and roles defined in time.

Constructive conflicts might help in change and some leadership models

(for ex.visionary, facilitative, spiritual, self are participative) could

enhance it. The power of expert service-entrepreneurs is humanity147

one group says this:”We cannot build a company that fits for the future

unless we built the company that fits for the human beings. Only human-

friendly organizations can win, develop and compete. Like Porter-

O´Grady said, the job of health care professionals is very human and he

suggested a conflict resolution program with mediation for the whole staff.

Schwarz R. The Skilled Facilitator: A comprehensive Resource for Consultants, facilitators, managers,

trainers and coaches, San Francisco (2002), Jossey-Bass 146

http://www.schwarzassociates.com/files/229.pdf, 12.4.2009 and Moore T. Library Trends Vol. 53,

No. 1(Summer 2004), p. 231

147 Pietiläinen T. et al. Tiedon kauppiaat (Knowledge Sellers), WSOY (2007 ) first edition, p. 258 translated

from Asiantuntijapalveluyrittäjyyden voimavara on inhimillisyys

A mediator should always be available.148

Consequently, trust is the

attention as trust is the core element of all human being relationships.” 149

Leaders have to manage the reciprocity and transitivity in social networks

and this cannot be a one man responsibility. Everyone has to be a leader

in its own rights. Knowledge and emotions are tied together through

believes or assumptions, they are the first indicators of change and

constitute thus a lot of useful knowledge to back-up business decisions150

Stacey handles knowledge as Sveiby – it has to be turned into action (see

Organizational Change).151

Mabey has pointed out the power and

knowledge dimension of them as possessions. There is need for organic

change since knowledge is created in stories community practitioners tell

each other and on the other hand we (according to Stacey and Boisot)

seem to be victims of an evolutionary process of information flow and pay

the price of complexity for that. Knowledge is a process and conflicts are

highly contextual, which many mediators pay attention to. 152

Conflicts

affect the emotional atmosphere and break cooperational working

relationships.153

People learn better through emotions154

, which could

mean that by facilitating knowledge and emotions and conflicts

performance should follow. Education at least for middle management in

a form of mediation and negotiation training is motivated.155

Mediation

has been shown to work, but managers might not be natural mediators and

need education.

Porter-O’Grady T. Health Care Manage Review, Vol. 29(4), 2004, p.281 149

Czajkiewics Z. et al. Economics and Organization of Enterprise Vol. 2, No.2 (2008), p.9 150

Pietiläinen T. et al. Tiedon kauppiaat (Knowledge Sellers), WSOY (2007 ) first edition, p. pages 216,217 and

221 that refer to Martha Nussbaum Upheavals of Thoughts, Cambridge University Press (2001).Freely

translated from Nussbaum: translated from Asiantuntijapalveluyrittäjyyden voimavara on inhimillisyys

,rakentaa tunteiden ja tietämisen yhteyttä uskomusten kautta. Tunteminen on tietoista ajattelua nopeampi keino

tunnistaa ymäristön muutokset.Tunteet sisältävät paljon käyttökelpoista tietoa liiketoiminnan

päätöksentekotilanteissa. 151

Stacey R. Complex Responsive Processes in Organizations, Routledge, New York and London, 2001

p.223 152

for ex. Isaacs H. The CPA Journal (September 1999), p. 52 153

Pietiläinen T. et al. Tiedon kauppiaat (Knowledge Sellers), WSOY (2007 ) first edition, p. 232. Freely

translated from Ristiriitatilanteet vaikuttavat tunneilmpiiriin ja rikkovat yhteistyösuhteita. 154

Hart J. Modern Eclectic Therapy (1983), Plenium Press, New York 155

for ex. Bendersky C. Industrial and Labor Relations Review, Vol 60, No.2 (January 20027), p.221, Zweibel

E. et al. Conflict Resolution Quarterly Vol. 25, No.3 (Spring 2008), p.321-350

and Haraway D. et al. Hospital topics Vol. 83, No. 4 (Fall 2005), p. 11

Of relevance to HUS is the notion, that autonomic departments mean more

perceptual conflicts where as lack of resources, intergroup conflicts.

Politics help for the latter, but organizations have a tendency to perceive

conflicts as individual and use analytic methods (more suitable for private

conflicts) to solve them. Bargaining used for intergroup conflict

management can cause legitimating of goals heterogeneity and thus strains

in power systems (read problems of leadership). This is shown with

tyrannical and Laissez-faire leaderships and interpolated into “milder”

forms. Health care is prone to conflicts due to a combination of

interactive systems and responsibilities and eagerness to help among staff.

Supervisor role is prevalent. They should show attributed charisma,

idealized influence, intellectual stimulation, individualized consideration

and contingent reward. Active participation is a remedy for better worker

health.

Reliability

In many cases the findings were done by at least two independent

researchers or groups. Some lack of hospital nursing staff data was

apparent, but I found the major ones and the plans of TERTTU and

TEKES had similar findings, although the TEKES FinnWell is working at

the high political level and is not finished yet. The publications were peer

reviewed academic journals and the books from well known sources and

cited at least ones in the papers. Five different sources were used for

literary review to add to the reliability. I tried to use meta-analysis and

different sources from different cultures when possible. Also the number

of citations was a criterion to choose – the more the better and more likely

to be used in this dissertation. However, conflict resolving, being a new,

cross-scientific and innovative branch of research, needs more since

innovative ideas might come firstly from unknown sources. I took a wide

look at the papers and read the abstracts, conclusions and/or discussions in

over thousand of cited and not cited papers. The DOAJ is a source of such

publications.

Validity

The nature of human actions in such a complex context as conflict

situations hospitals is almost impossible to comprehend. I looked for

theories, which are usually better formulated and wider than hypothesis of

a couple of parameters of situations. When I found an observation in a

paper I also searched for its counterpart (like conflict – conflict free) to get

hold of the causalities. The papers and books were all from the recent time

period after the major findings in organizational learning. The conflict

resolution programs are relatively new to the health care system.156

I also

found a couple from Finnish hospitals and from HUS, which comes

culturally closer to the interviewed material. The works of Yrjö Engstöm,

Juhani Aer are not ready, but Elke Suomi’s has already been published.

Both a personal interview with a pioneering hospital director Dr. Päivi

Laitinen157

and with Timo Pehrman158

convinced, that the Change

Laboratory doesn’t have a significant effect on conflicts at least not in a

couple of years perspective. Juhani Aer is not ready with his work with

the clinic of psychology and that could be used in this dissertation work

either. I could have improved the validity by concentrating on the hospital

context only, but then the reliability in such a small material would have

been jeopardized. I have my experience to thank, that I could choose the

right papers in the second view (after the initial filtering with the databases

with their search engines).

Telephone interview with Dr. Laitinen on the 7.11.2008 (they have used Change Laboratory since 2004) 158

Interview with MBA Timo Pehrman on the 19.5.2009 (have familiarized himself with Change Laboratory

through literature and interviewed HUS personnel)

4. Research

4.1 Execution of Research

The interviews had two most important questions embedded into five to

secure, at least partially, the repeatability of them. It is unlikely that an

interview, not revealed to be an interview and questions that doesn’t just

include those answers are critical for the work, would steer the answers.

The questioning was carried out at the same timeframe and by the same

interviewer. The semi-structured (with a theme), group interview is rich

of facts, perceptions, feelings and opinions159

, which would be of help in

this work with conflicts. The group interview is better than separate ones

since the theme doesn’t hold from one situation to another and could

disturb the results. Also an action resource spiral of the kind Saunders

show in his method book is possible throughout the interview.160

group helped to formulate the questions for the questionnaire buy

circulating the proposals through the different leaders and managers –

some of them a couple of times. I worked with the interview the Working

Through the Paradox method in mind to make it clear that we have gone

beyond the problem and have something comprehendible in my hands.161

A “disguise” interview was done with a group of HRM managers. It was

agreed that I’d prepare the minutes. Everyone invited could attend. I had

chosen a manager from every HRM area. The atmosphere was open (also

because it went under the “disguise” name of informal coffee break

meeting for looking at different options to work out the plan for the bigger

plan of Working Safety Fund/HUS research) and relaxed. It went well

and discovered that there were an increasing amount of conflicts. I did

have to interrupt the proceeding discussion once, when one of them hadn’t

said anything yet.

The HUS questionnaire was sent to all in direct patient care working nursing

staff, but the self-selected random samples was prematurely agreed to represent

those answering within the first four days (from Sunday on) of total nursing staff

Greiner L. et al. Consulting to Management (1983) Prentice_Hall Inc., Englewood Cliffs, p. 220 160

Saunders M. et al. Research Methods for Business Students, Prentice Hall, Essex (2007 ) fourth edition, p.141 161

Lüscher L. et al. Academy of Management Journal Vol. 51, No. 2 (2008), p. 228

of some 14 000 to correlate with the IY/MBA answering time. The whole

project is of action research character, but this dissertation is only about the first

phase of it, which is why the answering time exceeds that of this work.

The questionnaire is circulated through a pilot audience of one clinic before

sending to the sample population. No other premature methods were used (like

pre-survey contact letter), since the organization has an informed plan on

organization leadership and conflict handling already in place.

The other survey was sent to 29 persons representing leaders (age 32-64) from

different backgrounds and jobs. This was done to add to the reliability of this

qualitative work.

The HUS questionnaire was sent to the whole staff and nursing staff (those

working with patients) was diluted from it by the help of one question.

Both surveys were circulated and recovered under a short period of time.

Meaning was to get the first response, which should mirror those

interested in conflict handling (either positively or negatively) and filter

out those, that didn’t see the need to respond. This was done to maximize

the recovery. In the case of IY/MBA survey I made one mailing to notice

about answering due to the limited number of participants. In the case of

HUS, none was sent due to the large number of participants.

The questions were designed to reveal the validity and extend of conflict

experience among the participants. This is why the years of over all

working experience and working experience at the same employer were

asked as well as how often they had faced conflicts. The method question

was the most essential one and taken from the prior literature review

fractioned to sub-questions of task/relationship conflicts as well as own

and supervisor/managerial involvement, ways the conflicts are resolved or

disappeared or prevented. Reason question was there for the importance

of resolving the conflicts and thus a sort of validity question.

4.2 Research Results

IY/MBA

The IY/MBA –survey was answered by 15 of 29 persons (52%) with a help of

one E-Mail reminder three days after the first one. Over half of the participants

had been working for at least 20 years and none less than 10. 11 of the 14 that

answered had over 8 years of working experience as a supervisor or a foreman

(only three of the 14 had less than five years of experience). Mode is 15 years of

experience. There was thus enough working experience of both

as a member and as a supervisor/foreman in this group to make the answers

relevant.

