Conflict situations in medicine. Causes and types of conflict situations in medicine

12.10.2019

Dissertation abstractin medicine on the topic Conflicts in medical institutions: causes, conditions, social consequences

As a manuscript

Popova Ekaterina Georgievna

CONFLICTS IN MEDICAL INSTITUTIONS: CAUSES, CONDITIONS, SOCIAL CONSEQUENCES

dissertations for competition degree candidate of medical sciences

Volgograd -2005

The work was carried out at the Department of Public Health and Health Care, Volgograd State Medical University

Scientific adviser:

Honored Worker of the Higher School of the Russian Federation, Candidate of Medical Sciences, Professor Sabanov Valery Ivanovich

Official opponents:

Honored Worker of Science of the Russian Federation, corresponding member. RAMS, Doctor of Medical Sciences, Professor Kucherenko Vladimir Zakharovich

Doctor of Sociological Sciences, Professor Baidalova Olga Vasilievna

Lead organization:

Kuban State Medical Academy

The defense will take place on May 14, 2005 at a meeting of the dissertation council D 208. 008. 04 at the Volgograd State Medical University at the address: 400131, Volgograd, pl. Fallen fighters, 1, in the meeting room of the Academic Council.

The dissertation can be found in the scientific - fundamental library of the Volgograd State Medical University.

Scientific Secretary of the Dissertation Council, Associate Professor

Medvedeva L M.

Relevance of the research topic. Health is one of the basic needs and an inalienable human right. This value setting is a socio-psychological landmark that determines the motivational behavior of individuals, social groups and society as a whole, reflected in the social policy of the state (Vyalkov A.I., 2001; Reshetnikov A.V., 2004; Shchepin O.V. et al., 2000).

The reform of the state healthcare system has been going on for more than 10 years, but contrary to expectations, it is accompanied by an increase in contradictions and conflict in healthcare institutions, a decrease in the degree of satisfaction of patients and doctors with the quality of medical care provided, which are the main criteria for the validity and correctness of the chosen direction of reforms, which indicates trouble in this socially significant sphere (Voitsekhovich B.A., 2002; Kadyrova S.M., 2002; Komarov Yu.M., 1994; Kulakov V.I., 2001; Starodubov V.I., 1997, etc.).

Despite the statement that the conflict is an unavoidable phenomenon in the life of society, the team and each person, ensuring progress and their progressive development, conflict situations in medical institutions are assessed by participants and outside observers of these processes as undesirable, requiring immediate resolution. The stress that occurs among the subjects of conflict interaction complicates interpersonal communication, reduces the effectiveness of the treatment, negatively affects the psycho-physiological state of medical workers, increases social tension among providers and recipients of medical services.

Conflicts in radiation and prophylactic institutions (HCIs) are only superficially local in nature. Functionally, they are closely related to the processes and contradictions that make up the main content of social change in society (G.M. Gaidarov et al., 2004; Yu.M. Komarov, 1995).

Medical workers are currently in a difficult socio-professional situation. Their social adaptation in society is extremely difficult. Due to insufficient funding of the industry and the inability to provide patients with medical care using modern medical technologies and in accordance with high standards its provision is reduced emotional background, a state of internal anxiety and professional dissatisfaction is maintained. Low remuneration of employees of medical institutions reduces the motivation for the quality performance of their professional duties. Often, social and domestic problems are extrapolated by the participants in the conflict to the process of interpersonal communication, which contributes to the growth of conflict in health care facilities.

At the same time, with financing of hospitals and polyclinics inadequate to real costs, a search is underway for new forms of organization and remuneration of medical workers. The intensification of the work of physicians in the context of the introduction of the "final result" limits the time of communication between the doctor and the patient, leads to the formalization of the treatment process, which is also manifested by an increase in the number of conflicts.

Identification of conflict situations, the study of the causes of occurrence, the dynamics of conflict interaction processes and their consequences, as well as the development of an adequate social technology for managing conflicts in healthcare facilities, during the period of reforms in the industry, will not only allow timely identification of problem areas of ongoing transformations and adapt them to the realities of practical health care, but also to influence the quality of medical care provided to patients, public health, and reduce the severity of social contradictions.

To achieve the goal, the following research tasks were solved:

Identification of regularities in the emergence and development of conflict situations in healthcare facilities in the context of the establishment of market relations and the reform of the country's healthcare system;

Sociological characteristics of participants in conflicts in health care facilities;

Determination of the influence of reactive and personal anxiety of medical personnel on the emergence and dynamics of conflicts in health facilities;

Assessment of the consequences of interpersonal conflicts in health care facilities on the quality and effectiveness of medical care for the population;

Development of a classification of conflicts in medical institutions;

The object of the study is the professional activity of employees of municipal health care institutions (hospitals, outpatient clinics) and private medical and diagnostic centers in the cities of Volgograd and Volzhsky.

In the extremely difficult conditions of reforming the healthcare system, the humanity of the mission and professional ethics require the medical worker to fulfill his professional duty, but the accumulated contradictions and psycho-emotional stress in the process of providing medical care at any time can lead to a conflict situation.

Even a minimal conflict in the case when one of its parties is a sick person will have negative consequences, as it will indirectly affect the health of its participants.

The conflict in health care facilities, being the extreme case of exacerbation of contradictions, requires modern identification, quick and effective intervention in order to minimize its negative consequences. To do this, it is necessary to clearly navigate the patterns of occurrence, the dynamics of the development of conflict interaction, that is, be able to predict it, and therefore prevent it. It is necessary to determine its functions and possible consequences in a timely manner, as well as to choose the optimal tactics of regulation.

The methodological basis of the study was scientific principles objectivity and consistency in the approach to the analysis of the problem. The work was carried out using classical methods of sociology (Zborovsky G.E., Osipov G.V., Yadov VA) and sociology of medicine (Volchansky M.E., Reshetnikov A.V., Tatarnikov M.A.). The study was carried out in the tradition of conceptual concepts " general theory conflict” by K. Boulding, “conflict model of the development of society” by R. Dahrendorf, the theory of “conflict functionalism” by L. Koser. The heuristic potential of domestic conflictology was applied (Antsupov A.Ya., Danakin N.S., Dmitriev A.V., Zdravomyslov A.G., Kozyrev G.I., Speransky V.I., Stepanov E.I. and etc.) in the normative field of bioethics (Petrov V.I., Sedova N.N., Siluyanova I.V.), medical law, conceptual models of the relationship between a medical worker and a patient, and the main provisions of the healthcare reform in Russia.

The scientific novelty of the study lies in the fact that for the first time a systematic sociological analysis of conflict situations in various healthcare institutions was carried out during the formation of market relations in Russia and the implementation of healthcare reform.

The scientific novelty of the research is revealed in the provisions submitted for defense:

3. The reforms carried out in the healthcare system have a destabilizing effect on the socio-psychological climate in health care facilities, and in the process of ongoing reforms, the number of medical workers who are satisfied with their work is decreasing.

4. The introduction of a system of remuneration of medical workers according to the “final result” at economically unjustified low prices for medical services in the system of compulsory medical insurance (CHI) leads to a reduction in the time for receiving patients, a deterioration in the quality of medical care for the population, and an increase in the number of complaints-conflicts in the system "doctor-patient" and reduces the level of satisfaction of patients with the help provided to them in medical institutions.

5. The classical classification of conflicts, adapted by the author to the conditions of professional activity of doctors at health care facilities, makes it possible to predict the occurrence of conflict situations in healthcare institutions, control the process of their development and choose the most rational ways of resolving, reducing the destructiveness of their consequences.

The scientific and practical significance of the work lies in the fact that the results of the study made it possible to give a comprehensive sociological description of the causes of conflicts in health care facilities in the context of the formation of market relations in the economy and the reform of the healthcare system. A new proven social technology of conflict management in health care institutions is proposed.

The materials and conclusions of the scientific work on conflict management in healthcare facilities are used in advanced training and advanced training courses for specialists in public health and healthcare at the Volgograd State Medical University.

Implementation acts were drawn up for the questionnaires and interviews developed by the dissertation student, “Regulations on the work of the conflict commission in the medical institution”.

Implementation of research results into practice. The dissertation student developed the "Regulations on the conflict commission in health care facilities" and organized the work of conflict commissions in seven health care institutions in the city of Volgograd and the city of Volzhsky. The textbook “The World of Politics: Actual Problems of Political Science. (Modern system of medical care in Russia and public health: problems and conflicts)”, which is used in the organization of the educational process of students of III-U1 courses, interns, clinical residents, advanced training courses for doctors at the Volgograd State Medical University.

Dissertation structure. The dissertation consists of an introduction, three chapters, a conclusion, conclusions and applications, illustrated with 8 figures and 10 tables. The literature index includes 233 sources, including 9 foreign ones. The total volume of the dissertation is 133 pages of typewritten text.

The introduction substantiates the relevance of the research topic, characterizes the state of its scientific development; the object and subject of research are determined; purpose and objectives of the work; methodological basis of the dissertation research; outlines the main provisions submitted for defense; the theoretical and practical significance of the study is highlighted.

The first chapter - "Literature Review" - consists of three paragraphs.

In the first paragraph - "Social conflicts: the evolution of views, the current state of the problem" - an analysis of the essence of social conflict is given, the causes of occurrence, the place and role of social conflicts in the system of social relations are considered.

The author proceeds from the methodological position that the functional basis of any social clash is an objective contradiction that arises between the opposing sides. Based on the theoretical concepts of K. Boulding, R. Dahrendorf and L. Koser, the dissertation considers social conflict as an integral element of development. public systems. Being an irremovable kind of social relations, the processes of conflict interaction are determined by the nature of the organization of the social system in which they arise and develop. Consequently, the definition of the essence of social conflict implies the need for a systematic approach to understanding this phenomenon and includes: analysis of the external conditions in which a conflict situation arises and develops; the study of its characteristics and components, the study of the dynamics and functions of the conflict. This allows us to consider the features of the process in specific socio-professional conditions, in conjunction with subjective factors presented in the form of interests, psycho-emotional state, gender, age, educational and other characteristics of specific participants in the events.

In the second paragraph - "Conflict in the organization: concept, essence, structure, conflict management and their consequences" - the causes of occurrence, features of the dynamics of development and specific forms manifestations of conflict in organizations. The author emphasizes that the knowledge of the participants in the conflict about the possible ways and means of regulating the conflict situation, as well as the awareness of the disastrous consequences of the conflict, which increase in proportion to its escalation, always have a positive effect on the dynamics of the development of conflict interaction. On the contrary, insufficient awareness of the volume of real contradictions, the desire for violent actions in resolving the conflict, increase the destructive potential of conflict.

Along with this, a theoretical substantiation of the mechanisms of managerial influence on conflict situations is given. It is noted that the best means of preventing the emergence of a conflict is the rational organization of the labor process, deliberate decision-making, conscientious performance by all employees of their duties, fair distribution of material remuneration for the work performed.

Analyzing the techniques and methods of conflict resolution developed in the sociology of conflict, the dissertation argues that the tactics of compromise is the most preferable as a way out of a conflict situation, since it is the most reliable basis for cooperation after overcoming the conflict. In addition, the influence of the authority of the leader, the need for his active influence on the motivation of the actions of the participants in the conflict, blocking their aggressive intentions, is emphasized. The criterion for the effectiveness of managerial decisions is the creation of conditions that exclude the possibility of disorganization of the identified social system and ensuring that the conflict fulfills its positive functions.

In the third paragraph - "Peculiarities of conflicts in healthcare institutions" - the dissertation emphasizes that the system of knowledge about human health is not limited to medical aspects, but involves a social and humanitarian approach, that is, the study of the entire set of relationships between a doctor and a patient in the range from traditional care for mental the patient's condition to the principles of ethical and legislative regulation of medical practice.

The author outlines the essence of the stage-by-stage reform of the healthcare system, carried out in accordance with the Concept for the Development of Healthcare and Medical Science, approved by the Government of the Russian Federation, fixes the problem areas of innovations, analyzes the legal support of medical activity in specific socio-economic conditions.

