Managing Conflict in Health and Social Care: Guidance on Recognising and Handling Confrontations

Victoria O'Regan

August 30, 2021

8 min read

Within a health and social care environment, whether you work in the sector or have a loved one requiring care, you can find yourself in highly stressful and emotive situations. It is incredibly important for the wellbeing of the worker, service user and their families if there are good conflict resolution processes in place and any confrontations can be managed calmly and effectively.

Within this article we will explain what conflict in health and social care is, providing examples of some scenarios that can present themselves in a health and social care setting, guidance on how to handle confrontation, and how to implement positive confrontation techniques.

Conflict is natural, we will likely all have experienced it to a greater or lesser extent in our lives. It is not always outwardly expressed and can, rather damagingly at times, simmer under the surface. Conflict can be described as the serious incompatibility of two or more opinions, needs or drives or a serious and often protracted disagreement or argument. When conflict is expressed outwardly it can lead to confrontations between the opposing parties and we will look more into this later in the article.

There can be numerous factors that lead to conflict and a health and social care setting can bring together a diverse group of people in a notoriously challenging environment. It is therefore likely there will be differences in opinions and beliefs, incompatible personalities, varying expectations and power struggles.

There are additional physical and emotional pressures that can heighten any cause of conflict within health and social care settings. Staff are generally working in roles that place many demands on their time and resources. Those utilising the services are often heavily reliant on the care and attention of staff, with those suffering ill-health or reduced independence often feeling anxious. Family members can too have their own opinions and expectations regarding their loved ones’ care. The combination of all these factors increases the potential for conflict.

Types of Conflict in Healthcare

There are many variations of conflict types, some more specific to certain environments than others. Here we will look at five causes of conflict with examples of how they can relate to a health and social care setting.

Information Conflicts – when there is different or insufficient information available or a disagreement on what information is relevant. This can be a very frustrating situation in health and social care because it can heavily impact on the care provided and those implementing it. Lost or missing medical notes, information missed off a prescription and poor handovers are all common examples.

Value Conflicts – incompatible belief systems or trying to impose personal values onto others. A health and social care worker may hold a set of values on the standard of care they believe they should be able to deliver, but time constraints and lack of resources may mean they are unable to achieve this. Values do not tend to be negotiable and this can often lead to conflict between the member of staff and whoever they deem responsible.

Interest Conflicts – competition over needs or resources such as money or time. Service users, patients or their relatives may feel their needs are more necessary than those of others, and they may feel time given by staff is not being justly divided. This can cause conflict between several parties.

Relationship Conflicts – negative emotions, distrust, misconceptions or poor communication between people. The reasons for such conflicts can be many, as stressful environments and emotional situations can breed these emotions very easily.

Structural Conflicts – Oppressive behaviour toward others, a lack of resources or opportunities and the structure of an organisation. Health and social care organisations can have a high turnover of staff; when working in a demanding role, often with staff shortages and high demand, it can be very easy for conflict to arise if they begin to feel undervalued, under-resourced and are not provided with support and opportunities for progression.

Regardless of cause, conflicts can be detrimental to morale, productivity, staff retention and the standard of care and wellbeing of those utilising health and social care services. Every effort should be made to prevent, minimise and resolve conflicts. From aiming to reach a satisfactory solution in which all parties are happy, the issue of ethical dilemmas can occur when it is simply not possible to satisfy everyone.

An example of the link between conflict and ethical dilemmas could be; a family member who is appointed to make medical decisions on behalf of the patient is demanding everything is done to keep their loved one alive. As a medical professional the opinion is that it is time to withdraw life support and doing more could cause pain or discomfort without proving beneficial.

Different Conflict Scenarios in Healthcare

To put some of the conflict types we have discussed into context, here are a couple of conflict scenario examples:

A healthcare assistant is working a busy night shift on a hospital ward. The other healthcare assistants are currently in a side room with a patient who requires two members of staff. Several of the patients are pressing their call bells at once. The healthcare assistant answers the first two bells and can still hear a bell call. As they dash from place to place they notice two nurses at the nurses station laughing together. As they pass a nurse asks if they could please answer the bell as it has been going for a while.

This situation could appear to be a structural conflict as the healthcare worker may feel oppressed and frustrated by staff in a higher position. But it could equally be a relationship conflict – a simple misconception of the situation. The nurse may not be aware that the other staff are busy with another patient, or that the call bell sound was in fact numerous. In this situation the healthcare worker could simply communicate openly, explain calmly and ask for additional support if needed.