They had experienced a conflict situations in a working community from very

seldom to often (mode: not often/not seldom by 6 of them) and likewise been

involved in them themselves (although the mode shifted to very seldom, by 8 of

them). They had contributed or self solved conflicts from very seldom to very

often (mode: often by 5 of them). They had been involved in solving the

conflicts at least as frequently as they had experienced them. There is, namely, a

possibility here to change the attitude from the amount of conflicts they had

experienced to how many times they felt they should have been active in

resolving them. The result was almost the same, when the same question about

their involvement was asked in their supervisor/foreman post or someone else as

a supervisor/foreman. There was no significant difference on their own

involvement and resolved frequency by the parties themselves although they

hadn’t been involved in the conflict themselves at the same frequency (rather the

opposite).

In less than half of the cases were the conflicts solved passively (passive

forgotten/waiting). The previous results correlate well with the third party

involvement: from not even once to not often/not seldom (mode: not even once).

The conflict frequencies and solutions are thus valid results. I checked the

individual answers for controversy and found none. The two who replied not

often/not seldom had both long working experience, but there were more (5) in

the not even once category, who also had a long working experience.

Conflict prevention measures were answered by eight (53%), but there were no

comments about them either, which could give us reasons not to (like for ex.

question not understandable etc.) rely on them. This was probably due to an

open question format. However, open or clear communication or discussion was

mentioned in each of them. Norms in a form of agreements, citizenship skills or

policies or procedures were mentioned in all but two. Respect was mentioned in

three answers and education and/or learning in two. According to two,

separation was a good preventive method. Likewise two took managers into the

conflict solving procedure and one talked like he/she was a manager.

Conflict prevention (n=8)

Talk/Speak etc. Norms Respect Manager or Education Separation

Policies etc. Manager with

8 6 3 3 2 2

Table 2. Conflict Prevention

Conflict resolving question was answered by 10 (75%). Nine spoke about

discussion or conversation or talk and one didn’t directly mention them,

although a procedure mentioned could be interpreted as one. One mentioned

that knowing each other helps. A third party and/or management involvement

was considered to be a good procedure by seven of them. One didn’t want to

have any outside help due to bad experience and two suggested having help from

an outsider (the other talked only about relationship conflicts). Outside help

with a combination of something else was mentioned by five. Seven mentioned

that the parties themselves were the best to solve the problem. A combination of

parties’ involvement and management and/or a third party involvement if the

parties cannot do it, is the answer to conflict solving activities. There was one,

though, who suggested, that management rules could take care of the small

conflicts, but others should be resolved by the parties.

Conflict resolving (n=10)

Talk/Speak etc. Talk/speak 3rd party 3rd party Parties

and supervisor and something else themselves

9 7 7 5 7

Table 3. Conflict resolving

Majority of respondents 12 out of 15 (80%) answered to the questions about

conflicts role in working communities. Majority thought them to do also good,

to disturb working environment, to cause health problems, asocial behaviours

and absenteeism. Only some voted for conflicts as a cause of injuries and result

decline. Revealing faults, creating innovations and problem solving, progress as

well as developing working actions and task was seen as the good sides of

conflicts. A good working atmosphere after a conflict was also mentioned.

The HUS survey accommodated the results of the same questions asked from

both audiences, namely, long working careers, participation in conflict solving

and how the conflicts should be solved and lastly, whether there is something

good about conflicts as well. Less nursing staff workers voted for management

or 3rd

party involvement in conflict solving activities and approx. the same

amount have resolved the conflicts by themselves compared to IY/MBA (64% to

70% respectively).

Over 200 answered, and 72 were filtered to represent nursing staff who have

worked over two years without changing jobs during that time. This is well

above the usually used n=30/category)162

and leaves room for a possible low

response percent due to time limit. The rest is to increase the reliability

(marginal of error) and viability in numbers, if a bigger sample size would be of

Saunders M. et al. Research Methods for Business Students, Prentice Hall, Essex (2007 ) fourth edition, p.

210-213

Table 4. Answering frequencies of the questionnaires (x-axis are days)

HUS nursing staff was also asked about the use of employees’ health care and/or

working safety personnel in conflict resolution and if, to all conflicts or only to

the ones they have participated in themselves. By subtracting the all from those

of their own we get the recommendation of their use to others, which was high

compared to own use. The majority hadn’t used either one, which positively

correlates to literature findings. They have been solving relational conflicts

more than task (which according to literature review means they have not

resolved their task conflicts in time). Disagreements, disputes or conflicts were

seen to be the biggest cause of working atmosphere (74%) and lack of time or

resources to cause them. There were needs of foreman (23%) and cooperational

(23%) consultancy (concern the other departments directly, like closing them)

that goes over one’s own department on decision making. However this was

only an expression of need. Majority answered, that conflict handling didn’t

show in leadership or activity plans, which suggests, that more should be done.

This was a dual question as I wanted to have them combined in their thinking,

but this doesn’t mean they answered like that- it can be either or both, which is

fine since the correction is made on both anyhow.

The position of a foreman in a conflict came out as a bit of a controversy. 24%

wanted to have a foreman that would mediate or resolve the conflict and 21%

didn’t want him to have any role. However, 17% wanted him to take up and

interrupt the conflict. Almost half (32%) of the conflict that the respondent

1 2 3 4 5

Answering frequency

IY/MBA

hadn’t resolved themselves were handled by their supervisors or foreman. This

is approx. half of what the IY/MBA mentioned.

The medium amount of conflicts resolved by the participants themselves was

over 4 (50% answered) and six answered many (not counted in this statistics of a

medium >4). Less than 39% minority hadn’t solved conflicts by themselves.

The most used method of conflict resolving was discussion (61% by the parties

or with the help of a supervisor) holding its position (together with negligence)

also, if the conflict wasn’t resolved by the first attempt. Whether it is a good

method or not depend on what the target is. There were a number of persistent

cases that either weren’t solved at all (11%), were neglected or forgotten (4%) or

solved by separation (3%) or solved naturally (1%). Together this is 19% which

correlated well with the 13% (51 out of 401 all, unfiltered answers gathered in

six days) of a bigger sample (2% of the whole personnel of HUS instead of the

0,3% filtered answers used in this study). Taken, that somewhere around 20%

of working time goes to solving conflicts and about 80% of them are resolved is

not so bad relation since 46% saw a positive effect on conflicts as well. These

are bigger numbers, when translated into financials.

Out of the 36 that answered, that they had resolved relationship conflicts, 36%

answered not seeing any positive effects of these conflicts. 42% of those who

had resolved task conflicts answered “no”. Out of the ones that had solved only

relationship or task conflicts (subtracting the combinations) the relationship

conflict resolvers answered according to the literature review (majority “no”),

but not the task resolvers (majority answered “no”). Since the sample size is

only 6 and 8 respectively for the latter ones (single resolvers), this cannot be

taken as a proof against the literature review.

Here are some examples of the HUS survey answers:

“The respect of workers increases and reminds the foremen that humanly

treatment isn’t authoritarian or indiscriminate”

They clean also”the air” all right and belong to life. The dealing with them just

halts...”

”When some conflict is brought up – it goes either to a favorable direction or

not. At one case in my working department, everyone started to think about

their own behavior and tolerance”

Validity

The leadership and bullying restructuring at HUS could render the survey to be

biased to be too positive on management usage in conflicts. This is why I used

the IY/MBA survey to be able to compare the results. However, the results in

HUS are diluted, because managers and members were not separated and in

IY/MBA all were managers, which wouldn’t give a valid result. Therefore I put

a notion to the questionnaire for everyone to answer as they would be a manager

supporting it by the fact that they are (at least their own). This is not going to

take away the possible positive bias against using managers. It depends on the

relation between member-manager participation, which is also overestimated

since the members don’t have as easy access to the questionnaire as the

managers have. The diminishing factor is the amount of managers to leaders

overall (the ratio been somewhere in 1/10, which came through at the interview

with managers). Furthermore, the managers might on the other hand feel that

the conflicts are their responsibility and on the other hand, they might want to

show, that there are many conflicts with the present leader. No one interviewed

had the answer to that. The managers are not natural born mediators. Their

conflict management has at least looked like (in the80’s) an exercise of authority

than third party facilitation.163

The results validity is jeopardized by these facts as

what comes to the use of management and somewhat 3rd

party use as well. This

is why we used the first answers that are more likely to come from the managers

(previous experience, since the managers have more responsibility, they a

courage to use PC’s and better access to the intranet) and we could compare

these to the IY/MBA manager’s answers. Since there was no significant

difference between those, I conclude that the two forces balanced each other or

the forces were too small to show up. The question of how to resolve conflicts

was the topic and answers to that question require experience. Therefore the

filtering was used to get the first results in (those interested in the subject) from

people that have worked over 2 years in the same community. No reward other

Kolb D. et al. Journal of Organizational Behavior, Vol. 13 (1992), p. 316

than a mention about the incentive effect of participating to one’s own working

community.

I used both closed and open questions (despite lowering effect on the number of

answers) and comment lines to add to the validity of dissertation. There were no

comments about interpretation of the questions or difficulties to answer, but one

supportive to the findings. I also cross-checked individual answers for

conflicting answers – there were none.

The nature (see Picture 6.) of conflict in a social context makes it difficult to

justify when trying to find the cause and the cure. There is an ambiguity about

the causal direction. For ex. many papers and some of the answers talked about

a good leadership being able to minimize conflicts were as bad leadership does

the opposite. Same with discussions: dialogue was seen as a good thing and

wrongly timed or managed (mood and choice of words) conversation was bad.

The questions and interview summaries could be made directly (without

using any interpretative methods) from the documents, which helps to

decrease the errors, but there is a possibility that categorization might have

increased them. This is why I went through them three times.

The results of the questionnaires cannot be generalized, since the there is only a

separation between nursing staff and others between HUS and IY/MBA and

inside HUS (separating question in the questionnaire). The amount is too small

in IY/MBA and the non-nursing staff of HUS work at the same facilities and

thus with almost the same (with the exception of patient contact effect)

challenges of conflicts. The timing and chosen (patient care, nursing staff) adds

to the validity. Like Porter-O´Grady says, 90% of conflicts will emerge at the

point of service164

. The literature findings were however similar (congruent) in

conflict existence, their bad influence, managerial responsibility and negotiation

(or other talkative) ways to prevent and resolve conflicts as well as use of

mediation, but differences in between health care organizations themselves have

been found165,166

, which doesn’t speak for generalization either.