Health care is developing not only taking into account the needs of the population in health, but also in accordance with the ability of society to meet these needs. The processes of reforming the economy as a whole inevitably affect the development of all sectors of the national economy. drastic reduction budget spending on health care and the limited funds of compulsory medical insurance leads to an expansion of the list of paid medical services that are not available to everyone. Formally, the legal basis for the functioning of health care comes into conflict with the real possibilities of economic regulation of medical activities in the transition to market relations. The deformation of moral values and social norms in modern society leads to a decrease in the professional responsibility of medical

botnikov, complicating interpersonal relationships with colleagues and patients. The author comes to the conclusion that the national health care system is currently unable to provide equal opportunities to meet the needs of citizens in qualified and high-quality medical care.

An indicator of the problems associated with the introduction of economically unjustified innovations are conflict situations that arise at various levels. social interaction, in the provision of medical services in health facilities.

Chapter 2. "Materials and methods of research."

The strategy of scientific work is a descriptive (descriptive) version of the study in order to identify the qualitative and quantitative features of such a social phenomenon as a conflict in a medical institution.

The general population consisted of medical workers of seven polyclinics, two hospitals and two private diagnostic and treatment centers of the city of Volgograd and their patients. The object of observation, in the process of the current (continuous) study, with the registration of data as they arise (complaints) and receive (results of questionnaires and interviews, timing data for the duration of medical appointments in outpatient clinics (APUs), were employees of each of the selected health facilities , their patients.

The complexity of the object under study necessitated, for its more objective description, the use of various methods for collecting and analyzing information obtained in the framework of a selective study with the calculation of the allowable sampling error and statistical indicators of the description reliability. The composition of the sample was determined by the goals of the study and was as close as possible to the corresponding proportions in the general population. In the ongoing study, the reliability of the data is ensured by the representation in the sample of health care institutions, gender, age, socio-professional and socio-economic composition of the subjects, using the principles of unity of time and place for obtaining data.

The author presents a program of a comprehensive medical and social research conducted in 1997-2004, consisting of six blocks, in each of which the solution of the tasks set was carried out in several stages.

The research program provides for the following options for obtaining initial information: copying data from reporting and accounting documents, direct observation (chronometry of the duration

medical reception), questionnaire survey, testing and interview method. All accounting and reporting documentation used for analysis in scientific work has passed a preliminary expert assessment of reliability, its availability in full and completeness of data registration. Participatory observation was carried out in the conflict commissions. The assessment of the expediency of creating conflict commissions was carried out by questioning the persons whose complaints were examined at their meetings.

Summary data on the scope and methods of research are presented in Table. one.

Table 1

Summary data on the scope and methods of research

№ Research method Number of observations

1. Questionnaire for the study of intrapersonal conflict-geneity of medical personnel. 246 doctors 98 m/sisters

2. Scale of the level of personal and reactive anxiety Ch.D. Silberger and Yu.L. Khanina. 152 doctors, participants in conflicts; 96 doctors with no complaints

3. Questionnaire for the identification of latent intra-group conflict in health care facilities. 268 doctors

4. Timekeeping of the duration of medical appointments in APU with various forms of remuneration for employees. 300 observations for each specialty, total measurements - 3900.

5. Copying of written complaints received by the health facility. 208 incidents

6. Questionnaire for APU patients, which allows assessing the degree of their satisfaction with the medical care provided. 2334 patients

7. Interviewing patients of health care facilities, participants in conflicts (complaints) to compile a social characteristic of a conflict-prone personality. 205 people

8. Analysis of the number of appeals to healthcare facilities before and after the conflict of patients who filed complaints and temporary disability of medical personnel in the same situation. 208 patients, 208 doctors

9. Questioning of participants in conflict situations resolved in the conflict commissions of health care facilities in order to establish the degree of their satisfaction with this form of conflict resolution. 203 respondents

Analysis of the results of the study was carried out using various methods of statistical processing. To determine the correspondence between fluctuations in the values of signs, namely the duration of a medical appointment and the number of complaints about the quality of medical care, we used the covariance coefficient (Co), as well as the Pearson linear correlation coefficient (r), which specifies the presence of a causal relationship between accounting signs. In order to establish the share of influence of the analyzed factor sign - the duration of admission, on the effective sign - the number of complaints, the calculation of the coefficient of determination (r2) was applied. Determination of the severity of the relationship between the number of patients' visits to the APU before and after the conflict in the main group and visits to the clinic, over the same period of time, in the control group was performed using the method of tables of mutual contingency and the Yule association coefficient (0. Statistical significance (E proved with by determining the Pearson's coefficient of agreement The probability of the influence of socio-demographic, socio-economic characteristics, as well as the state of health of a medical worker and a patient on the conflict of their behavior in conditions of direct interaction, was determined by calculating the Spearman's rank correlation coefficient (p).

The third chapter - "The results of the research" - consists of seven paragraphs. In the first paragraph - "Intrapersonal conflict of employees of medical institutions: emergence and genesis" - it is emphasized that in the transition to a market economy, the entire previously existing system of values is destroyed, the socio-psychological motivation of the professional work of a medical worker changes.

In order to identify latent intrapersonal conflicts among medical workers, their causes, as well as the impact on the psychological climate in health facilities and the nature of communication with patients, we conducted questionnaire surveys of employees of municipal medical institutions and private medical diagnostic centers with a research interval of 7 years (1997 and 2004). The data obtained showed that the majority of physicians (regardless of which medical institutions they worked in) considered their work to be socially significant (91.4% in 1997 and 90.2% in 2004).

At the same time, in 1997, 59.2% of doctors working in municipal healthcare institutions and 76.3% in private medical centers were satisfied with the results of their work. In 2004, these figures increased to 61.8% in municipal and 81.4% in private medical institutions.

niyakh. Respondents deciphered job satisfaction in open questions, noting the effectiveness of their work for patients, a decrease in morbidity at the sites, and a decrease in the primary exit to disability. Dissatisfaction with the results of their work was mainly expressed due to the inability to treat with high-quality, modern, expensive medicines, to perform various diagnostic tests for patients in a timely manner and free of charge using modern medical technologies, and problems of prolonging the treatment of chronic patients outside the hospital period. Over the 7 years that have passed between the surveys, the respondents have not noted any dynamics in this matter.

In 1997, 76.2% of physicians in municipal medical institutions and 22.4% of physicians in private medical centers believed that the amount of work they did was excessive and did not correspond to the appropriate workload. In 2004, this figure increased and amounted to 87.4% and 37.2%, respectively. At the same time, in 1997 and 2004, all respondents of municipal hospitals and polyclinics noted that the main factor that reduces the efficiency of working time is the registration a large number medical documentation. With a high assessment of the results of their work, the vast majority of respondents (84.6% in municipal medical institutions in 1997 and 91.1% in 2004) note a discrepancy between wages and labor costs, pointing to low wages, which forces 38.9% doctors to work part-time. The working day for this category of respondents averaged 12 hours, excluding scheduled daily and night shifts. But even this made it possible to bring the level of income per family member to an average of only 2,000 rubles. Identified problems with the organization of the provision of paid medical services. All of the above is the basis for the emergence of intrapersonal conflicts among medical workers. The sharpness of the emerging contradictions is exacerbated by the difficulties of adapting to the high pace of change in society and the system of practical health care. Reducing the zones of state paternalism and guaranteed minimum living goods worsens the economic, social and moral condition of the majority of the population. Medical personnel of medical institutions have to cope not only with the difficulties of survival in a rapidly changing society (this problem is common for physicians and patients), but also to be a kind of buffer in the event of various social contradictions at the time of providing medical care, mitigating the negative consequences of ongoing in the industry reforms.

In the second paragraph - "Intra-group conflicts in medical institutions" - the patterns of occurrence of intra-group conflicts are analyzed and pre-conflict situations in medical institutions are revealed.

The studied municipal health care facilities were combined into two groups: low-conflict health care facilities (with isolated cases of dismissal of employees with the wording “of their own free will”); high-conflict health care facilities (with the renewal of the staff over the past 2-3 years by more than one third).

44.8% of respondents worked in low-conflict healthcare facilities, 43.3% - in high-conflict health facilities, and 11.9% - in private clinics. 59.5% of doctors are dissatisfied with the work in their specialty in high-conflict healthcare facilities, and 50.0% of respondents in low-conflict healthcare institutions. The largest share in these groups is made up of district therapists of municipal outpatient clinics who would like to work as "narrow" specialists. The free-form explanations to the answer to the proposed question testified to the problems that local therapists and other specialists face when it comes to providing medical care to patients at home. In private medical center 31.3% of doctors are dissatisfied with their specialty. Here the situation is somewhat different and is mainly related to the differences in remuneration of physicians of therapeutic and surgical specialties. Working conditions are not satisfactory for three quarters of doctors in high-conflict healthcare facilities (72.4%), in low-conflict healthcare facilities and private clinic their number is small - 16.7% and 6.2%, respectively. About half of the employees of high-conflict health facilities (43.9%) and only 16.7% of doctors of low-conflict hospitals and polyclinics are not satisfied with the organization of work in their institutions. In a private medical center, there are practically no complaints about the organization of work (3.1%). Interpersonal relationships were also in the focus of our study. To the question about relationships in the team, the answers were distributed as follows: in low-conflict healthcare facilities, the bulk of the team of doctors is satisfied with the microclimate in the institution, only 15.0% of employees experienced problems. In a private clinic and high-conflict healthcare facilities, there are slightly more such individuals - 25.1% and 27.6%, respectively. A significant difference is noted in the answers to the question of the questionnaires about the relationship between doctors and heads of health care institutions. If in low-conflict healthcare facilities and private clinics only 12.5% and 15.6% of doctors experience difficulties in communicating with the administration, then in high-conflict healthcare facilities more than half of them (64.7%) indicated unsatisfactory relations.

At the same time, only 6.7% of doctors in low-conflict healthcare facilities and 3.1% in a private medical and diagnostic center would like to change their job. The motivating reason for this in low-conflict healthcare facilities, in the vast majority of cases, is higher wages (50.0% of respondents) and interesting work with the prospect of professional and career growth (25.0% of respondents). In high-conflict healthcare facilities, about half of the employees (42.2%) expressed a desire to change their place of work, and in this case, the main goal was to find a quieter place of work (67.3% of respondents) and only 24.5% would choose a place with higher pay labor. Further analysis of the questionnaires revealed that in low-conflict healthcare facilities, negative answers were given mainly by women aged 40-45 years with work experience of 11-20 years, who have the highest qualification category and additional employment in the form of part-time jobs in their specialty for 0.5-1 rate. In high-conflict healthcare facilities, this contingent was almost identical, but doctors of the first qualification category prevailed. In a private medical institution, the difference was in the absence of an additional burden in the form of part-time jobs for the bulk of doctors. Thus, with an unstable socio-psychological climate in health care facilities (these institutions are identified by us in the group of highly conflicting ones), prerequisites arise, and then conflict situations within the team. They can be identified as intragroup and intergroup, depending on the characteristics of the subjects of conflict interaction.

In the third paragraph - "Conflict potential of various schemes of remuneration of medical workers in outpatient clinics" - the regularities of the emergence and development of interpersonal conflicts in the "doctor-patient" system are studied.

We have studied conflict situations that arise in the provision of medical services in outpatient clinics that pay medical workers according to the unified tariff scale (ETC) and the “final result” (CR), their relationship with the function of a medical position and, accordingly, with the average duration of admission , as well as the ability to comply with all the requirements of regulatory organizations for the quality of treatment and documentation.

As part of the study, we monitored the admission of patients by doctors of various specialties. The time of admission during the initial and repeated visits of patients averaged 25.2 minutes. This is 3.3 times more than the actual time obtained when calculating according to the reports provided by medical institutions when working with payment according to the “final result”.

tu” and 2.4 times more than when working with payment by ETC. An analysis of the quality of medical care and filling out documentation, carried out after chronomegaly studies, revealed that even with such a significant increase in the time for receiving one patient, only in 82% of cases the experts did not reveal defects in the prescribed examination, treatment and preparation of primary medical documentation.

Written complaints of patients about medical care in polyclinics were also analyzed. Of the 208 written complaints of patients found to be justified, 26.4% were filed on treatment issues, 31.7% on drug provision, and 41.8% on ethics and deontology issues. Complaints arose 1.7-1.9 times more often in polyclinics working with the form of payment according to the “final result”. The average satisfaction score for outpatient clinics paying by “outcome” was 3.4 points, while for those paying by ETC it was 3.8 points (on a 5-point scale).

