The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches

doi:10.1097/ACM.0000000000003604

. 2021 Jan 1;96(1):134-141.

doi: 10.1097/ACM.0000000000003604.

The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches

Affiliations

¹ N. Bochatay is a postdoctoral scholar, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-6098-4262 .
² Á. Kuna is assistant professor, Department of Applied Linguistics and Phonetics, Eötvös Loránd University, Budapest, Hungary.
³ É. Csupor is a clinical psychologist, Department of Child and Adolescent Psychiatry, Pediatric Clinic, University of Szeged, Szeged, Hungary.
⁴ J.N. Pintér is associate professor, Department of Psychology of Counseling, Eötvös Loránd University, Budapest, Hungary; ORCID: https://orcid.org/0000-0002-2580-588X .
⁵ V. Muller-Juge is an associate specialist, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-2346-8904 .
⁶ P. Hudelson is a medical anthropologist, Department of Primary Care, Geneva University Hospitals, and lecturer, Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-2601-7479 .
⁷ M.R. Nendaz is professor and vice-dean, Department of Medicine and Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-3795-3254 .
⁸ M. Csabai is professor and head of department, Department of Personality, Clinical, and Health Psychology, University of Szeged, Szeged, Hungary.
⁹ N.M. Bajwa is residency program director, Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, and faculty member, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0002-1445-4594 .
¹⁰ S. Kim is research professor, Department of Surgery, School of Medicine, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0002-6623-5393 .

PMID: 33394664
DOI: 10.1097/ACM.0000000000003604

The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches

Naike Bochatay et al. Acad Med. 2021.

. 2021 Jan 1;96(1):134-141.

doi: 10.1097/ACM.0000000000003604.

Authors

Affiliations

¹ N. Bochatay is a postdoctoral scholar, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-6098-4262 .
² Á. Kuna is assistant professor, Department of Applied Linguistics and Phonetics, Eötvös Loránd University, Budapest, Hungary.
³ É. Csupor is a clinical psychologist, Department of Child and Adolescent Psychiatry, Pediatric Clinic, University of Szeged, Szeged, Hungary.
⁴ J.N. Pintér is associate professor, Department of Psychology of Counseling, Eötvös Loránd University, Budapest, Hungary; ORCID: https://orcid.org/0000-0002-2580-588X .
⁵ V. Muller-Juge is an associate specialist, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-2346-8904 .
⁶ P. Hudelson is a medical anthropologist, Department of Primary Care, Geneva University Hospitals, and lecturer, Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-2601-7479 .
⁷ M.R. Nendaz is professor and vice-dean, Department of Medicine and Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-3795-3254 .
⁸ M. Csabai is professor and head of department, Department of Personality, Clinical, and Health Psychology, University of Szeged, Szeged, Hungary.
⁹ N.M. Bajwa is residency program director, Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, and faculty member, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0002-1445-4594 .
¹⁰ S. Kim is research professor, Department of Surgery, School of Medicine, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0002-6623-5393 .

PMID: 33394664
DOI: 10.1097/ACM.0000000000003604

Abstract

Purpose: The combination of power and conflict is frequently reported to have a detrimental impact on communication and on patient care, and it is avoided and perceived negatively by health care professionals. In view of recent recommendations to explicitly address power and conflict in health professions education, adopting more constructive approaches toward power and conflict may be helpful. This study examined the role of power in conflicts between health care professionals in different cultural contexts to make recommendations for promoting more constructive approaches.

Method: The authors used social bases of power (positional, expert, informational, reward, coercive, referent) identified in the literature to examine the role of power in conflicts between health care professionals in different cultural settings. They drew upon semistructured interviews conducted from 2013 to 2016 with 249 health care professionals working at health centers in the United States, Switzerland, and Hungary, in which participants shared stories of conflict they had experienced with coworkers. The authors used a directed approach to content analysis to analyze the data.

Results: The social bases of power tended to be comparable across sites and included positional, expert, and coercive power. The rigid hierarchies that divide health care professionals, their professions, and their specialties contributed to negative experiences in conflicts. In addition, the presence of an audience, such as supervisors, coworkers, patients, and patients' families, prevented health care professionals from addressing conflicts when they occurred, resulting in conflict escalation.

Conclusions: These findings suggest that fostering more positive approaches toward power and conflict could be achieved by using social bases of power such as referent power and by addressing conflicts in a more private, backstage, manner.

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References

1. Kreindler SA, Dowd DA, Dana Star N, Gottschalk T. Silos and social identity: The social identity approach as a framework for understanding and overcoming divisions in health care. Milbank Q. 2012;90:347–374.
1. Hall P. Interprofessional teamwork: Professional cultures as barriers. J Interprof Care. 2005;19(suppl 1):188–196.
1. Kuper A, Veinot P, Leavitt J, et al. Epistemology, culture, justice and power: Non-bioscientific knowledge for medical training. Med Educ. 2017;51:158–173.
1. Parsons T. On the concept of political power. Proc Am Philos Soc. 1963;107:232–262.
1. Dahl RA. The concept of power. Syst Res. 1957 (2007)2:201–215.

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[1] Kreindler SA, Dowd DA, Dana Star N, Gottschalk T. Silos and social identity: The social identity approach as a framework for understanding and overcoming divisions in health care. Milbank Q. 2012;90:347–374.

[2] Kreindler SA, Dowd DA, Dana Star N, Gottschalk T. Silos and social identity: The social identity approach as a framework for understanding and overcoming divisions in health care. Milbank Q. 2012;90:347–374.

[3] Hall P. Interprofessional teamwork: Professional cultures as barriers. J Interprof Care. 2005;19(suppl 1):188–196.

[4] Hall P. Interprofessional teamwork: Professional cultures as barriers. J Interprof Care. 2005;19(suppl 1):188–196.

[5] Kuper A, Veinot P, Leavitt J, et al. Epistemology, culture, justice and power: Non-bioscientific knowledge for medical training. Med Educ. 2017;51:158–173.

[6] Kuper A, Veinot P, Leavitt J, et al. Epistemology, culture, justice and power: Non-bioscientific knowledge for medical training. Med Educ. 2017;51:158–173.

[7] Parsons T. On the concept of political power. Proc Am Philos Soc. 1963;107:232–262.

[8] Parsons T. On the concept of political power. Proc Am Philos Soc. 1963;107:232–262.

[9] Dahl RA. The concept of power. Syst Res. 1957 (2007)2:201–215.

[10] Dahl RA. The concept of power. Syst Res. 1957 (2007)2:201–215.

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The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches

Affiliations

The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches

Authors

Affiliations

Abstract

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