Sportsman S. Nursing Management, April 2005, p.32-40

Reliability

The time of both questionnaires we also picked up so, that the answers were

collected on Wednesday when the questions were sent the weekend before.

People feel usually more stressed on Mondays. This doesn’t display the actual

conflict occurrence and handling frequencies and opinions, rather a positive bias

could be found. This was, like mentioned, done to get into the most

stressed moments. The leisure period bias was overcome by sending the

questions out in between winter and summer holidays.

Like Elke Suomi in her masters work refers to Hirsimäki&Hurme:” to ensure the

reliability of a qualitative research the research data should be of high quality

and the interview outline well prepared, additional questions should be

considered in advance, interviews should be analyzed carefully, and

interviewees should be given a chance to comment on the researcher’s

interpretations.”167

4.3 Research Summary

The HUS and IY/MBA interviews showed that communication and norms were

by far the most used methods for conflict handling in both prevention and

resolving them. A bit of variations was seen in the semantic level. Instead of

communication, many other information exchange connotations were used

(conversation, discussion, talk etc.) and they were categorized to the same

category. Other than that, there was a mention of norms in forms of rules,

contracts, agreements and polices. Separation had also been used to solve the

conflict. A couple of answers went into details resembling mediation like

methods when describing the conflict handling procedure.

Talking in its various forms is hence already in use at HUS. They have also

started to work for a leadership development. These were found to be good

praxis to decrease the frequencies of conflicts taken they work with them

correctly. They are both ambiguity – when done right, there results are good and

vice versa. The dissertation points out some by HUS unused methods, which

Garman A. et al. Journal of Organizational Behavior, Vol.27, 2006, p.829-849 167

Suomi E. Master’s Thesis, Helsinki School of Economics (Fall 2008), No. 77679, p.38

would help them to minimize nursing staff conflicts, namely facilitative

leadership, heedful interrelating and mediation. These work as preventive

actions and present conflict resolving. Present relational conflicts are shown to

turn back to task conflicts by the help of shared goals and others interest. To

prevent task conflict to turn into relationship conflicts trust should be there.

Facilitative leadership, heedful interrelating and mediation are all good for

building trust on employees and supervisors (although heedful interrelating

didn’t have a significant correlation). Good results on working community

mediation have been gained with SOPU method in Valio168

. Also the peer

mediation at schools and victim offender mediation at the municipalities’ pupils

work well and the promises they make about their disputes hold approx. 95%:ly

during a follow-up period (usually two weeks). The victim offender mediation

doesn’t yet have (but is soon going to have) statistics on how mediation works

with adults.

Participation becomes apparent in organizational changes which are the

showrooms for leadership. Care should be taken when planning or confronting

changes, since they are prone to conflicts. A discrepancy seems to lie in the kind

of conflicts. If leadership is using constructive conflicts right and making

organic changes – the results will be better than facing outside pressure for

changes - and having to use norms, diversity and role clarification will enhance

this further.

Education was possible according to both literature review and research. The

plan, of which this dissertation is a part of, is going to address this with

leadership education.

Some decrease in conflict frequencies should be found outside of the major

suggestions of facilitative leadership, heedful interrelating and mediation. Taken

from the research and literature review complex systems (incompatible activities

– attention to them) and norms (although many times done and controlled by

management) are suggested and found to work. The study pointed out, that

Pehrman T. Business Development and Training Director at Valio Oyj, interview and personal

correspondence and education with the pioneering group of working community mediation I belong to

employees’ health care and working safety are not commonly used – so these

could be better utilized and they could also work with mediation (this is the plan

already) and facilitative leadership. They also have some power over control

that could be used in heedful interrelating ways. Participation could also take a

form of between departments networking, which was a need expressed at the

research answers. This is not done at the present time other than in exceptional

cases, which renders the departments autonomic and team like working places

where according to literature, great cause have to be taken when leading and

managing it.

Conflict has been (by Saksvik P. et al.) compared to organizational

changes in relations. What applies to relationship conflicts as a mediator

of task conflicts and team’s affective climate is also true for individual

conflicts. Hence, I took a closer look at relationship conflicts. I found

similarities among many researchers as what comes to the roles of

leadership, conflict management and occupational well-being.

Knowledge and staff are the main constituents of an organization. They

make the organization work. This is postulated by Stacey: Knowledge

must be codified to become an asset but once this happens, they lose

value.169

A mainstream definition of knowledge is the capacity to act and

of organization that they are taken to be learning, knowledge-generating

systems of individuals interacting with each other in group/social contexts.

Individuals and contexts are two distinct phenomenological levels

interacting with each to form the whole system. It is then taken for

granted, that these must be managed. In other words, one has to manage

the individuals, who possess the tacit knowledge. This goes well along the

lines of Nonaka &Takeuchi.

Complex Responsive Processes in Organizations, Routledge, New York and London, 2001, p.23.

The answers to the research questions of:

What could be done to manage conflict resolving in organizations?

By pursuing to take care of a situation of change by paying attention and making

them to take part of the different options and choices. Prevention by education

has also worked. When task conflicts arise, they should be taken care of, since

there is a risk, that they convert to relationship conflicts, which are not so easy

to handle and have also a negative effect on the team and relations.

It is stated in HUS bullying handling instructions and came through in the

interviews and literature search that it is everyone’s responsibility to intervene

or to do something.

What could be done to prevent conflicts to happen?

Since the process from a small disagreement to bullying is gradual and the

symptoms hard to notice (like mentioned in the leadership chapter 3.2.2), the

preventive and educational measures become handy. Preventive measurements

are a lot in the hands of the leadership, team mood and structures (norms).

Supervisors and leaders should apply a heedful interrelation/control on the staff

responsible of operations and processes. Control here doesn’t mean en external

one that harms the relationships and systems as a power of someone over

another. What makes such control harmful is that not only does our belief in it

create the problems we are trying to solve, but it is also used to deal with the

problems170

. Communication (also dialog) and free choice based on free

information flow are important organizational entities. Stress was one of the

factors contributing to bullying and the responsibility of management to see, that

it doesn’t effect a satisfactory working environment171

Smith L. Journal of Innovative Management (summer 2007), p. 48 171

Hauge L. et al. Work &Stress Vol. 21, No. 3 (July-September 2007), p.237

What could be done to conflicts

Most of the conflicts are resolved by references to regulations and /or

passively letting them be

They are taken care of by the persons themselves

Time takes care of some of them

Education helps

Some should be dealt by supervisors. The leaders should have emotional

management skills, time and a procedure to handle the conflicts. No

every leader has that.

A third party has three basic choices to intervene: order from authority,

by law - or if no law exist/apply – by according to the habits of the land

or by non-legalized other methods.

Mediation and facilitative leadership (including control) is the authors

choice after this dissertation job and by experience with health care

professionals

With what methods are the conflicts solved?

This would mean that task conflicts are taken care of in the early stages, before

becoming relational. Orienteering to new entrants take care of the cultural,

conflict prohibiting procedures in the occupational surroundings of everyone

and other education is also provided along the way, since changes are precursors

to conflicts.

Such a structure/atmosphere/culture of only progressive conflicts could be a

result of a combination of structure (information and communication flow,

dialog, low hierarchy in a kind of matrix/project type of organization ,

centralization/decentralization, networking and partnering), leadership (control,

facilitation), roles, team and individual learning and steering (self-steering

responsibility of others well-being and working processes). There is for ex. a

model called adaptive self-regulation that decreases the amount of laissez-faire

and passive management by exception and increases transformational

leadership.172

De Dreu spoke against participation in relationship conflicts as she saw

avoidance being better than contending and collaboration. Pietiläinen et al.

propose that the conflicts are turned into a positive collision. To do this, one

needs emotional management skills, enough time and the procedure to solve it.

Other suggested shared goals and others interest (taking them into account).

They also refer to The ministry of Social- and health care publication from

2002: Working society conflict ruling – violence or creativity

(Työyhteisökonfliktien hallinta- väkivaltaa vai luovuutta , Sosiaali- ja

terveysministeriö). This is a method, were a foreman instead of a mediator work

in a similar manner, than in SOPU-mediation.

Sosik J. et al. The Journal of Social Psychology Vol. 142, No. 2 (2002), p.211

5. Summary of Research and Literature Review

Figure 6. Summary of factors in a conflict situation (those in blue may work for and

against)

We ought to take care of the intern processes, since these are not likely to

match nor are they going to be unaffected by these changes. Managing and

leading differences doesn’t come automatically in our culture173,174

moderators of the diversity-performance relationship, managerial span of

control and organizational lifecycle are related.

The above (see 2.1) mentioned McKinsey 7-S’s, are guidelines for

marketing. Strategy (for ex. generic innovation), structure (for ex.

centralized, decentralised), systems (for ex. operative), skills (for ex.

Hoofstede G. Culture’s consequences,Surge 2003 (100 000 IBM workers) 174

Javidan et al. Cultural Acumen for the Global Manager: Lessons from Project GLOBE, Organisational

Dynamics Vol. 29,No. 4 289-305,2001

Trust and commitment Knowledge-Dialogue Delegation of authority Network of relations Empowerment Shared goals and interest Leadership Participation

Stress and frustration Absenteeism and flight behavior Reduced well-being (renewal, innovation, chance, good working atmosphere)

Organization Leadership and mediation and talk Change and constructive conflicts Control/heedful interrelating Norms and policy

People Time 3rd party Supervisor Education Separation Talk

Conflict

marketing), staff (for ex. education), style (for ex. design) and super

ordinate goals (for ex. growth) and the mix of these are part of the

organization and thus conflict management. In other words, we have here

7x7 different combinations of major functions, that all account for many

subcategories, which renders the options and opportunities uncountable.

One cannot follow every path all the way through, but have to prioritize.

There was some diversity about the importance of the factors or mediators

of conflict. The “serious” ones are questioning the whole idea of conflict

reduction. “Conflict is a fuel that drives system growth and enables

learning and adaptive behaviours, making innovation possible.” 175

researchers think that managers should focus on encouraging mindfulness,

improvisation and reconfiguration as responses to conflict that enable

learning and effective adaptation. The diversity deals mostly about some

(like Laymann 1992) stating, that working environment is a sole cause of

bullying or (like Brodsky in 1976), that leadership is inevitably the major

player. Also about whether it has more negative or positive effects

(Hansen et al. 2006, Baumeister et al. 2001, Laymann 1996) . Also gender

has got votes from Eriksen et al. in 2004 among assistant nurses making a

difference of been bullied and Vartia among municipal workers that there

was no effect.