A certain pattern was revealed in the ratio of the number of complaints, the degree of satisfaction of patients with medical care from various specialists and the time devoted to them at the reception. Thus, with a reduction in the reception time of only 2.9 minutes, the number of recorded complaints almost doubled.

Reducing the duration of medical appointments, which is inevitable under the existing forms of remuneration, extremely low prices for medical services in the MHI system inevitably leads to a decrease in the quality of medical care provided at outpatient appointments and increases interpersonal conflict in the “medical staff-patient” system.

In the fourth paragraph - "Classification of conflicts in medical institutions" - we have developed and proposed a classical typological classification of conflicts adapted to the conditions of professional activity of medical workers, and given a detailed commentary on it.

The fifth paragraph - "Social characteristics of participants in conflict interaction in medical institutions" - reveals the features of the social portrait of subjects of conflict interaction in healthcare institutions. The study showed that conflict behavior among patients of health care facilities is more typical of people of pre-retirement or retirement age, who have a low level of education, an unsettled personal life, who have little comfortable life.

tovy conditions. Among them, a significant proportion of those who, despite poor health, are forced to work, sometimes even in excess of the normal workload established by specialty or age. The subjects of conflicts in health care facilities are more often citizens with low incomes, which limit their ability to receive paid (or partially paid) types of medical care and quality treatment. medicines. Socio-economic characteristics of medical workers and their partners in conflict interaction - patients are almost the same. Differences are revealed in the fact that doctors with high professional qualification. Despite the conscious choice of specialty and significant experience in working with people, low wages, corresponding only to the subsistence level, are one of the main factors that determine the psychological discomfort of medical personnel and affect the nature of interpersonal relationships at the time of providing medical care.

In the sixth paragraph - "Social Consequences of Conflicts in Health Care Institutions" - the conducted studies prove that the total number of patients' visits to healthcare facilities for 6 months after the conflict occurred is significantly higher than before it (Fig. 1.2).

Identification of an increase in the number of requests for medical care in health facilities and the negative impact of the conflict on human health confirms the destructiveness of the consequences of conflicts for patients in health facilities.

a 6 c d e f

0 main group III control group

Rice. 1. Frequency of visits to healthcare facilities of patients of the main and control groups during

6 months before the conflict: a) did not apply to health facilities; b) applied 1 time; c) applied 2 times; d) applied 3 times; e) applied 4 times; e) applied 5 times

a b c d e c

B main group 0 control group

Rice. 2. The frequency of visits to healthcare facilities by patients of the main and control groups within 6 months after the conflict: a) did not apply to healthcare facilities; b) applied 1 time; c) applied 2 times; d) applied 3 times; e) applied 4 times; f) applied S times

The seventh paragraph - "Social subjects of conflict management in medical institutions" - indicates the need to organize monitoring of latent conflict in healthcare facilities, which would allow predicting the occurrence of conflict situations, as well as the feasibility of creating conflict commissions in healthcare facilities on a functional basis, the purpose of which is - stabilization of social well-being of providers and consumers of medical services, improvement of the quality of medical care provided to patients. This collegial body can provide significant assistance in the timely consideration of citizens' appeals to healthcare institutions in the manner prescribed by federal and regional legislation, make informed decisions on complaints and ensure their correct implementation, systematically monitor the state of affairs in considering citizens' applications, analyze the causes of conflicts, take measures to eliminate them.

We analyzed the experience of the conflict commissions created in seven medical institutions.

During the work of the conflict commissions (2001-2003), they considered 588 oral and written complaints (2.1% of this number were complaints from medical workers). All conflict situations were settled out of court. In 4.6% of cases, for the final solution of the problems that arose, the intervention of higher health authorities was required. Structural distribution of complaints considered in the conflict commissions is shown in fig. 3.

For questions:

And treatment

PI drugs, providing. 0 organization honey. service Her ethics and deont. ■ others

Rice. 3. Structural distribution of complaints considered in conflict commissions

The result of the consideration of complaints and appeals of patients to the conflict commissions was the adoption of management decisions on the organization of the work of the structural units of health care facilities, the introduction of adjustments to the work schedules of doctors in polyclinics, the conduct of classes on ethics, deontology and psychology of the treatment process with doctors and paramedical staff.

The positive impact of peer review of complaints on the quality of medical care in the polyclinic was noted by 81.4% of respondents.

Medical workers - participants in conflict situations also highly appreciated the work of the commissions. In this group, 92.4% of respondents indicated that the discussion of the complaint in the conflict commission significantly reduced the emotional burden on the participants in the conflict and made it possible to achieve a constructive settlement.

In conclusion, the results of the dissertation research are summed up, its conclusions and practical recommendations based on the results of the work performed are formulated.

4. The growth of conflictogenicity of interpersonal communication in the dyads "doctor (m / sister) - head of the institution (department)", "doctor (m / sister) - doctor (m / sister)", "doctor (m / sister) - patient" reflects destabilization of the socio-psychological climate in health care facilities in the current socio-economic situation in society.

5. Low level wages most medical workers and the need to work part-time lead to a feeling of chronic fatigue, have a significant impact on the conflict potential of their communication with colleagues and patients.

6. An increase in the number of complaints-conflicts in the "doctor-patient" system, a decrease in patient satisfaction with the quality of care provided in medical facilities, indicate the seriousness of problems in the organization of public health.

7. The collective portrait of a conflictant - a visitor to a health facility is determined by socio-economic factors. The overwhelming majority are women of pre-retirement and early retirement age (75.6% of respondents), with secondary specialized education (85.0%), working at state enterprises (58.3%), having additional employment in the form of part-time jobs (67, 7%) and at the same time the income per family member is below the subsistence level (92.9%).

1. In order to limit the destructive consequences of conflicts in health care facilities, it is recommended to create in them, on a functional basis, conflict commissions in accordance with the methodological recommendations set out in the “Regulations on the conflict commission in health facilities”.

3. Territorial health authorities to revise the norms for the workload of doctors at outpatient clinics, taking into account the real time costs in connection with the introduction of the compulsory medical insurance system and preferential drug provision.

4. In order to improve the quality of medical care to the population, optimize personnel policy and stabilize the psychological climate in health facilities, carry out preliminary testing of medical workers in order to identify potentially high-conflict personalities.

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Popova Ekaterina Georgievna

CONFLICTS IN MEDICAL INSTITUTIONS: CAUSES, CONDITIONS, SOCIAL CONSEQUENCES

Signed and stamped 05.04.2005

Circulation 100 eu. office paper. Uch.-ed. l. 1.5.

Printed in the printing house of the VolGMU Publishing House 400063, Volgograd, st. Rokossovsky, 1g

INTRODUCTION

Chapter 1. LITERATURE REVIEW.

1.1. Social conflicts: the evolution of views, the current state of the problem.

1.2. Conflict in the organization: concept, essence, structure.

1.3. Features of conflicts in healthcare institutions.

Chapter 2. MATERIALS AND RESEARCH METHODS.

Chapter 3. RESULTS OF RESEARCH.

3.1. Intrapersonal conflict among employees of medical institutions: emergence and genesis.

3.2. Intra-group conflicts in medical institutions

3.3. Conflictogenic potential of various schemes of remuneration of medical workers in outpatient clinics.

3.4. Classification of conflicts in medical institutions.

3.5. Social characteristics of participants in conflict interaction in medical institutions.

3.6. Social consequences of conflicts in health care facilities.

3.7. Social subjects of conflict management in medical institutions.

Dissertation Introductionon the topic "Sociology of Medicine", Popova, Ekaterina Georgievna, abstract

Relevance of the research topic. Socio-Economic Development Program Russian Federation for the medium term (2003 - 2005) in the section "Health Reform" declares as the goal of the state "improving the health status of the population based on ensuring the availability of quality medical care", while pointing out the need to achieve "balance in the volume of state guarantees in the field of providing the population with free medical care, drug provision and its financial capabilities. The state abandoned the extensive method of increasing health care resources and outlined a transition to its intensive development.

In the conditions of a "transitional state" society, the national health care system in Russia is not able to provide equal opportunities and meet the needs of all members of society, its various social groups. folding political structure and social stratification of the population determine the real content of medical care provided to various social strata. That is, in the process of ongoing reforms, the state policy in the industry objectively diverges from the ongoing actions. In a country with extremely high mortality, including those of working age (in 2002 - 15.3 per 1000 population), negative natural population growth (according to the forecasts of the Center for Human Demography and Ecology of the Institute of Economic Forecasting of the Russian Academy of Architecture, the population of Russia by 2050 may amount to 87 million people), unsatisfactory life expectancy (according to the World Health Organization (WHO) - 60 - 61.9 years) and low incomes of the main part of the population, state and municipal medical institutions are being reduced, state guarantees for the provision of free medical care are being cut. help .

The UN defines the "quality of life" index of countries as the degree of development and satisfaction of people's needs. The health status indicator is part of it. The World Health Organization, recognizing the multifactorial nature of the conditions on which health depends, also considers the level of medical care to be the most important. In a socially oriented state, ensuring high satisfaction of consumers of medical services with the quality of medical care provided is one of the main tasks of the entire healthcare system.

Combining the Soviet model of centralized management of the industry and the liberal capitalist elements of its organization, being the executor of state-guaranteed obligations in relation to ensuring the health of the population, in the context of continuing funding on a residual basis, for more than 10 years of ill-conceived reforms, health care is in crisis. The discrepancy between the managerial and economic mechanisms of the functioning of the health care system reduces the efficiency of the industry and leads to the development of degradation processes in the health of the population.

At the VI All-Russian Pirogov Congress, it was noted that “as a result of a ten-year reform of the industry, it is an unmanageable system, neither vertically nor horizontally, in which insurance and budgetary financing methods that are inherently contradictory are built in, which causes disintegration and destruction of the constituent parts of Russian healthcare » .

The stagnation of medical science, the collapsing material and technical base of medical institutions, the impossibility due to limited funds to provide modern level diagnostics and treatment of diseases, uncontrolled commercialization of medicine, which reduces the level of access to medical care, low incomes of doctors and nurses, all this does not stabilize social relations and does not bring coherence into the actions of members of society.

In this situation, it is natural to openly compare the interests of all groups of people involved in the provision and receipt of medical services. Their social interaction acquires a conflictogenic character.

The above requires the adoption of a set of measures to form an effective system for the provision of medical services, paid according to the volume and quality of their provision, the dynamic development of insurance mechanisms for financing medical care, and an increase in funds allocated by the state for the implementation of the "Program of state guarantees for providing citizens of the Russian Federation with free medical care" .

Conflicts are an integral element in the development of social systems. Being an irremovable kind of social relations, conflict interaction is to a certain extent determined by the nature of the organization of the social system in which it arises and develops.

Thus, conflicts in medical institutions (HCIs) are an indicator of problems that have not yet been resolved by the reforms carried out in the healthcare system.

The issue of conflicts in health care during the formation of a market economy has not been sufficiently studied in domestic sociology. An objective necessity is to study the motives and causes of conflict processes in medical institutions in connection with their negative impact on the quality of medical care provided to the patient. The issue of creating an effective technology for managing conflict processes in health care facilities, including their forecasting, identification, reduction and settlement, is relevant.

The sociology of medicine has a sufficient set of methods to comprehensively analyze the issues of conflict interaction in healthcare, thereby actively influencing the development strategy of the industry.

Medical and sociological monitoring makes it possible to timely identify areas of tension (latently existing contradictions) inevitable during the reform period, assess the significance of innovations for society, study the social frustrations of a medical worker and patient, their impact on the treatment process and the psychological climate in healthcare facilities and, ultimately, on the state of public health.

Reducing the level of conflict in health care facilities is one of the important means of improving the efficiency of the health care system.

An analysis of empirical material and a review of information sources confirm the relevance of studying conflicts in healthcare facilities in the context of reforms, when the social status of healthcare institutions is significantly changing, economic situation medical workers, the nature of interaction in medical teams, new relationships that were previously absent in the systems "doctor - doctor", "doctor - patient", etc., appear.

The purpose of the scientific work is to develop a methodology for the prevention and management of conflict processes in medical institutions based on a comprehensive sociological study of their causes, conditions of occurrence, content and social consequences.