A care worker has just begun her day shift in a care home following a handover from the night staff. The handover mentioned a resident had a urine infection and had been presenting as very confused and kept trying to leave the premises, becoming aggressive when they were prevented. They decided to allocate a member of staff to them to act as a distraction and monitor them. A family member of another resident noticed how much one to one time they were receiving and began complaining about favouritism.

This could be an example of an interest conflict as the family member believes the attention was not justly divided. In this situation a member of staff could request a private word to explain. Addressing the issue would prevent any misconception and lingering resentment toward staff.

Whilst not a scenario as such, it seems worth noting here that many situations of confrontation and even aggression can occur most commonly in a health and social care setting due to cognitive, behavioural or medical issues. Dementia, mania, infection, delirium, and autism are a few examples. These may be managed through medications, restraint, and trained support workers and cannot all be successfully managed through positive confrontation techniques.

Interested in Reading More?

Why not check out our other conflict related articles: Signs of conflict in the workplace and Managing Conflict in the Workplace: A Guide for Line Managers.

How to Handle Confrontations

We have looked at possible scenarios of conflict and confrontations you may face and the factors involved. When faced with confrontations it is important to understand how to de-escalate the situation and try to reach a calm resolve. This is known as conflict management or conflict resolution. The best way to manage conflict is to aim to prevent it or reduce its frequency or its intensity.

When practicing conflict management you must identify and handle the conflict in a sensible, fair and efficient manner. The skills required to do this include effective communication such as active listening, problem solving, staying calm and focusing on how to tackle the problem. Within this setting, emotions can play a large part in confrontations, therefore compassion and empathy are often required when managing the situation.

As a health and social care worker, do bear in mind the environment you are in when dealing with any conflict or confrontation. Do not air any grievances in front of service users, patients or their relatives. Go somewhere private and quiet to talk. If the confrontation is with a service user, patient or relative and it is not practical to move the situation away from others, perhaps try screen off the area and talk in calm and quiet tones to limit the distress to others.

How to Handle Confrontation at Work

If you are a health and social care worker and it becomes necessary to handle confrontation with colleagues, here are a few steps to consider:

Act and speak calmly.
Try to implement positive confrontation techniques.
You can seek advice from a manager or mediator or if appropriate just ask them for a chat.
Choose a neutral space away from other colleagues, service users, patients and their families.
Listen and clarify the issue on both sides.
Work together to tackle the problem and seek advice if unable to do so.
Thank them for hearing you out.

How to Handle Confrontation with Family

Handling confrontation with the family members of a service user or patient would be approached in a similar way to colleagues. Do remember they are often going through a difficult time and if it is possible to prevent or avoid conflict then that may provide the most stable and calm environment all round. When that isn’t possible and a resolve regarding someone’s care or treatment is required, these are a few additional things to consider:

Act and speak calmly.
Be patient and understanding – they may need your empathy and compassion.
Actively listen to understand their concerns and requests.
Always remember a patient-centred approach to care and their rights.
Evaluate a solution, which may require multiple parties and healthcare professionals.
Clearly communicate information.
Consider providing additional reading materials for them if being more informed around certain topics would help them.
Decide on a mutually acceptable solution together.

Positive Confrontation Techniques to Implement

Learning how to approach confrontation in a confident and positive manner can be very beneficial to health and social care workers, service users, residents and families. Here are a few techniques to bear in mind:

Avoid a combative state of mind – you may feel you have been wronged, that you are right, and want to make your point, but remember the purpose is to reach a resolve to end the conflict on both sides.
Acknowledgement – sometimes acknowledging the other person’s point of view and any fault on your part is the first step to understanding.
Be aware of emotions – emotions can play a large part in conflict. Be empathetic when needed and know emotions can make an easily resolvable issue seem much greater.
Focus on the problem, not the person – remember addressing the problem is the key to resolving it. Do not be tempted to focus on the person as they may feel attacked.
Keep a calm and neutral voice – shouting or aggressive tones only feeds a conflict. Show you are here to help make the situation better.
Actively listen – you can’t learn the full extent of an issue unless you have all the information. There are times, especially in high stress situations where someone needs a release of their frustrations, where this act can often make the negative feelings pass and allow a more calm discussion and resolve to take place.
Use first person language – saying “I” instead of “you did” helps avoid making the other party feel defensive.

Try implementing these techniques into your communications – they can keep discussions calm and help minimise and even prevent conflicts occuring or escalating, creating an environment more suitable for health and wellbeing.

The health and social care sector will always be susceptible to conflict – it can be a demanding and highly emotive environment. Increasing your awareness of how to recognise where conflicts can arise and how to handle confrontation effectively can help create a more resilient and harmonious industry.