There have been two different perspectives to conflict and bullying,

aggression-frustration and social-interactions. Both are still been worked

at. The working place conflicts are a pretty new object to studying. It

started in late 80’s in Nordic countries176

. It is in other words early days –

we are not long from heuristics and the different measuring methods since

Einarsen’s (1994) 177

days are not yet sophisticated enough to measure

cause and effect dependences. De Dreu uses the word in its infancy, when

he talks about interrelations between conflicts and other variables than

Andrade L et al. Emergence:Complexity and Organization Vol 10, No. 1 (2008), p.23

Zapf D. et al. European Journal of Work and Organizational Psychology Vol. 10, No. 4 (2001), p.370 177

Einarsen et al. European Work and Organizational Psychologist Vol. 4, No. 4 (1994), p.381-401

individual and work team effectiveness.178

I started with well-being and

the effects of conflicts to it. On the side of social theories also

psychological theories and management and organizational theories are

adopted in this field.179

A new psychometric test has been tested for

conflict management at work. The researchers suggest, that five factor

taxonomy should be used in conflict management instead of the usually

seen compete-cooperate. These five factors are: avoiding, compromising,

problem solving, forcing and yielding (Appendix XVII). 180

Newest

method might be the intractable conflict handling method which stem

partly from social identity theory, where both in-group distinctiveness and

intergroup differentiation are promoted in a sequential manner or a

computer aided dispute resolution model (if developed further from formal

ADR).181,182

The collaborative process of working through paradox183

could help and

gain ground, since it suits the format of heedful interrelating. In a study

of nurses in a U.S. Hospitals the problem solving was mostly done (in

93% of the cases) by correcting just the present situation without

communicating it to supervisors or to the ones that would have had the

best knowledge. While picking up – if doing that at all – the socially

closest individual, they didn’t lose their credibility and trust. But this is

not a ground for organizational learning in many organizations184

. A study

done with students working in many different occupations highlight the

importance of high-quality relationships of cultivating and developing

perceptions of psychological safety and ultimate learning behaviours in

organizations.185

We have not climbed the whole way up the ladder of

communication and information while most of the problem solving stays

De Dreu et al European Journal of Work and Organizational Psychology Vol. 14, No.2 (2005), p113 179

Stacey R. Complex Responsive Processes in Organizations, Routledge, New York and London, 2001

p.39 180

De Dreu C. at al. Journal of Organizational Behavior Vol. 22 (2001), p. 645-668 181

Fiol C. et al. Academy of Management Review Vol. 34, No. 1 (2009), p.32-55 182

Zondag B. et al. International Review of Law Computers & Technology Vol. 21,No. 2 (July 2008), p.191-205 183

Lüscher L. et al. Academy of Management Journal Vol. 51, No. 2 (2008), p. 221-240 184

Tucker a. et al. Californian Management review Vol. 75, No.2 (Winter 2003), p.55-72 185

Carmeli A. et al. systems Research and Behavioral Science, Vol. 26 (2009), p. 81

at the problem level and doesn’t continue with circular, reflexive and

strategic questioning into a workable certainty.

In mediation, these steps can most often be shortened since one works for

a sole conflict in one’s hands. Having said that, many people (like Vartia

have shown to apply to observers of bullying) and many parameters are

involved and a broader view could be of use. At least, a follow-up period

should be agreed upon and if many symptoms come alive in this kind of

longitudinal search, deeper involvements are in place.

Looking at the data it became obvious, that discussion is the method of

choice but some new remedy surfaced. It doesn’t matter in what extent in

a qualitative study. Mediation is something I’ve seen to work with pupils

and violent offender mediations. Although it hasn’t been extensively

tested with working communities (except in Scotland), it doesn’t mean,

that it couldn’t become a major player. It is a question of timing and

probabilities.

6. Generation, evaluation and selection of options

6.1. Options

The requirements for a chosen method: 1)it should minimize (at least

lower as there isn’t any literature nor this research which was qualitative

to measure what could the difference in minimizing and decreasing be)

the relationship conflict frequency and 2) be a new method, which they

haven’t used yet 3) it should be facilitative.

These are the options driven from the literature review and/or research that

HUS could consider:

A) One possibility should always be to continue or to make a break and

discuss every other option including the present situation – busier than that

one should be. Like stated, the organism tend first to find a way out of the

dilemma,186

so it might be, that other solutions could be better. Conflicts

might vanish, when time goes by. It has already been tested here, without

any significant results on the conflicts that come to the attention of the

supervisors and leaders.

B) A second possibility is to continue neglecting and “forgetting” the

conflicts, but contrary to option A other parameters might be changed

C) A third option is to take a third party in the picture (be it an outsider or

not) and let them take control or have them as a mentor.

D) A fourth possibility is to influence the source with education and

facilitative leadership making local and present circumstances more

repellent to relationship conflicts while allowing constructive conflicts to

E) A fifth option is to start mediation for conflict management.

F) A sixth option of making the whole organisation repellent to conflicts

by making the structure, processes, norms and culture to leave no room for

conflicts (especially role clarifications in mind)

G) The seventh option is influencing the mediator role the conflicts have

on cause and consequences (like using task conflicts in enhancing

innovativeness and performance which in turn, indirectly could lower

relationship conflicts, using heedful interrelating, shared goals and/or

others interest)

H) There was lack of time and resources known (literature review) to

cause conflicts at HUS, so the eight option is to find resources Also

urgent jobs we according to the research shown to cause conflicts which

could be another option or counted in depending on the target of the new

resources. This differs from option A in that it would be an active search

of new resources

I) A hierarchic system with the combination of eagerness of its staff to

help increases conflicts, so the ninth method could be to change the

hierarchy so that the conflicts become more perceptual and easier to

minimize

J) Working atmosphere correlated, according to the literature review and

research, to conflict frequencies. To influence working atmosphere

positively would thus lower the conflict frequencies (alas with the cost of

innovativeness) is the tenth option. These are many and some of them

ought to be new.

K) The eleventh possibility could be any, other, to HUS new method we

could develop to work better and to be facilitative and lower the

relationship conflicts

L) The relationship conflicts could be turned into something else with the

help of shared goals and others interest. This differs from G-option as the

influence is directed only to the relationship conflicts

M) Any combination of the above that would further decrease the

relationship conflicts. These methods can all be combined, since they

don’t disturb each other.

N) Leadership; as according to the interviewed group there hasn’t been

6.2 Choosing the option

The firstly mentioned possibility to stay put and discuss whether other

options are better. If found not to and the decision is to stay put and do

nothing would mean, that the outside, independent conditions would

change to favour relationship conflict decrease at HUS. In a form of

resources, I could think it could work, but this is for the first too unlikely

and for the second not a new approach or system and not a permanent

facilitative way, which was a request from our research interview and the

choice.

The secondly mentioned B-option hasn’t been according to the two

research groups yet scientifically shown to work in general. Nor does our

research support it. Having been already in use, it wouldn’t be a new idea.

The third C-option of a third party is not new, but shown to work also in

hospital surrounding including HUS in this research. These third parties

have been high management (managers are no better off, than anybody

else in this sense, rather worse.187

) employees’ health care/working safety,

but not consultancy/outsourcing. This is a candidate if a new party with

facilitative capabilities is chosen that would make it a new method.

The D-option fills every requirement and is thus a candidate.

E-option of mediation is a candidate while it also fills every requirement.

The sixth F-option is not new and not facilitative in a long run so it

doesn’t count.

G-option is new as far as I know and it has been shown to lower

relationship conflicts. It is also a bit facilitative in a sense it activates

people to find the ways to do it but leaves a question mark on how much it

Nugent P. et al. Academy of Management Executive, Feb2002, Vol. 16 Issue 1, p139-154

will affect the relationship conflicts (will it be measurable) since it will

increase the task conflicts levelling the consequences if the knowhow is

not found. The literature review revealed it to be circumstantial and thus

sensitive. It is a candidate with fewer guarantees than C,D and E.

Option H is not new (they are constantly trying to find organic and outside

resources and also found some, like nurses from Philippines). It has an

impact on decreasing the relationship conflicts according to our literature

review, but it is only half facilitative since it only facilitates the structures

not empowering and facilitating learning and decision making. This

doesn’t rank high – not an option.

Option I is not new, but facilitative if the hierarchy was working against

the performance and it would most probably decrease the relationship

conflicts. It is a candidate if HUS themselves would succeed in lowering

the hierarchy and would thus back away from the requirement of a new

method.

There is a possibility to find new methods to work for a better working

atmosphere that could simultaneously be facilitative and has been shown

in this dissertation paper to lower relationship conflicts. Problem now is,

that we know that plenty has been tested and not documented. It would be

almost impossible to find one. J-option is not a candidate.

K-option was searched once again through the documentations and

interviews made. Nothing was found – not an option.

Option L is the 12th

candidate could fill all the requirements, but as with

K, I couldn’t find others interests (if not our plan is taken into account or

the nationwide plans would have an impact) nor new shared goals, which

renders L not an option outside of our own plan since the nationwide

programs are indirect (relationship conflicts are not directly their target)

factor with limited guarantees of working. Some nationwide plans

haven’t decreased the well-being at work at all, sometimes on the

contrary188

, it remains to be seen how big an effect this will have on

nursing staff conflicts. Not a viable option at least for now and what we

M-option works if there are two or more options that fill the requirements

and support for the combination found in the literature (or no opposite

impacts).

N-option is found to have even a strong impact and a facilitative

leadership type, which is new to HUS can be found. To predict, that

facilitative leadership would have a huge minimizing effects on conflict

occurrence and negative effects of work, is not confirmed by this single

dissertation. What speaks for it, is the fact that the earlier one

acknowledges and acts on a conflict, the smaller the impact. Facilitative

leadership gives power to everyone to act upon finding conflicts and make

suggestions to minimize them and their effect. A candidate.

Conclusion

The options are thus C,D,E,M and N with conditional G and I. This

translates into a third party involvement with mediation and education

programs and facilitative leadership type as well as with the possibility to

influence the mediator role of conflicts and hierarchy in HUS. These are

not shown to collide and could be mixed together. With any of these the

goal is met, but the work continues to find out about more and to narrow

down the selction.

Using other methods for conflict handling than mediation has been based

on negotiations between supervisors and parties or between working

safety and/or employees’ health care. It has also been steered from values

and norms. This is why the negotiating parties liked to see other tools to

be used as well.