To achieve the goal, the following research tasks were solved: identifying patterns of emergence and development of conflict situations in health care facilities in the context of the establishment of market relations and reforms in the country's health care system; sociological characteristics of participants in conflicts in health care facilities;

Determination of the influence of reactive and personal anxiety of medical personnel on the emergence and dynamics of conflicts in health facilities; assessment of the consequences of interpersonal conflicts in healthcare facilities on the quality and effectiveness of medical care for the population; development of a classification of conflicts in medical institutions;

The object of the study is the professional activity of employees of health care institutions (hospitals, outpatient clinics (APU), private medical and diagnostic centers) of the cities of Volgograd and Volzhsky.

The subject of the study is conflict situations that arise in the process of providing medical care in health facilities.

Research hypothesis. The transitional society in today's Russia has become an arena of deep contradictions in all spheres of life. The radical reorganization of economic relations led to rapid social differentiation and a sharp polarization of the views of the country's population. The healthcare system, as a branch of the national economy, is no exception, experiencing all the economic and psychological problems of modern society. The reform of the state healthcare system has been going on for more than 10 years, but it has not been possible to fully achieve the stated goals for a number of objective and subjective reasons.

In these extremely difficult conditions, the humanity of the mission and professional ethics require the medical worker to fulfill his professional duty, but the accumulated contradictions and psycho-emotional stress in the process of providing medical care at any time can lead to a conflict situation.

Even a minimal conflict in the case when one of its parties is a sick person will have negative consequences, as it will indirectly affect the health of its participants.

Conflict in health care facilities - as an extreme case of exacerbation of contradictions, requires modern identification, quick and effective intervention in order to minimize its negative consequences.

To do this, it is necessary to clearly navigate the patterns of occurrence, the dynamics of the development of conflict interaction, that is, be able to predict it, and therefore prevent it. It is necessary to determine its functions and possible consequences in a timely manner, as well as to choose the optimal tactics of regulation.

Conflict management in such a socially significant area as the provision of medical care will improve the quality of medical services provided, optimize the process of restoring the health of patients.

The methodological basis of the study was the scientific principles of objectivity and consistency in the approach to the analysis of the problem. The work was done using classical methods of sociology and sociology of medicine. The study was carried out in the tradition of the conceptual concepts of the "general theory of conflict" by K. Boulding, "conflict model of the development of society" by R. Dahrendorf, the theory of "conflict functionalism" J1. Coser. The heuristic potential of domestic conflictology is applied in the regulatory field of bioethics, medical law, conceptual models of the relationship between a medical worker and a patient, the main provisions of the healthcare reform in Russia.

The scientific novelty of the study lies in the fact that a systematic sociological analysis of conflict situations in various healthcare institutions during the formation of market relations in Russia and the implementation of healthcare reform was carried out.

Based on the information received, a general, adapted to the conditions of professional medical activity, classification of conflicts in health care facilities has been developed.

The regularities of the influence of personal and reactive anxiety on the conflict behavior of medical personnel have been established.

A social portrait of a patient-conflictant has been compiled, which allows the doctor, in the process of treatment, to individualize the medical and deontological approach to the patient, in order to create a favorable psychological atmosphere in interpersonal communication.

The necessity of creating conflict commissions at health care institutions (on a functional basis) and introducing sociologists - conflictologists into the staff of healthcare facilities is substantiated. A new social technology for managing conflicts in medical institutions has been proposed and put into practice.

The expediency of testing medical workers in order to identify potentially high-conflict personalities in order to optimize the personnel policy of health facilities and stabilize the psychological climate in them has been proved.

Recommendations have been developed for changing the hourly workload of doctors at an outpatient appointment, taking into account real time costs in modern conditions and in connection with the introduction of a system of compulsory medical insurance.

The scientific novelty of the research is revealed in the provisions submitted for defense:

1. For medical workers (despite the high degree of adaptation to the profession), in conditions of socio-psychological discomfort during the formation of market relations in the state and reforms in health care, the presence of latent current intrapersonal conflicts is typical, complicating communication and reducing its constructiveness in the systems "head institutions - doctor", "doctor - doctor", "doctor - patient".

2. Severe personal anxiety is interconnected with a high level of reactive anxiety in a certain group of medical personnel of health facilities and objectively increases the conflict of interpersonal communication in the conditions of professional activity.

4. The introduction of a system of remuneration of medical workers according to the “final result”, with economically unjustified low prices for medical services in the compulsory health insurance system, leads to a reduction in the time for receiving patients, a deterioration in the quality of medical care for the population, an increase in the number of complaints - conflicts in the “doctor-patient” system ” and reduces the level of satisfaction of patients with the care provided to them in medical institutions.

5. The classical classification of conflicts, adapted by the author to the conditions of professional activity of doctors of health care facilities, makes it possible to predict the occurrence of conflict situations in healthcare institutions, control the process of their development and choose the most rational ways of resolving, reducing the destructiveness of their consequences.

6. The generalization of the empirical material of the study made it possible to determine the nature of the dependence of the incidence and the appeal of patients to medical institutions on the conflicts that arise in the process of providing medical care.

7. The creation of conflict commissions in health care facilities on a functional basis is a form of prevention and resolution of conflict situations that arise in the process of providing medical services.

The scientific and practical significance of the work lies in the fact that the results of the study provide a comprehensive sociological description of the problem of conflicts in healthcare facilities in the process of providing medical services to the population, in the context of the formation of market relations in the economy and reforming the healthcare system.

The results of the study can be used to improve the quality of the work of health facilities, optimize the personnel policy of institutions, improve work with patient complaints, stabilize the psychological climate of the organization, and improve the quality of medical care.

It is possible to use the materials and conclusions of scientific work in the advanced training courses for heads of medical institutions on conflict management in healthcare facilities.

Approbation of work. The materials of the dissertation were presented and reported at medical conferences in medical institutions that were part of the study; at the First All-Russian Scientific and Practical Conference "Sociology of Medicine - Healthcare Reform" (Volgograd, June 18-19, 2004); at the 3rd All-Russian scientific and practical conference "Medical-biological and psychological-pedagogical aspects of human adaptation and socialization" (Volgograd, October 1-3, 2004); the author published 6 scientific articles and 1 textbook (as part of a team of authors).

Implementation of research results into practice. The dissertation student developed the "Regulations on the conflict commission in health care facilities" and organized the work of conflict commissions in seven health care institutions in the city of Volgograd and the city of Volzhsky. The textbook “The World of Politics: Actual Problems of Political Science. (Modern system of medical care in Russia and public health: problems and conflicts)”, which is used in the organization of the educational process of students of III-VI courses, interns, clinical residents, advanced training courses for doctors at the Volgograd State Medical University. Implementation acts were drawn up for the developed questionnaires and interviews, "Regulations on the work of the conflict commission."

Conclusion of the dissertation researchon the topic "Conflicts in medical institutions: causes, conditions, social consequences"

1. Conflicts of any level in medical institutions are objectively determined by the socio-economic organization of society and the problems of the ongoing reform of the healthcare system.

2. Increasing latent intrapersonal conflict among employees of medical institutions, in the context of reforming the healthcare system, is a manifestation of the disintegration of the individual, expressed in the clash of conflicting internal motives, against the backdrop of an increasing gap between consumer expectations and value orientations medical personnel.

3. The high level of personal and reactive anxiety of a significant part of the surveyed medical workers is an indicator of the existing unfavorable socio-professional situation in the health care system and increases conflict in health care facilities.

4. The growth of conflictogenicity of interpersonal communication in the dyads "doctor (m/sister) - head of the institution (division)", "doctor (m/sister) - doctor (m/sister)", "doctor (m/sister) - patient" reflects destabilization of the socio-psychological climate in health care facilities in the current socio-economic situation in society.

5. The low level of salaries of most medical workers and the need to work part-time lead to a feeling of chronic fatigue, which has a significant impact on the conflict potential of their communication with colleagues and patients.

6. An increase in the number of complaints-conflicts in the "doctor-patient" system, a decrease in patient satisfaction with the quality of care provided in medical facilities, indicates the seriousness of problems in the organization of public health.

8. The classical typological classification of conflicts, adapted to the conditions of the professional activity of medical workers, allows for a prompt assessment of problem areas for timely adjustments to the proposed innovations in order to reduce tension in such a socially significant area as protecting the health of citizens.

9. The emergence of conflict situations in the process of providing medical care negatively affects the health of patients, increasing the number of their visits to healthcare facilities after the conflict, leads to an increase in both their personal costs and the costs in the compulsory medical insurance system.

10. The creation of conflict commissions in health care facilities on a functional basis is effective form forecasting, prevention and management of conflict situations that arise in the process of providing medical services.

1. In order to limit the destructive consequences of conflicts in healthcare facilities, recommend the creation of conflict commissions in them, on a functional basis, in accordance with the methodological recommendations set out in the “Regulations on the conflict commission in healthcare facilities”.

3. Territorial health authorities to revise the norms for the workload of doctors at outpatient appointments, taking into account real time costs, in connection with the introduction of the compulsory medical insurance system and preferential drug provision.

4. In order to improve the quality of medical care to the population, optimize personnel policy and stabilize the psychological climate in health facilities, carry out preliminary testing of medical workers to identify potentially high-conflict personalities.

5. Include in the program of training and improvement of heads of medical institutions the issues of managing conflicts in teams. The modular version was developed and tested by the author.

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228. Questionnaire No. 1. Appendix 1. Questionnaire for medical workers of a polyclinic (hospital) (filled in by the survey participants themselves)

229. Questioning is carried out with the aim of improving the quality of medical care for the population.

230. Dear employees! We ask you to express your opinion on issues related to the organization of work, the quality of medical care and relationships with work colleagues and patients in your medical institution.

231. The information received during the analysis will be depersonalized. The confidentiality of the survey is guaranteed by the administration of the medical institution.

232. When answering the questions, choose the proposed answers that satisfy you or express your opinion in free form.

233. Thank you in advance for your cooperation.

234. Do you consider your work socially significant, important for maintaining the stability of the state and society? - yes.□- not quite. |other.□

235. Do you think that medical care in your polyclinic (hospital) complies with generally accepted standards? - yes.□- not quite.

236. Do you think that the polyclinic (hospital) where you work is adequately provided with modern medical and diagnostic equipment? - yes.□- not quite.

237. Are you satisfied with the organization of work of the polyclinic (hospital) in general? - yes. □ - not quite. .□- no.□- difficult to answer.I Iother.□

238. Do you consider it convenient for you to organize work in a polyclinic (hospital)? - yes.□- not quite.

239. Does your current job match your professional capabilities?- yes.□- not quite.

240. Are you satisfied with the results of your professional activities? (If not, then explain what are the reasons for this dissatisfaction. If yes, then explain what exactly satisfies you.)- yes.□- not quite. |other.□

241. Do you think that your salary corresponds to labor costs? Yes, to the full extent. Not at all, it is higher than my labor costs. Not at all, it is below my labor costs.

242. Are you satisfied with your current salary? - yes.□not quite. Oh- no. Difficult to answer.| |other.□

243. Do you consider it possible for yourself to increase the length of working hours in order to increase material remuneration for your work? yes.□no. Difficult to answer.|~1other.□

244. What, in your opinion, is the main factor that reduces the effectiveness of the use of working time? (Answer the question in free form).

245. Do you have the opportunity to improve your professional skills, knowledge, improve your qualifications? - Yes.□- not quite.

246. Are issues of career growth of employees resolved in a polyclinic (hospital)? - yes.□- not quite. |other.□

247. Would you like to change your job?- yes.□- not quite.□- no.P- difficult to answer.| |other.□

248. From your point of view, the introduction of a system of compulsory medical insurance: made the work of the medical staff easier. It did not affect the work of the medical staff. .□

249. The introduction of a system of compulsory medical insurance, in your opinion: increased the level of remuneration of medical staff. It did not affect the level of remuneration of medical staff. Reduced the level of remuneration of medical staff.

250. Do you experience problems when assigning paid medical services to patients? (If yes, please explain why).yes.□not always.one.pdifficult to answer.oother.□

251. The volume of paid medical services provided in your medical institution: excessive. P- corresponds to the necessary needs. Lower than the needs of patients. Difficult to answer. P- other.