Some (24%) mentioned mediation or mediation-like resolving methods

having helped them or wanted their supervisors or foreman using them.

http://www.uta.fi/laitokset/tsph/terttu/ohjelmamuistio/to_rahoitus.html (15.5.2009)

Figure 7. A suggestion for minimizing conflicts. Conflicts II and III might

stay the same way as the original or evolve to something different

By facilitating and mediating one tries to solve the same conflict as the

antecedents are better known and the conflicts earlier noticed.

Conflict

precursors

Conflict

Discussion

Conflict II

Discussion II

Conflict

precursions

Facilitative

way, education

Conflict

Mediation

Conflict

Discussion

Conflict III

3 rd party

7. Action plan

The plan was made together with the personnel of HUS and the financing

institution (The Working safety trust) at the beginning of this year (see

Appendix I for schedule and resources). It comprises of a series of

interviews, meetings and check-up points. The interviews are carried with

10 different entities and the meetings with their and the personnel leaders.

This is to ensure, that we are in a right path and that we run in parallel

with the leadership and bullying plans of HUS.

The comparison with MBA students and a consultant company doesn’t

continue since it was just to compare the conflict situations at one point.

However, there is a similar work ongoing at the Kuusamo Community,

which includes health care and this is used for benchmarking.

Since we can anticipate at the light of this dissertation work, that there

aren’t any preventive methods to stop the conflict situations to rise at time

to time, we are implementing a series of educational sessions and a

training course with the HUS staff. The plan is that this is done by the end

of this year so that we are able to observe the results. I take the

responsibility of planning these 3 x 3 hour sessions together with the HRM

team. I take a partner from the mediation group of the trained Pehrman

group and work through the 10 cases. By the end of those, there will be a

big seminar held to the management by the end of 2010 to go through the

results and make a decision on the method and timetable for the conflict

management. There will be an outside mediator in place for their disposal

during the time of the plan.

The personnel leaders and me sit in the steering group and lead the plan

the whole way through. Working safety trust is the project owner. The

plan suits their general plans of improving the HRM and leadership while

increasing innovativeness and cooperation. Consultancy is going to

increase.189

As this is also in the strategy of HUS and HRM, the option of

outsourcing should be discussed and we made some criteria for decision

making before we do the deal:

The outsourcing criteria (when thinking of process or part of a process

outsourcing) according to Insigne et al190

alignment or outsourcing with the business strategy of the

enterprise

clarification of core capabilities and competencies

identification of strategic gaps and specific strategies for cost

saving and asset shedding

recognition of the enterprise’s significant dependencies and

vulnerabilities

They have constructed a grid of potential for an activity to yield

competitive advantage which is spotted against internal capability of the

enterprise to perform an activity in comparison with competitors.

Their key activities are:

Get capability

Built strength

Do in-house

Their Emerging activities are.

Partner

Collaborate

Share risk

Their basic activities are.

Buy develop second source

Make it a profit centre consider selling/buying

Suomi E. Master’s Thesis, Helsinki School of Economics (Fall 2008), No. 77679 190

Insinga R. Et al Academy of Management Executive; Vol. 1, No. 4 (2000), p. 58-70

Their commodity activities are:

Exit/buy

If the mediation education and conflict management minimizes the

amount of conflicts and improves at least some of the negative effects of

them, the plan has a chance to continue with mediation and facilitative

leadership coaching in 2011 and on. The measures are made from this

survey data to the next one by the end of 2010 and the interview results.

The measures are relationship conflict relation to overall conflict amounts

as well as a decrease in conflicts being the biggest, sole reason for a bad

working atmosphere question.

The interview with the managers and the mediations done in the clinics

should provide us with a better picture on leadership and we could start

planning for the facilitative leadership training and tutoring before the end

of 2010.

The second phase of this plan is to have some more people trained to work

place mediation who could then take the continuance of the mediation

processes under their custody. This takes place during 2012. The

selection of the mediators are done in cooperation with me and my partner

and department heads of these different clinic departments.

APPENDIX I 1(2)

BUDGET AND TIME TABLE FOR THE ACTION PLAN

Budget for the plan of Working safety in Health care 1.3.2009-28.2.2011 [a] [2a] [a] 2[a]

Compensations 61722 123444

123444 Sub-costs 1710 40824 17010 40824 Rents 2160 4320 2160 4320 ( 1/2 of a rent in a Office Hotel)

ICT 2650 5300 2650 5300 Travel (see below) 750 1499 750 1499 Bookkeeping 1100 2200 1100 2200 Material 100 200 100 200 Sub Total 68482 136964 68482 136964 Other* 930 1860 930 1860 Total 69412 138824 69412 138824 * universal price increase (1,4%), media of Nordea’s prognosis (20.1.2009)

á{€]/route or km Sum [a] Total 2 [a]

á{€]/matka tai km

Yhteensä [a] Yhteensä 2 [a]

Matkat (2 henkilöä) 1/a Helsinki-Kontiomäki-Helsinki 137,6 137,6 275,2

3/a Helsinki-Turku-Helsinki 0,45 405 810 HUS:iin ja klinikoiden väliset 0,45 207,4 414,8 Yhtensä

750 1500

137,6 137,6 275,2

0,45 405 810

0,45 207,4 414,8

750 1500

Financing plan

79% comes from Working safety funds and 21% from HUS (out of which some can be financed by a third party)

HUS don’t do any compensational work; work goes to the employer; alternatively and/or partly voluntary. Possible conferences and tradeshows abroad are financed by the parties themselves.

APPENDIX I 2(2)

Schedule (Operative activities) 7.1.2009-1.3.2009 Planning 1.3.2009-31.5.2009 Survey and the first interviews(admin., leaders, eye)

3.8.2009-15.9.2009 Interviews (endo., chir., allergy)

16.9.2009-19.9.2009 Reporting and meeting with Kuusamo reseachers and checkpoint of the plan

21.9.2009-23.12.2009 Reporting and follow up meetings with the interviewed 28.12.2009-27.2.2010 Interviews (otolar.- and lab., image.) 1.3.2010-31.3.2010 Reporting and interviews with the checkpoint leaders

1.4.2010-16.4.2010 Follow up with the interviewed 19.4.2010-31.5.2010 Interview(obd.&gyn. pedi. and the rest)

2.8.2010-3.9.2010 Reporting and follow up with the interviewed 6.9.2010-23.12.2010 Analysis and reporting

3.1.2011-28.2.2011 New survey and analysis

Reporting includes also literature review ICT and marketing plus marketing budgets separately

APPENDIX II

Ten essential processes of a facilitative leader (according to Ingrid Bens)

A New Leader Integration

Visioning

Team Launch

Operational Review

Survey Feed-back

After Action Debriefing

Need and Offers Negotiation

Peer Feed-back

Mediating Interpersonal Conflict

Coaching

Facilitative Leader Characteristics:

Ingrid Bens Global Business and Organizational Excellence (July/August 2007), p.43-55

(Reprinted from her book “Facilitating to Lead”: Leadership Strategies for a Networked

World, Jossey-Bass (2006))

APPENDIX III

The Group effectiveness model (by Schwarz R.)

A clearly defined facilitator role useful in a wide range of roles

Explicit core values

Ground rules for effective groups (see below)

The diagnosis-intervention cycle

Low-level inferences

Exploring and changing how we think

A process on agreeing how to work together

A systems approach

Grounded Rules for Effective Groups (by Schwarz R.)

Test assumptions and inferences

Share all relevant information

Use specific examples and agree what important words mean

Explain your reasoning and intent

Focus on interests not positions

Combine advocacy and inquiry

Jointly design steps and ways to test disagreements

Discuss undiscussable questions

Use decision making rules that generates the commitment needed

http://www.schwarzassociates.com/files/229.pdf, 12.4.2009

APPENDIX IV

TRUST AND ORGANIZATIONAL LEARNING

How the buyer gains trust on seller (Wood J. et al., 2008)

How to facilitate the organizational learning.

Copied from Carmeli A. et al. systems Reseach and Behavioral Science, Vol. 26 (2009), p.

APPENDIX V 1(2)

Rapport from the first mediation at HUS (by Juha Tykkyläinen)

Translation from the original Finnish description:

Working community mediation that was carried out in HUS Chirurgical

Hospital. It was a large mediation case in a sense that over 30 people

participated. Mediators were Juha Tykkyläinen and Marja-Leena Zotow. In the

core of the conflict was a bullying experienced conflict behavior of three

persons, but it turned out to handle multiple entities, that friction the working

atmosphere later on.

Mediation was carried out so that there were separate meetings open to everyone

to attend. About 18 people joined them. The purpose of the meetings was to

inform the participants about mediation process and principles that steer them.

Those, not participating in the separate meetings gained information through a

process description before the joined meeting. On the other hand, the

participants were asked about their visions about the conflict, the emotions it had

arisen and possible wishes on the resolution. There was also a strive at the

separate meetings to encourage participants to an open reciprocal

communication at the joint meeting.

The joined meeting started with “narrative rounds”, where everyone explained

their view of the conflict, its reasons and consequences as well as what kind of

resolution could be the best one. Because there were 30 people participating it is

clear, that the meeting carried on and on. A discussion was carried out after the

narrative round, which was lead by the mediators when needed. Much steering

wasn’t necessary because the participants were active and the discussion went on

in a constructive manner. At the end of the discussion a contract, where

corrective actions were collected, building took place.

At the end of a long discussion the participants began to feel tired and frustrated

and seemed to be waiting, that the mediators would have taken a more active in

writing the “conditions” of the contract. They were able to agree upon the

substance that seemed to suit everyone, however.

After a couple of month of the joined meeting, a feed-back –meeting took place

that was joined by ten participants or foreman. Critique was delivered above all

about bad information about the process flow although at the separate meetings

one tried especially to wipe off the uncertainty about the process flow. A part of

the participants felt also that the mediators remained too passive and didn’t bring

out their own thoughts about the conflict and its resolution enough. Third

issues that rouse critique was the experienced anxiety of the process and a

surprising difficulty for the attendants.

APPENDIX V 2(2)

In original Finnish:

Työyhteisösovittelu, joka toteutettiin HUS:n kirurgisessa sairaalassa. Kyseessä

oli suurehko sovittelujuttu siinä mielessä, että osallistujia oli n. 30 henkilöä.