252. Do you have additional employment in the form of a part-time job in your specialty?

253. If yes, please indicate its volume). I have no additional employment. I have additional employment. P0.25 of the rate. .□0.5 bet.|Sch0.75 bet. .□1 bid.Pmore than 1 bid.P

254. Indicate how long you have been working part-time. Permanently, for many years. About 1 year. Up to 6 months a year. No more than 1-3 months a year.

255. Does it satisfy you. moral and psychological climate in your clinic (hospital)? yes. not really. no. I find it difficult to answer another.

256. Do you have the greatest difficulty in communicating with: patients.

Introduction

Chapter I. Theoretical part. Conflicts.

1 General definition of conflict

2 Types of conflicts

3 Causes of conflicts

4 Types of people's behavior in a conflict situation

5 Boundaries of conflict

6 Forms of work with conflicts and methods of their resolution

7 Team management styles. Mediation

Chapter II. Theoretical part. Features of the flow of conflicts in health care facilities.

1 Conflicts in a medical institution

2 Ways to prevent and resolve conflicts in the medical environment

Chapter III. Practical - research part. Conflict situations in GBUZ "Prionezhskaya CRH" during the period of reorganization.

1 Characteristics of medical services and analysis of the state of medical care in the clinic

2 Organization and research methods

3 Processing of research results

Conclusion

Bibliography

Applications

The person who is lucky is the person who

did what others were about to do

Jules Renard, French writer

Introduction

One of the priorities of the state policy of the Russian Federation is the preservation and strengthening of the health of citizens. This goal can be achieved by promoting a healthy lifestyle and improving the availability and quality of medical care. An important role is given to specialists with a secondary medical education, an advanced level of education and a higher medical education in the specialty "Nursing", which is the largest category of health workers.

Nursing is an essential component of the health care system, with significant human resources and real potential to meet the needs of the population for affordable and affordable medical care. The diversity of roles nurses perform requires an understanding of the factors that affect health, the causes of disease, how it is treated and rehabilitated, and the environmental, social and other contexts in which care is provided and the health care system operates. The World Health Organization (WHO) sees nursing personnel as a real potential for meeting the growing needs of the population for affordable medical care.

Modernthe socio-economic situation, the aggravation of the problem of the quality of medical care dictates the need for professional mobility, the competitiveness of specialists. And without such a thing as competence, this is impossible.

With the formation and development of general and professional competencies of a specialist, the provision of nursing care in high level and the ability to apply them to specific situations. As well as the presence of professionally significant personal qualities: honesty, responsibility, accuracy, discipline, accuracy, ability to lead and obey, depending on the situation. At the same time, a contradiction is inherent in the daily work of a nurse: on the one hand, it is necessary to provide an individual approach to the patient, on the other hand, in order to avoid errors and complications, strictly adhere to standardized principles and rules. Competence- this is the personal ability of a specialist to solve a certain class of problems in a social, professional and personal context.

Interpersonal relationships, first of all, imply the internal psychological climate of the team and the ability to work in a team.

Women's groups are a fairly common phenomenon in our healthcare system. Modern researchers note that women are more likely than men to show sensitivity to the psychological climate in the team and the desire to work in a psychologically comfortable atmosphere for themselves. Arriving at a new place, they usually first try to establish emotional bonds with colleagues and only after that they are fully involved in the work. Satisfaction with relationships with colleagues and management is becoming one of the main determinants of women's job satisfaction. Sometimes this factor outweighs all the others: salary level, growth prospects, etc. The female team is usually weakly hierarchical and rests on personal relationships. An ideal team for women is one that is built on the principle of a family, since women tend to project family relationships onto workers and expect support, understanding, and emotional warmth from colleagues. Any changes can be perceived negatively by the women's team.

A person rarely works alone, most often he works together with other people in a work team, and therefore changes are inevitable, often they provoke conflicts. The nature of conflicts is different: from the distribution of bonuses, vacations to the work schedule, and they proceed more covertly, using rumors, intrigues, and only sometimes through open emotional outbursts and scandals (which, of course, negatively affects the efficiency of the team as a whole).

homethe goal of the manager of any link is to establish effective joint work of employees. However, difficult relationships sometimes develop in a team, not only hindering successful interaction, but also provoking conflict situations.

Topic thesis - conflict situations and ways to resolve them, which may arise in the process of reorganization of health facilities.

Object of study - the staff of a medical institution (polyclinic), as an operating system human relations during the period of reorganization.

Subject of study - conflict situations that arise in health care facilities in the process of reorganization.

Target diploma work:

.Definitionthe level of conflict of the medical staff of the polyclinic;

Revealing the reasonsconflict situation during the period of making a decision on the reorganization of the polyclinic;

Determination of ways to resolve and exit from conflict situations in the process of reorganization of the institution;

Improving the socio-psychological climate in the medical team;

The role of the organizing sister in managing conflicts in the institution during the reorganization period;

Within the framework of the problem posed, the followingtasks :

· analysis of literature on the research topic;

· choice of research methods;

· practical solution of the tasks (testing, questioning);

· analysis of the received data;

· development of practical recommendations for improving the psychological climate in the team during the period of reorganization.

If a person is not at peace with himself, there is a problem of relationships between him and other people, and in this case, with employees. So-called work conflicts can have a negative impact on the entire work process. The main postulate of the work is hypothesis that an unresolved conflict among employees inevitably leads to interpersonal disagreements, which leads to even greater tension during the reorganization of a medical facility.

Research methods :

Characteristics of medical services and analysis of the state of medical care in the clinic

Test "Assessment of conflict"

Test "Scale for assessing the need for achievement"

Questionnaire for patients "Assessment of the work of the polyclinic staff"

Document analysis method: local media publications about the polyclinic

· newspaper "Prionezhye" No. 17 (9008) dated 07/06/12

· weekly of Karelia "Gubernia" No. 29 (843) dated 18.07.12

· newspaper "Prionezhye" No. 21 (9012) dated 03.08.12

· weekly of Karelia "Gubernia" No. 32 (846) dated 08.08.12

· newspaper "Prionezhye" No. 29 dated 28.09.2012

Organization management is impossible without conflict management, and this must be taken into account in the work of the sister organizer. And for effective management, one should study the types, levels, nature of conflicts, as well as find and put into practice the most optimal ways to resolve disputes during the reorganization of medical facilities.

conflict controversial team behavior

Chapter I. Theoretical part

.1 General definition of conflict

In everyday speech, the word "conflict" is used in relation to a wide range of phenomena - from armed clashes and confrontation between various social groups to official or marital disagreements. The people who work in organizations are different. Accordingly, they perceive the situation in which they find themselves differently. They also perceive their roles in the team differently, have different motivations in their work. Differences in perception often lead to people experiencing disagreement and contradictions. This disagreement arises when the situation is really of a conflict nature. The most general definition of conflict (from lat. conflictus - clash) is a clash of conflicting or incompatible forces. Conflict is a fact of human existence. There are different levels of conflict in an organization: intrapersonal, interpersonal, intergroup, between an individual and a group, intraorganizational.

Intra-organizational conflict can take many forms and has a wide coverage of representatives of various levels. When conflict in an organization is unmanaged, it can lead to confrontation ( structural units organizations or members of a micro or macro collective cease to cooperate and communicate with each other). Ultimately, such a situation of disunity will lead to the degradation of the team and the organization as a whole.

There is an opinion that the conflict should be avoided if possible or immediately resolved as soon as it arises. However, it should be borne in mind that conflict, along with problems, can also bring benefits to the organization. It is believed that if there are no conflicts in the organization, the labor collective, then something is wrong there. There are no conflict-free organizations in life: it is important that the conflict is not destructive. The task of the organizer is to design a constructive, resolvable conflict. To benefit from it, you need an open, non-hostile, supportive environment. If such an environment exists, then the organization only gets better from the presence of conflicts, since a variety of points of view provides additional information, helps to identify more alternatives or problems. However, one should not discount the fact that individual, most often interpersonal conflicts are destructive. A specialist should also be aware of this, since people who are different in their professional training, life experience, individual character traits and temperament, etc. participate in joint activities. These differences inevitably leave their mark on assessments and opinions on issues that are significant for the individual and the organization, sometimes give rise to confrontation, which, as a rule, is accompanied by emotional excitement and often develops into conflict. In some cases, clashes of assessments and opinions go so far that the interests of the cause fade into the background: all the thoughts of the conflicting parties are directed to the struggle, which becomes an end in itself, which negatively affects the development of the organization. The conflict model is shown in fig. 2.

Rice. 2 Conflict model

Model (nature) of the conflict ↓

Base of the conflict (conflict situation) ↓

Incident ↓

Potential for conflict to escalate ↓

Reaction to a conflict situation↓ ↓

Presence of conflict Absence of conflict↓↓Management of conflictNo consequences of conflict↓

Functional and Dysfunctional Consequences of Conflict

What is the nature of the conflict? Any conflict is based on a situation that includes either opposite positions of the parties on some issue, or opposite goals or means of achieving them in given circumstances, or a mismatch of interests, desires, inclinations of opponents, etc. The conflict situation, therefore, necessarily includes the objects and subjects of the conflict. This is the basis of the conflict. In order for the conflict to develop, an incident is necessary when one of the parties begins to act in a way that infringes on the interests of the other. An incident can arise both on the initiative of the subjects of the conflict (opponents), and regardless of their will and desire - due to objective circumstances or chance.

Conflict situations can also arise on the initiative of opponents or objectively. In addition, the conflict situation can be "inherited", pass to new opponents. It can be created intentionally by opponents - in order to achieve certain goals in the future, but it can be generated, albeit intentionally, but without a specific goal, and sometimes to the detriment of oneself. The same applies to the incident. In the development of each conflict, it is possible to fix the emergence of a new conflict situation, its disappearance and the termination of the incident. Any change in the conflict situation leads to the termination of this conflict, and possibly to the beginning of a new one. So the conflict can be functionaluseful to members of the workforce and the organization as a whole, and dysfunctional, reducing productivity, personal satisfaction and eliminating cooperation between team members. The consequences of the conflict depend mainly on how effectively the leader manages it. In this regard, it is necessary to know not only the nature, but also the types of conflicts.

1.2 Types of conflicts

There are four main types of conflicts: intrapersonal, interpersonal, conflict between an individual and a group, intergroup conflict (one of the types is intraorganizational).

intrapersonal conflict occurs when conflicting demands are placed on the same person. Intrapersonal conflict can also arise as a result of the fact that production requirements are not consistent with personal needs or values. For example, a subordinate planned on Saturday - his day off - some kind of family events, and the boss announced to him on Friday evening that, due to production needs, he should work on Saturday. Intrapersonal conflict arises as a response to work overload or underload.

interpersonal conflict . This type of conflict is perhaps the most common. Most often it is the struggle of the leader for limited resources, labor force, finance, etc. Everyone believes that if resources are limited, then he must convince the higher authorities to allocate them to him, and not to another person. Interpersonal conflict can also manifest itself as a clash of personalities, i.e. people with different characters, incompatible temperaments are simply not able to get along with each other.

Conflict between the individual and the group. In production groups, certain norms of behavior are established, and it happens that the expectations of the group are in conflict with the expectations of the individual. In this case, a conflict occurs. In other words, a conflict arises between an individual and a group when this individual takes a position different from that of the group.

Intergroup conflict. As you know, organizations consist of a variety of both formal and informal groups. Even in the best organizations, conflicts can arise between them.

People who work in an organization that is constantly changing or has an environment of uncertainty may experience more intense interpersonal conflict than people who work in a stable environment due to constant high stress.

Besides, conflicts classifyalso according to the degree of manifestation: hidden and open. Hidden conflicts usually involve two people who, for the time being, try not to show the appearance that they are in conflict. But as soon as one of them loses his nerve, the hidden conflict turns into an open one. There are also random, spontaneously arising, and chronic, as well as deliberately provoked conflicts. How kind of conflictallocate intrigue. Intrigue is understood as a deliberate dishonest action that is beneficial to its initiator and which forces the team or individual to commit certain acts that harm them. Intrigues, as a rule, are carefully thought out, planned, have their own storyline. More often observed in women's groups.

.3 Causes of conflicts

Each conflict has its own cause (source) of occurrence.