Sovittelijoina toimivat Juha Tykkyläinen ja Marja-Leena Zotow. Konfliktin

ytimessä oli kolmen työntekijän välinen kiusaamiseksi koettu käyttäytyminen,

mutta prosessin edetessä paljastui monipuolisesti erilaisia työyhteisön ilmapiiriä

hiertäneitä seikkoja.

Sovittelu toteutettiin siten, että ensin järjestettiin erillistapaamisia, joihin saivat

osallistua kaikki halukkaat. Erillistapaamisissa kävi n. 18 henkilöä. Tapaamisen

tarkoituksena oli ensinnäkin informoida osanottajia sovitteluprosessin kulusta ja

sitä ohjaavista periaatteista. Ne, jotka eivät erillistapaamisiin osallistuneet, saivat

informaation yhteistapaamisen aluksi kerrottuna prosessikuvauksena. Toisaalta

osanottajilta kyseltiin heidän näkemyksiään kyseisestä konfliktista, sen

herättämistä tuntemuksista ja mahdollisista toiveista ratkaisun suhteen.

Erillistapaamisissa pyrittiin myös rohkaisemaan osanottajia avoimeen

vuorovaikutukseen sovittelun yhteistapaamisessa.

Yhteistapaaminen aloitettiin ”tarinakierroksella”, jossa jokainen osanottaja

vuoronperään esitti näkemyksensä konfliktista, sen syistä ja seurauksista sekä

siitä, minkälainen ratkaisu tapauksessa olisi paras. Koska tapaamiseen osallistui

kolmisenkymmentä henkilöä, on selvää että tapaaminen venyi mittavaksi.

Tarinakierroksen jälkeen käytiin asioista keskustelua, jonka kulkua sovittelijat

tarvittaessa ohjasivat. Ohjausta ei kuitenkaan tarvittu paljon, sillä keskustelijat

olivat aktiivisia ja keskustelu käytiin pääasiallisesti hyvässä hengessä.

Keskustelun päätteeksi ryhdyttiin laatimaan sopimusta, johon koottaisiin

tarvittavat toimenpiteet tilanteen korjaamiseksi. Pitkän istunnon päätteeksi

osanottajat alkoivat hieman väsyä ja turhautua, ja tuntuivat odottavan, että

sovittelijat olisivat aktiivisempia sopimukseen otettavien ”ehtojen” laatimisessa.

Osallistujat pystyivät kuitenkin löytämään itse sopimuksen sisällön, joka tuntui

tyydyttävän kaikkia keskustelijoita.

Muutaman kuukauden kuluttua yhteistapaamisesta järjestettiin palautetilaisuus,

johon osallistui kymmenen yhteistapaamiseen osallistunut työntekijää tai

esimiestä. Kritiikkiä saatiin erityisesti siitä, että osanottajat eivät kokeneet

tulleensa riittävästi informoiduiksi prosessin kulusta, vaikka erityistapaamisissa

pyrittiin erityisesti poistamaan epätietoisuutta siitä, miten prosessi tulee

etenemään. Jotkut osallistujista kokivat myös, että sovittelijat olivat turhan

passiivisia, eivätkä riittävästi tuoneet esille omaa näkemystään konfliktista ja

sen ratkaisusta. Kolmantena kritiikkiä herättäneenä seikkana koettiin prosessi

ahdistavuus ja yllättävä vaikeus osanottajille.

APPENDIX VI 1(2)

Interview meeting with the HRM staff in HUS, Meilahti Hospital on the 22.4.2009

Present:

Cenita Blomqvist, Working Safety Manager

Anne-Maria Mäkinen, Chief, Working Relationships

Päivi Vaheri, Human Resource Manager, belongs to the executive board and group administration

Iina Mikkola, Manager, Collective Negotiations

Anu Meriö, Department Head, Intensive Care

Mika Koskinen, undersigned and dissertation author

What kind of conflicts have you experienced here in HUS?

CB: I’d say all kinds and with increasing phase, although we have not a long history of surveying, rather

cuts feeling of what we’ve seen. Does everyone agree? (They did). They vary a lot in character, but

I’d say most of them are relational (at least what we have seen and know about) although they might

have been task conflicts at the beginning. Some of them have a very strong personal “pondus”.

So what have you done about that?

CB: We have conducted a TOP-survey under some six or seven years, but the questions have varied so it

cannot directly be used for this study. We have a version one bullying rule/guide published and the second

version is under way (see Appendix XXVI for the older version, authors notice). We have been

working with that during the six or seven years, but we haven't seen a decrease in the conflict cases.

PV: I’m quite new at this position, but I’ll agree with CB – new ideas are welcome, because I have

a handful of bullying cases right now. We have worked according to the instructions and had a lot

of talks here and they most often turn to us only after they have talked with their supervisors and/or groups.

Unfortunately, many have to be replaced or they leave, which is a huge loss in human and economical

resources.

A-MM:Also the unions are “in the picture” in almost every case, which depolarizes the situation –

it is not neutral.

AM: We were taking part at the first mediation meeting and I understand now, when you described the

situation, what went wrong. I’m in strong favour of mediation. The personal talks with the parties

don’t always help.

MK:In how many cases have you succeeded within your group.

AM: I don’t know exactly, but I’d presume that it is however in majority of cases.

MK: Iina, do you agree in what have been said?

IM: Yes, just that we have received phone calls and people here without them showing up in paperwork.

Plenty have gained “treatment”. It is just not enough, we need to think and do more somehow.

AM: Maybe people just wanted to sort thing out faster than they actually could.

MK: What could you do, if resources and knowhow wouldn’t be a limiting factor?

CB: this mediation program is of great interest. It is a new deal. We have thought about an

educational project on issue of ”how to start talking about untellable things” also. We have agreed,

that we have to have something new that we haven’t tried on yet. Situation is getting worse.

Of course the government and municipals could do a lot in terms of wellness policy and helping us

with planning and resourcing.

PV: I admit, that I don’t know everything about mediation or even, what I probably should know,

APPENDIX VI 2(2)

but I agree.

It sounds like a good idea. Of course there is a lot to do in prevention as well, but this might already change

the culture in here.

CB: We have already in 2006 tried to launch a talking culture and that could be of interest. What would

you suggest?

MK: For me, there are right now three options: try to work with the talking culture further, take part of this

mediation plan or to educate the personnel to conflict handling or a mixture and/or a combination of these.

You have a paradox in limited resources and a working atmosphere that is getting worse. What is there

for you?

A-MM: We are not ready to pick up either of them like straight, now.

AM: We have got the education of a mediator so could we use you and someone of us to mediate at least to

begin with. Education sounds probably less expensive, but it eats the working hours of the staff.

Mediation could gradually

turn the situation over and build a culture of caring people.

CB: This might be an idea. We are working already with a new leadership and organization. I feel

we ought to do something for prevention and eventually mediation could do the trick, I don’t know.

PV: I’m relatively new, coming from private side. This mediation is new, how long has it been in use.

MK: Six years in Finland and only in Valio, but in Scotland it is used quite wildly.

PV. Do we have other options? I’d like to discuss this more, but maybe not now.

CB: What should we do? Could we start by sending out the inquirely and plan for the next steps after that?

Is the plan in schedule?

MK: Yes, we are in time.

CB: Could A-MM take the responsibility of a coordinator here. MK send the proposal to her and

she will pass it through.

A-MM: Fine for me.

APPENDIX VII

The cover letter for the HUS questionnaire (translation from the Finnish cover letter)

DISPUTE OR CONFLICT SITUATION

As a part of my MBA dissertation I’m conducting a questionnaire on “Employees’ health care

and working safety usage”. My work is about conflict handling, i.e. how could one minimize

and handle them so, that they don’t disturb working atmosphere or cause disputes among employees.

I’m cooperating with HUS Human Resource Management and the answers are a part of a ground

work on a possible development plan of mediation implementation.

Would you like to answer right away, incognito. You cannot be identified from the information

you provide if you don’t write your name on it. All information will be treated in the strictest confidence.

There are 12 questions to answer.

We are waiting for your reply at the very latest on the 19th

of June 2009 – so answer directly, please.

The sooner you answer, the sooner we can start working!

A big praise for your help – you came to help yourself and your working community at the same time!

Mika Koskinen

Working Community Mediator, Aava Development Ltd

Tel. 050-4068128 or E-Mail mikakoskinen@kolumbus.fi

APPENDIX VIII

The HUS questionnaire (translation from the Finnish questionnaire)

The use of working safety and employees’ health care services

HUS-health care services (the questions are about leadership, which concerns everybody – you are however at least the leader of yourself –

not about whether you are in a leading position, so please answer to all questions)

1. How long have you worked with the present job/vacancy in HUS?

2. Have you been changing jobs lately?

- if you answered yes, tell us how often

3. Are you working with patients?

4. What is the role of your supervisor in conflicts?

5. Have you been using our own working safety/employees’ health care in either of or in both of the following cases?

a) dispute, disagreement or conflict?

b) only for your own purposes (related to a dispute, disagreement or conflict) without taking other parties with?

6. Have you been using any other, than working safety/employees’ health care to resolve a disagreement, dispute or conflict?

7. Have you yourself settled a disagreement, dispute and/or conflict?

-if you answered YES, how many times

- which kind of disagreements, disputes or conflicts have you resolved?

a) between persons

b) about things

c) other

- how did you resolve them?

-if you answered NO – how did the disagreements/conflicts worked out?

8. According to your own judgment, are disagreements, disputes or conflicts the biggest factor of its own rights,

that has an effect on the deterioration of working environment?

9. Have you noticed that disagreements, disputes or conflicts could be beneficial?

-if you answered YES, how:

10. Are urgent situations at work a source of disagreements, disputes of conflicts and how does this become apparent?

11. Which kind of tasks cause over the department going decision-making processes, meaning, that they cannot be resolved within the department?

12. Does the nurturing of disagreements, disputes and conflicts show up in the plans and leadership?

APPENDIX IX

The cover letter for the HUS questionnaire in Finnish

RISTIRIITA/KONFLIKTITILANNE

Hyvä vastaaja,

Osana MBA-lopputyötäni toteutan ”Terveydenhuollon työterveyshuollon ja

työsuojelun käyttö ristiriita/konfliktilanteissa” koskevan kyselyn. Työni koskee

konfliktien hallintaa eli sitä, miten niitä voisi minimoida ja käsitellä niin, että ne eivät

pääsisi häiritsemään työilmapiiriä ja riitaannuttaa henkilökuntaa.

Teen yhteistyötä HUS:n henkilöstöjohdon kanssa ja kyselyn tulokset ovat osa

taustatyötä siihen käynnistetäänkö HUS:ssa kehittämishanke mahdollisen

sovittelumenettelyn käyttöönotosta.

Vastaatko heti nimettömänä tähän sähköpostikyselyyn. Sinua ei voida tunnistaa

vastauksista jos et kirjoita siihen nimeäsi. Kaikki vastaukset käsitellään

luottamuksellisesti.

Kysymyksiä on 12.

Odotan vastaustasi viimeistään 19.6.2009 mennessä – joten vastaa heti.

Mitä nopeammin vastaat, sitä nopeammin pääsemme toimiin!

Suurkiitos avustasi – olet samalla tullut auttaneeksi itseäsi ja työyhteisöäsi!

Mikäli sinulle on aiheesta kysyttävää, ota yhteys:

Mika Koskinen

Työyhteisösovittelija, Aava Development Oy

Puh. 050-4068128 tai s-posti: mikakoskinen@kolumbus.fi

APPENDIX X

The HUS questionnaire in Finnish

Terveydenhuollon ja työsuojelun käyttö terveydenhuollossa

HUS-terveyspalvelut

(kysymykset koskevat johtajuutta, joka siis koskee kaikkia- olethan ainakin itsesi johtaja – ei sitä oletko johtavassa

asemassa, joten vastaa kaikkiin kysymyksiin)

1.Kuinka kauan olet ollut nykyisessä ammatissasi/vakanssissa HUS:ssa?

2.Oletko välillä vaihtanut työpaikkaa ?

-mikäli vastaat KYLLÄ, kerro kuinka usein

3. Hoidatko potilaita?

4. Mikä on lähiesimiehen rooli konfliktinhallinnassa?

5. Oletko käyttänyt työterveyshuoltoa/työsuojelua molemmissa tai jommassa kummassa seuraavista?

c) riidan tai erimielisyyksien tai konfliktin vuoksi?

d) vain oman riidan tai erimielisyyksien tai konfliktin vuoksi ottamatta muita osapuolia mukaan?

6. Oletko tehnyt yhteistyötä jonkun muun tahon, kuin työterveyshuollon/työsuojelun kanssa riidan, erimielisyyden

tai konfliktin selvittämiseksi?

7. Oletko itse selvittänyt riidan, erimielisyyden ja/tai konfliktin?

-mikäli vastasit KYLLÄ, kuinka monta kertaa?

Millaisia riitoja, erimielisyyksiä ja/tai konflikteja olet ratkaissut?

a) henkilösuhteiden

b) asioiden

c) muiden

Miten ratkaisit ne?

-mikäli vastasit EI – miten riidat/konfliktit selvisivät?

8. Ovatko arviosi mukaan riidat, erimielisyydet tai konfliktit suurin yksittäinen tekijä, joka vaikuttaa työilmapiirin

heikkenemiseen?

9. Oletko havainnut, että riidoista, erimielisyyksistä tai konflikteista olisi hyötyä?

-mikäli vastasit KYLLÄ, mitä:

10. Aiheuttavatko kiireiset työtilanteet ristiriitoja, erimielisyyksiä tai konflikteja ja miten tämä ilmenee?

11. Millainen tehtävä aiheuttaa yli osaston meneviä päätöksentekoprosesseja eli asiaa ei voi ratkaista osaston

sisäisesti?

12. Näkyykö ristiriitojen, erimielisyyksien ja konfliktien hoito toimintasuunnitemissa tai johtamisessa?

APPENDIX XI 1(7)

IY/MBA (CONSULTING COMPANY AND MBA CANDIDATE) SURVEY QUESTIONS AND ANSWERS

Question No. 1

APPENDIX XI 2(7)

Question No. 2 (here divided into two pages)

APPENDIX XI 3(7)

Question No. 3

Question No. 4

APPENDIX XI 4(7)

Question No. 5

Answers to Question No. 5

APPENDIX XI 5(7)

Question No. 6

Answers to Question No.6

APPENDIX XI 6(7)

Question No. 7

Comments to Question No.7

APPENDIX XI 7(7)

Comments on the survey (Question No. 8)

APPENDIX XII 1(4)

The Graphical Representation of the HUS questionnaire answers (in percentages)

Categorized answers (discussion group includes all connotations

and department nurse similarly)

EHC/WS Self Others

Who resolves the problems (n=72)

Own conflicts

Relational Task All

Which kind of problems (n=72)

Discussion Discussion and Department nurse

EHC/WS

How did you resolve them (n=44)

APPENDIX XII 2(4)

Categorized answers

10 15 20 25 30 35

Persistant Discussion Forgetting Discussion with Department

How did the conflicts resolve if you didn't solve them (n=28)

Yes No

Are conflicts the biggest, sole factor of making the working

atmoshpere worse (n=72)

APPENDIX XII 3(4)

Categorized answers (the first four of them according to percentage)

Yes No

Have you noticed that conflicts could have a positive effect

(n=72)

0 10 20 30 40 50

If you answered yes, tell us why (n=33)

Yes No

Are urgent situations a source of conflicts

APPENDIX XII 4(4)

Categorized answers (the first four of them according to percentage)

Categorized answers (the first three of them according to percentage)

Resources Saying Tension Planning

If you answered yes, how does it show (n=52)

Foreman Cooperations Complains

What kind of conflicts should be taken outside of department

(n=56)

Yes No

Does conflict handling show in activity plans or leadership

(n=72)

APPENDIX XIII 1(2)

APPENDIX XIII 2(2)

APPENDIX XIV

Labour Process Theory

1. The consideration of labour as an important source of surplus value within capitalism. 2. The necessity for constant evolution of the forces of production, including those related to labour

skills, all due to the profit imperative inherent within capitalism. 3. A related control imperative over the labour process in order for capital to be competitively successful

in extracting surplus value from the production process. 4. An assumption in inherent power imbalances which create the structural tendency for antagonism

between labour and capital. Responses of labour can include resistance but also accommodation, compliance, consent or even active cooperation.

5. Research that involves acting politically to ultimately eliminate such imbalances or, in the short run to at least ameliorate their effects. This includes critical reflection on the one’s own ethical stance towards the subject of one’s research to avoid reproducing the kind of domination the research is aimed at undermining.

6. An open –minded approach to methodology to include both quantitative and qualitative methods and both dialectical and non-dialectical reasoning.

7. Recognition that other forms of domination (i.e. transcending those of class, and extending to issues such as race and gender) are also manifest in the workplace.

Jaros S.J Marxian critiques of

Thompson’s (1990) ‘core’ labour

process theory: an evaluation and

extension. Ephemera, Vol. 5, Nro 1

(2005), p. 5-25

APPENDIX XV Six Basic Mediation Styles:

1. Generic style (1970) 2. Settlement driven style (1980) 3. Cognitive, systemic style (1980)[2] 4. Transformative style (1990)[3] 5. Humanistic style (1990)[4] 6. Narrative[5] (1990) style may be a new bud on the tree of the mediation development[6]. 7. Different styles of communication in mediation often depend on the mediation style adopted. Some methods of communication are

inconsistent with some forms of mediation. 8. 9. In generic and settlement-driven mediation the communication – at least in the beginning – goes through the mediator. Language is a

problem solving language. 10. 11. In the cognitive mediation questions are meant to initiate a thinking process rather than a feeling process. The question: “What do you

feel?” leads to a completely different process and answer compared to the question: “What do you think?” 12. 13. In the systemic mediation questions are meant to disturb the system in order to initiate reflections. Focus is not on the individual rather

than the relation between the participants constituting the system. 14. 15. In the transformative mediation questions are meant to clarify process issues and to encourage decision-making. Questions are never

meant to provide information. Statements are replaced with conversations on how to process. 16. 17. In the humanistic mediation questions in preparatory meeting are meant to clarify, to encourage, to empower and to encourage to

empathy and recognition. In joint sessions questions are meant to clarify process issues and to encourage decision-making. 18. 19. In the narrative mediation questions are meant to challenge the ownership to the conflict story, to de-construct entitlements to the

context and the labelling of describing terminology, to deconstruct the conflict-saturated story, to engage the party into the externalizing conversation freeing the party to act and shape his own life in relation to others and to construct the alternative story

http://uk.mediator.dk/46-advanced%20techniques.htm, (15.5.2009) A not peer reviewed

article, but some sources are referred to: [1] A further elaboration of chapter 8 in “Mediations processen”, Boserup and Humle, Nyt Juridisk Forlag, 2001. First presented at the VOMA conference in Portland, OR 2001. Later presented on international conferences in Ellsinore, Denmark, Fort Lauderdale, FL, Oostende, Belgium, Heidelberg, Germany. [2] Prominent representatives of this style are the late John Haynes www.mediation-matters.com/res-haynes.htm(first president of AFM) and his successor in AFM Larry Fong, Calgary, Alberta, Canada (http://www.fongmediate.com/). John Haynes: The Fundamentals of Family Mediation, Old

Bailey Press, 1993. [3] This style was refined and defined by Bush and Folger (Bush, Robert and Folger, Joseph: The Promise of Mediation, Jossey-Bass, SF, 1994). In 2001 clarified in: Designing Mediation – Approaches to Training and Practice within a Transformative Framework, 2001, The Institute for the Study of Conflict Transformation, NY. http://www.transformativemediation.org/

[4] Mark Umbreit: Interpersonal Conflicts and Victim meet offender. http://ssw.che.umn.edu/rjp

[5] John Winslade and Gerald Monk: Narrative Mediation, A New Approach to Conflict Resolution, Jossey-Bass, 2000.

APPENDIX XVI

Innovation challenges and leadership imperatives

according to reference No. 2 (p.270) (one of the many examples in this book)

Innovation challenge: how do I give innovation the best possible change to succeed?

◘ Identify the most fundamental factors in your organization that are getting in the

way of innovation – and remove them

◘ Try not to let external forces such as market downturns or rising cost get in the way

of your innovation progress. Find ways to address the burning issue without losing

focus on growth goals.

◘ Don’t expect to become an innovation champion by just reading this book. Put your

reading into practice and start “hitting some shots”, learning and progressing as you

go, and then learning and progressing some more.

Innovation challenge: How do I deal with the tension between innovation and efficiency?

◙ Make innovation a “full citizen” – with the same rights, visibility, and impetus

behind it as operational excellence.

◙ Design your organization to keep innovation and efficiency in tension – so that the

interests of each side can always be heard, and so that neither side ever scores a

permanent victory over the other.

◙ Don’t ignore the warning signs that indicate when the healthy tension between

innovation and day-to-day execution is getting out of kilter.