The causes of conflicts can be grouped as follows:

Ø outdated organizational structure, unclear delimitation of rights and duties- the consequence of this is a double or triple subordination of performers. Naturally, there is not enough time or energy to follow the instructions of all the leaders. Then the subordinate is forced to: himself rank the received orders according to their degree of importance; demand this from your immediate supervisor; take on everything. In any case, there is a conflict situation. The ripening conflict is eliminated by the proper organizational design of the division and cooperation of labor, the elimination of firm standards, and the improvement of the procedure for delegating powers.

Ø limited resources - dEven in the largest organizations, resources are always limited. Management decides how to properly allocate materials, human resources and finances to different groups in order to achieve the organization's goals. Allocating a larger share of resources to one will mean that other members of the team will not receive them, which will cause their discontent and lead to various types of conflict.

Ø unequal treatment of members of the workforce- as a result of this, “trusted persons” and “favorites” appear. This situation always provokes conflict.

Ø contradiction between functions and type of labor activity- this contradiction is especially acute when the leader adheres to bureaucratic procedures.

Ø differences in behavior and life experiences- there are people who constantly show aggressiveness and hostility towards others and are ready to challenge their every word. Such people create a conflict situation around them. Differences in life experience, moral values, education, work experience, age and social characteristics reduce the degree of mutual understanding and cooperation between members of the workforce.

Ø uncertainty about growth prospects- if an employee has no growth prospects or doubts its possibility, then he works without enthusiasm, and labor process becomes painful and endless for him. In such circumstances, the likelihood of conflict is most obvious.

Ø adverse physical conditions- extraneous noise, heat or cold, poor layout of the workplace can also cause a conflict.

Ø Lack of attention from the leader- the cause of the conflict may be the intolerance of the staff to fair criticism, inattention to the needs and concerns of customers, public "dressing", etc.

Ø psychological phenomenon- this is a constant feeling of resentment and envy (others are doing better, others are luckier, happier, etc.).

Ø insufficient level of professionalism- in this case, the possibility of a conflict is due to the professional unpreparedness of the subordinate. He is not trusted to perform certain types of work that is performed by another employee. As a result, some workers are underloaded with work, while others are overloaded with it.

Ø insufficient coherence and inconsistency of the goals of individual groups and employees.

Considering the named causes of conflicts, it is impossible not to notice that in certain situations the leader himself is the source of the conflict. Many unwanted conflicts are generated by the personality and actions of the leader himself, especially if he is inclined to introduce a lot of petty things into the fundamental struggle of opinions, allows himself personal attacks, is vindictive, suspicious, does not hesitate to publicly demonstrate his likes and dislikes. The cause of the conflict may also be the unscrupulousness of the leader, his false understanding of unity of command as a principle of management, his vanity and arrogance, harshness and rudeness in dealing with subordinates. Many conflicts arise precisely through the fault of such leaders who are able to find loopholes and circumvent directives and regulations, continuing to imperceptibly do everything in their own way. Without showing proper exactingness to themselves, they put personal interest at the forefront and create an atmosphere of permissiveness around them. The incontinence of the leader, the inability to correctly assess the situation and find the right way out of it, the inability to understand and take into account the way of thinking and feel other people and give rise to conflict.

To avoid conflict, it is necessary to clarify the goals and objectives of each unit and employee by passing the appropriate instructions orally or in writing.

1.4 Types of behavior of people in a conflict situation

The communication process is influenced by many factors, such as psychological, organizational, physiological and socio-cultural (life position, temperament, human character, goals, motivation, cultural level, and so on). Priority are psychological factors. Each employee is a person with his own characteristics that make him unique and interesting for other people. However, among his many character traits, there may be those that increase the likelihood of problems in the team and tension in communication. People behave differently in conflict situations: some often give in, giving up their desires and opinions, others - rigidly defend their point of view. Psychological factors conflict can become conflictogenic personality. Among them, several characteristic types are distinguished:

Reactive, unmanaged subjects - these are people whose reaction in response to ongoing events (words, actions) occurs rapidly, instantly. These individuals are characterized by impulsiveness, unpredictability, thoughtless behavior, lack of self-control. Emotions are bright, excessive, uncontrollable. Such people around themselves create such a heat of emotions, even for a minor reason, that they tire those around them. If they have increased irritability and an aggressive reaction to criticism, then all these qualities can become a powerful source of conflict.

ultra-precise - these people tend to be conscientious workers. They are especially scrupulous in their approach to all employees from the standpoint of excessive demands, and anyone who is not satisfied is subjected to sharp criticism. They are distinguished by increased sensitivity to the assessments of others, anxiety, which borders on suspicion.

Critical and categorical - these are people who have a ready and “only correct” judgment about everything. They always know how to act in this or that case, they are ready to teach everyone and everyone how to behave, think and speak, not noticing that this makes others angry.

vulnerable and sensitive - have increased resentment, suspiciousness. They are afraid of a possible unfriendly attitude towards them, they can see injustice, a catch, disapproval where there are none at all. They are ready to endlessly discuss this topic with others, or they become isolated, withdrawing into themselves, into their resentment and, “silently” suffering “from the injustice” of others. These are very pessimistic people.

Demonstrative - people who strive to always be in the spotlight, enjoy success, even for the sake of this they can go to conflict in order to be in front of everyone.

"Adult children" (emotionally immature individuals) - do not know how to control their emotions, which prevail over the mind, or to show them in accordance with the circumstances. Their lack of social maturity is manifested in the presentation of high demands on others, shifting their share of responsibility to others, insufficient criticism of their own actions, exaggeration of the role of circumstances and people in their own lives.

"Rigid" - people belonging to this type are distinguished by ambition, high self-esteem, arrogance, unwillingness and inability to reckon with the opinions of others. Once and for all, their opinion unequivocally comes into conflict with changing conditions and leads to conflict. These people argue like this: "if the facts do not suit us, so much the worse for the facts."

"Willless" - people do not have their own beliefs, principles. The danger of this type is that they have a reputation for being kind people; no trick is expected of them. Therefore, the performance of such a person as the initiator of the conflict is perceived by the team in such a way that "the truth speaks through its lips." A weak-willed person can be a tool "in the hands" of the person under whose influence he has found himself.

"Rationalists" - very prudent people, ready for conflict at any moment when there is a real opportunity to achieve their personal (careerist, mercantile) goals. For a long time they can play the role of an unquestioning subordinate until “the chair is pumped” under the leader. Here the rationalist will show himself by betraying him first.

Individuals with undeveloped communication skills - these are people who do not know the generally accepted rules of communication: they do not greet when they meet, do not look into the eyes of the interlocutor, not showing their interest during the conversation, and so on.

Sometimes there are poorly educated people prone to obscene, rude forms of expressing their dissatisfaction. They often deliberately disregard the generally accepted norms of behavior.

The main sign of a person with personality disorder - this is the disharmony of the personal organization, which leads to an inadequate perception of oneself and the people around. They are characterized by anger towards others, not being critical in assessing their own actions, a sharp discrepancy between their ideas about themselves and their true personal appearance.

All of these types of people bring tension to working relationships. The likelihood of a conflict situation increases if several undesirable qualities are combined in one person, which makes it difficult not only for the organizing sister, but for the entire team.

People are differently receptive to contradictions and conflicts that affect them.

Doctor psychological sciences N. Obozov distinguishes three types of behavior in conflict: behavior "practice", "interlocutor", "thinker".Depending on the types of personalities included in the conflict, it can proceed in different ways.

"Practitioner"operates under the slogan "The best defense is an attack." The effectiveness of people of a practical type contributes to an increase in the duration of the conflict. His irrepressible need to transform the external environment, including changing the positions of other people, can lead to various clashes and tensions in relationships. The "practitioner" is less sensitive to small innuendos, so as a result of the conflict, relations are violated very much.

For "interlocutor"The slogan "A bad peace is better than a good war" is typical. The main thing for him is communication with people. “Interlocutors” are more superficial in relationships, their circle of acquaintances and friends is quite large, and close relationships are compensated for by this. "Interlocutors" are not capable of long-term confrontation in the conflict. They know how to resolve the conflict in such a way as to affect the deepest feelings as little as possible. This type of personality is sensitive to changes in the partner's mood and strives to smooth out the contradiction that arises at the very beginning. “Interlocutors” are more open to accepting the opinion of another and are not very eager to change this opinion, initially preferring cooperation. Therefore, very often they become unofficial emotional-confessional leaders of the team.

"Thinkers"the position “Let him think that he won!” is characteristic. "Thinker" is focused on the knowledge of oneself and the world around. In a conflict, he builds a complex system of proofs of his rightness and the wrongness of his opponent. The "thinker" thinks through the logic of his behavior well, is more cautious in his actions, although he is less sensitive than the "interlocutor". In communication, "thinkers" prefer distance, so they are less likely to get into conflict situations, but are more vulnerable in close personal relationships, where the degree of involvement in the conflict will be very high.

People are differently sensitive to contradictions and conflicts that affect them. Thus, "thinkers" are most sensitive to contradictions and conflicts in the sphere of spiritual values or ideas. "Practice" is more important than the unity of practical outcomes, the goals of joint activities. "Interlocutors" react sharply to the assessment of emotional and communicative abilities, while the assessment of intellectual qualities or practical acumen affects them much less.

In addition, studies show that all employees can be divided into three groups according to their commitment to conflicts:

conflict resistant;

adhering to conflicts;

conflict.

The number of the latter group is about 6-7% of the total staff, and to ensure a favorable psychological climate in the unit, it is necessary to make the main efforts only on a tenth of the staff. The remaining 9/10 themselves strive for orderliness. It must be understood that among subordinates there are so-called "difficult" people with whom it is necessary to be able to cooperate.

« Aggressive»divided into three subtypes: tanks, snipers and explosives.

tanksthey are absolutely sure that their advice is the most competent, they do not like an aggressive reaction from those with whom they communicate. To achieve in a dispute with tanksany success, it is necessary to give them the opportunity to "let off steam", and then, they often become even tame.

Snipers"shoot" at people with various barbs and witticisms, thereby introducing disagreements into the collective actions of the staff. The most effective method of influencing them is to require a detailed explanation of what he wants to express with one or another of his witticisms. But at the same time, the sniper should not lose his face, otherwise he "explodes" or hides "with a stone in his bosom."

Explosives- types that can fall upon opponents with abuse, at the same time they lose their temper so artistically that it seems that they were greatly offended. They need to be allowed to throw out the accumulated emotions.

« Complainers."This is the type of people who describe their "troubles" so colorfully that the listener often has an opinion in their favor. The best thing to do in such cases is to rephrase the complaint in your own words, making it clear that their experience has been noticed.

"Indecisive".This type of people take a lot of trial steps before doing anything, thus causing irritation among the staff. The indecisive shun employees who put pressure on them, the instructions imposed by them are carried out without enthusiasm.

"Irresponsible".To some extent, they can be called anxious personalities, but anxiety does not give rise to conflict, but to aggression. If they feel a warm attitude towards themselves, then their behavior will “become within the framework” by itself.

"Know-it-alls".In essence, they are valuable workers, but they behave so defiantly that others develop a feeling of inferiority about themselves. It should be remembered that they rarely agree to admit their mistakes.

1.5 Borders of the conflict

The boundaries of a conflict are determined by its structure. The latter is a set of its parts, elements and relations between them, which are factors of its integrity.

Main elements conflict structuresare:

the object of the conflict;
participants in the conflict;
social environment, which is a condition of conflict;
subjective perception of the conflict and its personal elements. An objectconflict, as already mentioned, arises due to the need to satisfy a need. What can satisfy this need is the object of the conflict. It can be material, social and spiritual values.

Participantsconflict can be various subjects of the social field: individuals, social groups, organizations, states, etc. But the main participants in the conflict are opposing parties or opponents. They form the backbone of the conflict. As a rule, when the confrontation between them ends, the conflict itself ends.

Along with the main parties to the conflict, there are other participants, they play secondary roles in the conflict. Although it should be recognized that these minor roles can be both insignificant and very significant.

The role settings of the participants in the conflict are not identical. So, from a psychological point of view, the role of a participant in a conflict can be both elevated and base. After all, it should be remembered that each social subject is guided by his own motives, goals, interests, values and attitudes. However, the latter appear only when the conflict reaches its highest degree of development.

From a sociological point of view, the participants in the conflict may be different in their social status, strength, and influence. This is especially evident in the confrontation between the personality of an individual and the state.