◙ Recognize and master all of the subtle paradoxes that exist within innovation, such

as being unbounded and focused, or creative and systematic, or impatient and

persistent -. By continuously “tuning” your innovation system to keep these tensions

in balance.

Own Comments:

Value creation (a part of which is innovation) can be organized through transactions

and the use of resources, within the product (experience, symbolic) or price/cost.

Innovativeness as well as QA goes right through all of them creates a framework of

relationship marketing. Since there is not much of a symbolic value (which doesn’t

mean that there isn’t any or that we could put it in) and since the prices follow the total

production volume*, we should put a lot of efforts (especially management) to

transactions and resources to be able to innovate more.

*Brown A. et al. Journal of Medical Marketing; Vol. 7, No. 3 (2007), p. 203

APPENDIX XVII

By Fiol C. et al. Academy of Management Review Vol.34, No.1(2009), p.38

APPENDIX XVIII

APPENDIX XIX

TEKES WELLNESS AND HEALTH

Ageing and changes at the population structure

- Impact on service relations and health

- Developing the Finnish welfare society

- Individual and human point of view

- availability of the services, treatments and care point of view

- service system functioning, power and effectiveness

Knowledge, skill and technological usability potentials for individual and comprehensive

quality of life, health improvement as well as care and treatment enhancement

Kyselyn tulosten mukaan lähivuosien ja –vuosikymmenien merkittävimpien globaalien

innovaatioalueiden arvioidaan löytyvän energia-alalta (mm. hiilidioksidin hallinta), logistiikasta,

luontoon ja luonnonvaroihin liittyvistä asioista (mm. vesi, maatalous, biopolttoaineet), viestinnästä

sekä ihmisen terveyteen ja turvallisuuteen liittyvistä aloista.

Same in English:

According to the survey results, the global innovation areas during the nearest years and decades are

predicted to be found in energy (for ex.carbondioxide control), logistics, nature and its resources

related entities (for ex. water, agriculture, bioenergy), communication as well as human health and

safety related issues.

From the half year rapport (TEKES, Technology program rapports 8/2007, s.28)

Toimepidesuositus:

1. Prosessien ja rakenteiden uudistamista tukevien hankkeiden colyymin kasvattaminen

2. Yksityisen, julisen ja komannen sektorin valisten kumppanuushankkeiden osuuden merkittävä

lisääminen. Verkostomaisuuden ottamienn myös hankkeiden valintakriteeriksi

3. Monitieteisyyden distäminen aj tukemien hankevalinnassa ja –toteuksessa. Tulevaisuudessa

terveyden edistämisen kehittämiseen tarvitaan yhä monitieteisempää lähestymistapaa mukaan

lukien tekniset tieteet, lääke-, terveys-, yhteikunta-,käyttäytymis-,liikunta-, ja taloustieteet

sekä viestintä

The recommendations for action:

1. Plans to increase the volumes of processes and structures

2. Increasing relevantly the partnering of private, public and 3rd

sector operations.

Networking also as a criteria for choosing

3. Cross-sientific enhancing and supporting in choosing plans and executing them. In

the future we need more cross-scientifically approach including technical science,

medicine, health, community, behaviour, motional and economical sciences and

communication in promoting health enhancement development

APPENDIX XX

The comparisons according to the latest drives and theories (see 3.2 Literature review)

The latest tensions are between transaction vs. relationship marketing (Vargo S. et al.

and Palmatier R et al.), contingency or discontinuity (congruent) vs. disruptive markets

(Drazin R et al.,Vargo S. et al. and Christensen C.), Kaizen vs. innovative development

(Hamel et al.), brick by brick vs. leap of faith building as well as affective or cognitive

organization (Homburg e al.) or decentralized or centralized management (Simon H.).

Olson et al. says, that “every strategy needs different combinations of organization

structures and strategic behaviours for success*” But as P.Duncker said, the core is

innovativeness and marketing and Vargo and Lusch said, that skill and knowledge is all

you need, the targets should be customer’s (in a very broad, society wide meaning as

well) benefits and job opportunities coupled to one’s own benefits and cultural

developments of convergence, divergence or crossvergence (RalstonD. and Hofstede G.

and Beals R.).

Innovative development exists, but not in a disruptive way, rather like it always has. HUS is

therefore closer to Kaizen kind of gradual improvements. Same goes for the risk taking and

growth - gradually with almost zero risk.

Affective organization culture and responsiveness are far from our thinking. Cognitive turns

are typical and suits competition better than customers (Homburg et al.)

* Olson et al. Journal of Marketing; Vol. 69 (2005), p. 49

APPENDIX XXI 1(2)

APPENDIX XXI 2(2)

A five factor taxonomy model by De Dreu C. at al. Journal of Organizational Behavior Vol.

22 (2001), p. 645-668

Yielding Problem

solving

S Compromising

Avoidance Forcing

This is taken from the Action Manual in

case of working community harassment,

HUS Corporate Board of Directors (2005),

p.4 (translated by the author)

APPENDIX XXII

Activity Plan in case or working

community harassment

Stage 1 Employee’s notice to the harassing

parties

Harassment continues

Stage 2 New notice to the harassing parties

Stage 3 Talkative discussions between the

parties

Harassment continues/needs broader

clarification

Stage 4 Resolving, action and follow-up

with the help of a professional

Stage 5 Start of continuing action Written Notice by the foreman, task organization,

staff transference

Actions carry a result or Harassment

continues

Peace reached or a second written Notice

and discontinuance of the post or job

Working Safety

Employees’

health care

Ombudsman

APPENDIX XXIII

Sportsman S. Nursing Management, April 2005, p.32-40

APPENDIX XXIV 1(6)

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78 ibid, p.255

79 ibid, p.310-328

80 ibid.

81 ibid. p. 29,citing Jehn and Amason in Journal of Applied Psychology 85/1 (February 2000)

82 ibid. p. 53-64

83 ibid. p.11

84 ibid. p.12

85 ibid. p.127-128

86 ibid. p.25

87 ibid. p.50-51

88 ibid., p.256

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Glossary APPENDIX XXV

ADR Alternative Dispute Resolution

ASP Alternative Service Provider

BPR Business Process Reorganization

Bullying Small accumulative acts, that have caused a situation amounting to a pattern of systematic

maltreatment (Salin D.)

CEO Chief executive officer

Conflict See explanation in Introduction. Term used here in a broad meaning (anything from

a small misunderstanding to long disputes and bullying)

Constructive conflict Conflicts that have a positive effect

CRM Customer resource management

Dispute (legalized conflict)

DOAJ Directory of open access journals: http://www.doaj.org/doaj?func=subject&cpid=18

EBSCO Public Library Database of EBSCO Publishing

Epistemology Theory of knowledge

Facilitative leader A facilitative leader doesn’t do for others, what the others can do for themselves (Rees)

Half juridical The decisions are not directly enforceable (by law enforcement)

Heuristics Problem solving with trial and error and experimenting

Hermeneutics Interpretation processes

HRM Human Resource Management

HUS Helsinki and Uusimaa healtcare district (Helsingin ja Uudenmaan sairaanhoitopiiri)

i.e. In this case

Identity conflict a bit like role conflict, since it has to do with social and organizational identity, but

more as a group thing (Northrup)

Intangible assets Like trademarks, logos, copyrights (see for ex. Weston Anson, Consor Intellectual

Asset Management)

Intellectual property Like contracts, drawings, designs, royalties (see for ex. Michael Mard et al.

Consulting Services Practice Aid 99-2: Valueing Intellectual Property and

Calculating Infringement Damages (New York:AICPA,1999), p. 1-15

IY Valmenustalo Itsensäylittäjät Oy

Leader Manager whom people want to lead them and the organization

Leadership All entities that steer the people in an organization

Manager A person in a leading position responsible of the processes more than he feels

responsibility towards people

Management All entities that steer the organization

MBA My set group in MBA

MI Marketing Intelligence

Mobbing Scandinavian-German speaking countries name for bullying (English speaking)

according to Zapf

MSAH Ministry of Social Affairs and Health

MSOC Managerial Span of Control (=proportion managers/employees or degree of

hierarchy of authority in organization)

non-juridical this doesn’t include litigation or arbitration methods, but methods, that do have a

law to indirectly or directly back them up (mediation, employees’ health care and

working safety) as well as other in-house methods (like solving the conflicts in a team)

Nursing staff Doctors and nurses who work in a clinical setting

Ontology Studies being and existence

Outside of court room The line between juridical – half-juridical – and non-juridical is not a clear cut.

Outside of court room means, that the process is not handled by the authority of law

Perceptual conflicts Conflicts one can more easily find

Phenomenology The reflective study of the essence of consciousness

Porter’s model Model by Michael Porter on marketing penetration

R&D Research and development

Resilience The capacity of individuals to cope successfully in a face of significant change,

adversity or risk

Resolution Act that stops a dispute

SCB Superior Customer Benefit

SMB Small and Medium size Businesses (less than 250 employees)

TEKES Teknologian Edistämiskeskus (The Centre of Technological Achievements)

TENTTU Public Library database of The Helsinki University of Technology

Teleology Learning based on meaning that points to a target or end result as explanation.

Formative Teleology (norms and rules), Transformative Teleology (builds up

with the help of dialogue)

Transitivity Someone is friends with persons who is friends with another person and creates

thus pressure for the first person to become friends with that other person as well

Literature

Burns J.M. Leadership, Harper&Row, New York (1978)

Terttu Grönfors, Action Learning, e-learning, Espoo, Facile Publishing (2002)

Pehrman T. Studie, that I’ve been taking part with and that is at the same time part of his thesis work

Laitinen P. Implemented Change Laboratory™ in Oulu University Hospital

Health care leadership and conflict handling

Documents

Transcript of Health care leadership and conflict handling

APPOINTMENT OF HANDLING CONTRACTOR FOR ...

SF Gas Handling

Handling of Public Fill - CEDD

Engaging Leadership

Leadership Perspective: The Language of Leadership

Garlic Postharvest Handling Trials

Leadership Communication

Automation & Material Handling - LabVolt

Err exceptn interrupt handling

File Handling

Recursion, Exception handling

YAML file handling in JEDI

Livestock handling Facilities Designs

Handling Conflict - ISS Online

School Conflict Management: Evaluating Your Conflict ...

Conflict Resolution

NAVY LEADERSHIP

Complaint Handling - DiVA Portal

Ground Handling Management - ISO-Gruppe

POST-HARVEST HANDLING & MANAGEMENT