You can build a hierarchy of the roles of the participants in the conflict:

1)individuals acting independently;

)groups of individuals;

)social strata;

)state.

An important factor in the development and boundaries of the conflict are the specific historical, socio-psychological conditions in which it unfolds. The social environment in this regard is the soil on which the conflict arises and develops. This includes not only the immediate environment, but also more wide range conflicting parties.

However, the specificity of the conflict depends not only on the objective conditions, but also on the subjective perception by the participants of this conflict, which is created by the subjects of the conflict situation. This image is not always identical to the true state of affairs. These subjective images can be of three types:

1) ideas about themselves;

representations of other participants in the conflict;
images external environment, large and small, in which the conflict unfolds.

It is these images, the ideal pictures of the conflict situation, and not the objective reality itself, that are the direct basis for the behavior of conflict participants.

At the same time, regardless of the ideas about the conflict, it will not begin until they are realized in appropriate mutual actions. The causes of the conflict, as well as the composition of its subjects, also determine the set of possible methods of action, the behavior of the parties. The actions of the subject of the conflict cause a corresponding counteraction, they are interdependent and interact with each other.

Determining the temporal, spatial and systemic boundaries of the conflict is an important prerequisite for successful regulation and prevention of its destructive impact.

1.6 Forms of work with conflicts and methods of their resolution

Conflictologists have developed and continue to develop ways to prevent, prevent conflicts and methods for their “painless” resolution. Ideally, it is believed that the leader should not eliminate the conflict, but manage it and use it effectively (Fig. 3). The first step in conflict management is to understand its sources. After determining the causes of the conflict, he must minimize the number of participants in the conflict. It has been established that the fewer people involved in the conflict, the less effort will be required to resolve it.

If in the process of analyzing the conflict, the leader cannot understand its nature and source, he can involve competent persons (experts) for this. The opinion of experts is often more convincing than the opinion of the immediate supervisor. However, in this case, each of the conflicting parties may suspect that the expert arbitrator, under certain conditions or for some subjective reasons, may take the side of her opponent. And in such a situation, the conflict does not fade, but intensifies, since the “offended” side must also fight against the expert - the arbitrator.

Rice. 3. Actions of the leader in resolving conflicts

Studying the causes of the conflict↓

Limiting the number of participants in the conflict↓

Conflict Analysis↓

Conflict resolution

There are three points of view regarding the conflict:

1.the leader believes that the conflict is not needed and only harms the organization. In this case, eliminate it in any way;

2.supporters of the second approach believe that conflict is an undesirable, but quite common by-product of the organization and the leader must eliminate it, wherever it arises;

.leaders with a third perspective believe that conflict is not only inevitable, but necessary and potentially beneficial. For example, it may be a labor dispute, as a result of which truth is born. They believe that no matter how much an organization grows and no matter how well the organization is managed, conflicts will always arise and this is quite normal.

Depending on which of these points of view the leader adheres to, the procedure for overcoming the conflict will depend. In this regard, conflict management methods are divided into two groups: pedagogical and administrative (Fig. 4).

Rice. 4. Conflict management

Ways to overcome (resolve) conflicts

PedagogicalAdministrativeConversation, request, persuasion, clarification of the requirements for work and illegal actions of the conflicting and other measures of the educational aspect Forceful resolution of the conflict - suppression of the interests of the conflicting, transfer to another job, various options for separating the conflicting. Resolution of the conflict by verdict - the decision of the commission, the order of the head of the organization, the decision of the court.

Of particular difficulty is finding ways to resolve interpersonal conflicts. In this sense, there are several possible behavioral strategies and corresponding options for the leader's actions aimed at eliminating the conflict. His behavior in a conflict has, in essence, two independent dimensions: assertiveness, perseverance characterize the behavior of the individual, aimed at realizing their own interests, achieving their own, often mercantile goals; cooperative characterizes behavior aimed at taking into account the interests of other persons (persons) in order to meet the satisfaction of their (his) needs. The combination of these parameters with varying degrees of their severity determines the five main ways to resolve interpersonal conflicts.

Avoidance, evasion(weak assertiveness is combined with low cooperativeness). With this strategy of behavior, a person’s actions are aimed at getting out of the situation without yielding, but also without insisting on one’s own, refraining from entering into disputes and discussions, from expressing one’s position. In response to demands or accusations made against him, such a leader turns the conversation to another topic. He does not take responsibility for solving problems, does not want to see controversial issues, does not attach importance to disagreements, denies the existence of a conflict or even considers it useless, tries not to get into situations that provoke a conflict.

Coercion (confrontation)- in this case, high assertiveness is combined with low cooperativity. The actions of the leader are aimed at insisting on their own through an open struggle for their interests, the use of power, coercion. Confrontation involves the perception of the situation as a victory or defeat, taking a tough position and the manifestation of irreconcilable antagonism in the event of a partner's resistance. Such a leader will make you accept your point of view at any cost.

Smoothing (yielding)- low assertiveness is combined with high cooperativeness. The actions of the leader in a conflict situation are aimed at preserving or restoring good relations, to ensure the satisfaction of the other person by ironing out disagreements. For the sake of this, he is ready to give in, to neglect his own interests, to strive to support another, not to hurt his feelings, to take into account his arguments. His motto is: "Don't quarrel, as we are all one happy team, in the same boat, which should not be rocked."

Compromise, cooperation- high assertiveness is combined with high cooperativeness. In this case, the actions of the leader are aimed at finding a solution that fully satisfies both his interests and the wishes of another person in the course of an open and frank exchange of views on the problem. He tries to resolve disagreements, giving in something in exchange for concessions from the other side, in the process of negotiations he is looking for intermediate “middle” solutions that suit both sides, in which no one especially loses anything, but does not gain either.

Among most leaders, there is a belief that even with full confidence in one's rightness, it is better not to "get involved" in a conflict situation at all or to retreat than to enter into a frank confrontation. However, if we are talking about a business decision, on the correctness of which the success of the business depends, such compliance turns into errors in management and other losses. According to experts in the field of management, the choice of a compromise strategy is the best way to eliminate contradictions. Through cooperation, the most effective, sustainable and reliable results can be achieved.

RivalryCooperationCompromiseEvasionCompliance

Having analyzed all the styles of conflict resolution (Fig. No. 5), we can draw the following conclusion: style cooperationthe most difficult, but also very effective, and, nevertheless, each of all styles gives positive results only in certain conditions and none of them can be singled out as the best. The optimal approach will be determined by the specific situation, as well as the warehouse of your character. What was the price of victory and what is defeat for another - extremely difficult questions for the leader, since it is important that the defeat of the opponent does not become the basis for the development of a new conflict.With all the right words about cooperation,for all the criticism of non-constructive approaches to conflict, there are times when agreement, compromise or avoidance of conflictare the only possible behavior. Sometimes it is important to simply understand, accept and help a person, and not succumb to his aggression.

In this way, conflict can be managed so that its negative effects can be minimized and constructive possibilities enhanced. This means that conflict is something to work with. Conflict management is a targeted impact to eliminate the causes that gave rise to the conflict, or to correct the behavior of the participants.

Solving the problem involves recognizing differences of opinion and a willingness to get acquainted with other points of view in order to understand the causes of the conflict and resolve it in a way acceptable to all parties. The one who uses this strategy does not try to achieve his goal at the expense of others, but seeks the best option resolving a conflict situation. Here are some suggestions for using this management style in conflict resolution:

ü define the problem in terms of goals, not solutions;

ü once the problem is identified, determine solutions that are acceptable to both parties;

ü focus on the problem, not on the personal qualities of the other party;

ü create an atmosphere of trust by increasing mutual influence on the exchange of information;

ü during communication, create a positive attitude of the conflicting parties towards each other, showing sympathy and listening to the opinions of one and the other side, as well as minimizing their manifestations of anger and threats.

There are other ways to resolve interpersonal conflicts:

coordination- coordination of tactical sub-goals and behavior in the interests of main goal or solving a common problem. Such coordination between organizational units can be made on different levels management pyramid (vertical coordination), at organizational levels of the same rank (horizontal coordination) and in the form of a mixed form of both options. If coordination succeeds, then conflicts are resolved with less cost and effort;

integrative problem solving- conflict resolution is based on the assumption that there may be a solution to the problem that eliminates all conflict elements and is acceptable to both parties. It is believed that this is one of the most successful strategies for the behavior of a leader in a conflict, since in this case he comes closest to resolving the conditions that initially gave rise to this conflict. However, the problem-solving approach to conflict is often very difficult to follow. This is due to the fact that it largely depends on professionalism. In addition, in this case, it takes a long time to resolve the conflict. In such conditions, the leader must have good technology - a model for solving problems;

confrontationas a way to resolve the conflict - making the problem public. This makes it possible to freely discuss it with the involvement of the maximum number of participants in the conflict (in essence, this is no longer a conflict, but a labor dispute), to confront the problem, and not with each other, in order to identify and eliminate all shortcomings. Target confrontational meetings- bring people together in a non-hostile forum that promotes communication. Public and frank communication is one of the means of conflict management.

The main task of the leader is to identify the conflict and "enter" it at its initial stage. It has been established that if it enters into a conflict in the initial phase, it is resolved in 92%; in the recovery phase - 46%, and at the "peak" stage, when passions are heated to the limit, conflicts are practically not resolved or are resolved very rarely. When all forces are given to the struggle (stage "peak"), a recession occurs and, if the conflict is not resolved in the next period, it grows from new force, because during the period of recession, new forces and new methods can be used to fight.

Conflict prevention, sometimes called "prevention", as a way to avoid it at the very beginning - is possible only in the case of a very successful application of manipulation, which has an effect only for a while, and in fact does not eliminate the conflict, but temporarily drowns it out. In this case, it will manifest itself later, and it is not known whether this will be more beneficial to the initiator of the manipulation, since then an escalation of the conflict, destructive in the form of manifestations, will follow (it cannot but follow). However, for the head of an organization, who expects his rapid career growth (as for any other political leader), sometimes it is “profitable” to silence the conflict, preventing it from manifesting itself during the period of “activity” in this position. A long-term pseudo-containment of the conflict is also possible. But in this case, significant resources are required. In addition, this actually means the creation of a crisis.

Conflict prevention- work with not yet begun, but only possible conflicts. We must remember that there is no objective description of the conflict, it is always subjective. Prevention should be aimed at eliminating the conditions for the emergence of conflicts. Conflict prevention is ensured by any activity aimed at developing the intellectual and communicative culture of an organization (state structure), at disseminating their norms in corporate culture organizations.

The term "conflict resolution" is usually used in two meanings: as the termination of the conflict by the participants themselves and as an external influence on the conflict (the very conditions of conflict interaction, its participants), based on the establishment and neutralization of its causes and the prevention of open clashes between the parties.

A settlement, as a rule, is the prevention of violent actions, the achievement of at least some agreements, the implementation of which is more beneficial to the parties than the continuation of conflict-based interaction. In practice, the settlement of conflict situations through negotiations, mediation, arbitration is more common than their resolution. Unfortunately, such primitive and unproductive methods as suppression and the use of force are no less common.

1.7. Team management styles. Mediation

It is important for the leaders of nursing staff to have leadership qualities, that is, not only to be able to organize the work of subordinates, but, most importantly, to lead them, infecting them with enthusiasm. The microclimate in the team depends on the style of personnel management, and, consequently, the likelihood of conflict situations.Many leadership theories have been developed, most of which are built around management styles: authoritarian, democratic, liberal.

At authoritarian style all power is concentrated in only one hand, the leader takes full responsibility for making decisions. Subordinates are more often ordered, forced to carry out instructions, makes a remark in a rude, incorrect form. He is conservative, recognizes only his own initiative, therefore he interferes in the actions of his subordinates, unfairly finding fault with them, but he does not allow himself to give advice, having a negative attitude towards criticism. Contact with employees is limited, he keeps himself at a distance from them, and when communicating with them he is not guided by moral standards, humiliating his subordinates. He considers himself an indispensable leader.

liberal style management is based on the leader's complete trust in subordinates, while allowing complete freedom of action. He himself prefers to act on instructions from above, trying to shift the solution of the problem to others, while reducing his responsibility. He controls subordinates from case to case, spontaneously, in requirements he is more often guided by persuasion. He listens to criticism, but does not correct the shortcomings, avoiding any initiative. Experiencing difficulties in communicating with subordinates, he often follows their lead, that is, he takes the position of a dependent person.

Democratic style is built on the basis of business and personal authority . The manager prefers the active participation of employees in decision-making. Cares about the development of the personality and business initiative of subordinates, often seeking advice and listening to the opinions of employees, he himself is an innovator, but also supports the initiative of others. Serves as an example in everything, often notes successes, praises performers, is sociable, optimistic, polite. Nothing reveals his superiority, correctly responding to criticism.

The number of features for describing leadership styles should not be expanded, since according to this figure (Appendix No. 5), it is already possible to analyze the features of each style. Prolonged attraction to one of the styles gives a peculiar dynamics of the effectiveness of managerial work.

The first curve reflects authoritarian style,which may be accompanied by an increase in efficiency, but in the future, tendencies to reverse development invariably increase. The main positive feature of this style is the discipline of labor with a pronounced business character: strict regulation of the rhythm of work and control. But positive signs can turn into the opposite: excessive formality in relationships, tight control suppress individuality, reduce staff self-esteem. As a result, efficiency turns into overload and a negative attitude towards this work.

liberal stylesaves steady trend to a decrease in management efficiency. Despite the positive aspects of this style: attention to the person, the possibility of implementation, the lack of petty control, negative consequences can be complete anarchy, familiarity, and so on.

D democratic stylemultiplies its potential, since rationalism and balance can be traced in everything.

Mediation (mediation) is the completion of the conflict with the help of a third party - mediator,not directly interested in the outcome of the conflict. The conflicting parties and the mediator systematically identify problems and ways to resolve them, look for alternatives and try to reach a consensus that would satisfy both parties. Anyone can act as a mediator, however, there are groups of people related to official mediators:arbitration court, prosecutor's office, trade unions, professional conflict mediators and so on.

Unofficial mediatorsare people who can be approached for help because of their education or great experience: representatives of religious organizations, psychologists, lawyers, social educators.

Cast spontaneous mediatorsthere may be witnesses to the conflict, for example, work colleagues, but in this case one cannot speak of professional assistance.

Conflicting parties should resort to the support of mediators if:

all means to resolve the conflict have been exhausted, and there is no way out;

the parties initially defend opposing interests;

one of the parties suffered serious damage;

there is a temporary truce, but the conflict is not over;

a third party is required to monitor the execution of the agreement.

Mediators can act as:

. "arbitrator"who has the maximum opportunity to solve the problem, not subject to appeal.

. "arbiter"- this is the same, but the parties can turn to another person, not agreeing with the decision of the "arbitrator".

. "intermediary"which plays a neutral role in resolving the conflict, since the final decision belongs to the opponents.

. "assistant"organizing the meeting, while not taking part in the discussion;

. "observer"which, by its presence, only softens the course of the conflict.

The leader must remember that the results of the mediator's participation in conflicts can be different. According to scientific research, their influence on conflicts is effective in 50% of cases, in 25% it does not affect its outcome, and in 10% it has a negative effect. For the influence of the mediator on the situation to be most effective, the opponents must also be interested in finding a compromise solution, and this can be achieved with a high degree of tension and transience of the conflict, with the persistence and interest of the mediator.

The mediator can influence the conflicting parties in different ways.

Tactics "listening in turn"is used in the acute period of the conflict, when the separation of the parties is impossible.

"Directive influence"turns out to be when focusing on weak points, inclining opponents to reconciliation.

Mediator uses "deal"for negotiating with both sides.

The mediator proves the erroneous position of one of the opponents using "pressure".

"Shuttle Diplomacy"used by the mediator to separate the conflicting parties, plying between them and agreeing on decisions.

One of the common mistakes of a nurse organizer acting as a mediator is to allow some opponents manipulate yourselfthat is, to use in relation to oneself an "emotional weapon", "playing on feelings", the manifestation of which can be tears, a colorful description of one's problems.

The mediator should correctly respond to the conflict situation, taking into account the different behavior of the opponents.

Participating in conflict as a mediator, the leader must follow certain rules:

1.it is necessary to be neutral towards opponents and emphasize this;

2.it is impossible to give assessments to the conflicting parties, let the parties to the conflict do this in relation to each other;

.confidentiality must be respected;

2.1. Levels of Conflict in Medicine

Conflicts in medicine, as well as in other industries, occur at three levels of contradictions (high, medium and low):

1. Health system - society;

2. Health care institutions (administration) - medical personnel;

3. Medical staff - patients (and their relatives).

The above diagram reveals the so-called vertical conflicts, the subjects of which occupy different social positions, ranks and have different strengths.

There are also horizontal conflicts in the healthcare system:

1. At the “SOCIETY” level, contradictions and conflicts may arise regarding the health policy pursued in society between the main part of citizens (civil society), on the one hand, and the highest governing structures (authorities), on the other.

2. At the "ADMINISTRATION" level, both vertical conflicts between different levels of management structures and horizontal conflicts, for example, between various medical institutions, are possible.

3. At the level of "DOCTOR", "SICK" there are horizontal conflicts: doctor-doctor, patient-patient.

2.2. Contradictions that cause conflicts

in the healthcare system

At the SOCIETY - HEALTH CARE level

1. Lack of a coherent and consistent concept of healthcare development.

2. Insufficiency of financial and logistical support of the health care system. It has objective (economy in decline, lack of resources) and subjective (short-sighted, irresponsible state policy) reasons.

3. The scarcity of allocated funds leads to such negative consequences how:

· Social and labor conflicts, strikes, rallies, picketing;

· Closure of district hospitals;

Lack of funds for drug supply and equipment;

· Dissatisfaction of medical personnel with the level of remuneration of their work. This forces them to look for additional earnings, which reduces the quality of work.

2.3. Conflicts in the doctor-patient system

The essence of conflicts in the doctor-patient system lies in the clash of opinions, views, ideas, interests, points of view and expectations of the participants in the interaction.

stand out objective, subjective and unrealistic conflicts.

Objective conflicts caused by dissatisfaction with the promised, unfair distribution of any duties, benefits and are aimed at achieving specific results.

Examples are:

1. The promise by the doctor to the patient of a complete cure, and as a result of the peculiarities of the course of the disease, a permanent loss of ability to work has occurred;

2. Poor performance of their duties (postoperative complications due to the fault of a medical worker, untimely rounds);

3. Refusal to hospitalize the patient or untimely hospitalization.

4. Untimely execution of operations, procedures, etc.

5. Placement in a ward with a dying patient.

6. Requirement to purchase medicines.

7. Requiring remuneration for work performed.

subjective conflicts. This type of conflict is often associated with a mismatch between the patient's expectations and reality.

The reason may be an inappropriate idea of the proper behavior of medical personnel (rudeness, impoliteness), procedures (irregularity, lack of punctuality, negligence), sanitary and hygienic conditions in the hospital (dirt, noise, smell), incorrect diagnosis or incorrect prescription of therapy.

Unrealistic Conflicts have as their goal the open expression of accumulated negative emotions, resentment, hostility - when acute conflict interaction becomes not a means to achieve a specific result, but an end in itself.

This conflict is often due to the patient's prejudiced attitude towards the medical service in general or towards an individual doctor in particular.

Conflict situations in the medical team and ways to resolve them Prepared by a student of group 240 Yulia Yanieva

The process of providing medical care includes various types of relationships in the triad "medical employee-patient-society" (information, economic, legal, ethical, etc.), as well as different types social interactions - competition, cooperation, conflict, taking into account the set of functions of each of them.

The subjects of medical practice participating in conflict situations or being opponents in emerging conflicts should be considered medical workers, patients, medical teams as a whole, support groups that take the side of the patient and other participants in the field of medical activity.

The parties to the conflict in medicine are: a) in interpersonal: medical officer - patient; medic - medic; employee - administrator; b) in intergroup: the administration of the health facility - the patient, the staff - the relatives of the patient, the administration of the health facility (legal entity) - the patient (the plaintiff in court).

The subject of the conflict in medicine are: a) objective reasons (not dependent on the doctor); b) subjective reasons (depending on the doctor)

It was revealed that conflict behavior among patients is inherent in persons of pre-retirement or retirement age, who have a low level of education, an unsettled personal life, and who have little comfortable living conditions. The subjects of conflicts in medical practice are more often citizens with a low level of income, which limits their ability to receive paid (or partially paid) types of medical care and treatment with high-quality (and therefore effective) medicines.

Socio-economic characteristics of medical workers and their partners in conflict interaction - patients are almost the same. Differences are revealed in the fact that doctors with high professional qualifications often come into conflict. Despite the conscious choice of specialty and significant experience in working with people, low wages, corresponding only to the subsistence level, are one of the main factors that determine the socio-psychological discomfort of medical personnel and affect the nature of relationships at the time of providing assistance.

For different branches of medical activity, different types of conflicts are leading: a reduction in the duration of an appointment is the main factor of conflict in the system of relations "medical staff - patient" at an outpatient appointment; in forensic practice, the situation of conflict interaction between the subjects of medical practice is formed by the results of the examination;

in dental practice, the main conflict factor is the discrepancy between the price and quality of the service; in pharmacy, the conflict between a doctor and a pharmacist is a conflict between professionals, which can be positive, and the conflict between a patient and a pharmacist is a conflict between a professional and a non-professional, which is unproductive, but can be resolved by more fully informing the patient; Of the types of conflict that exist in medical science, conflicts in clinical trials are of the greatest social importance, since they provoke risks for the subjects.

The main components of the structure of a conflict situation can be represented as follows: a conflict situation (a situation that objectively contains the prerequisites for a conflict, provoking hostile actions); the subject of the conflict (what causes the conflict); object (specific cause, motivation, driving force of the conflict); motives (inducements to enter into a conflict related to the satisfaction of needs); information model of a conflict situation (subjective representation in the psyche of people of an object, phenomenon or process of the material world, based on the information that the subject has); strategy (orientation of the individual in relation to the conflict) and tactics (choice of behavior in the conflict); participants in the conflict: opponents (individuals) or opposing groups (small and large).

There are various descriptions of the dynamics of conflicts. According to the most common description, any conflict consists of three phases or periods: Phase I - incubation (open); Phase II - open confrontation and clashes of the parties; Phase III - post-conflict.

The moral aspect is the most important in the field of relations between medical workers in their professional activities, which is manifested in the value-oriented unity, the manifestation of cohesion, mutual exactingness, sensitivity, mutual assistance, since the life and health of patients depends on this. In the medical workforce, we consider only role conflicts. Conflicts, differences in the points of view of the health worker and the patient, as well as the health workers themselves, may be due to their social roles.

Most of all, the group expressed agreement. The dominant style of interaction is cooperation. This may be due to the specifics of working in a medical institution. Employees also evaluate their team as successful, ready for cooperation and mutual support. The subjects rate the warmth and satisfaction of working in a team the lowest. That is, in a medical team, emotional relationships are evaluated lower than behavioral and cognitive ones. This may be due to the dissatisfaction or partial satisfaction of such needs as security needs, social needs, the need for recognition and self-expression among the majority of team members.

Since it is not always possible to prevent conflicts, the issue of their regulation is important. Therefore, the task of increasing the level of conflict resistance, prevention of conflict prevention is important. In the medical team, the problem of conflicts is especially important, since the relationship between employees affects the quality of the work performed, and this is the life and health of people.

Ways to resolve conflict situations in medical teams In the work of a medical institution for the prevention of conflicts, it is necessary to use such methods of conflict prevention as: 1. A clear formulation of requirements, rules, evaluation criteria; 2. An unambiguous hierarchical structure and the use of coordinating mechanisms (everyone knows who is in charge, who is responsible for what, who makes decisions in case of disagreement); 3. Establishment of common goals, formation of common values; 4. A reward system that excludes clashes between various units or members of a group.

The cooperation strategy will be most effective if: the solution of the problem is very important for both parties and no one wants to completely move away from it; there is time, desire and strength to solve the problem; - the parties are able to state the essence of their interests and listen to each other.

A strategy for resolving a conflict situation through cooperation requires the following steps: Determine what need is behind the desires (claims) of both parties. Find out how the disagreement compensates for the friend (sometimes the problem itself is solved at this stage). Contribute to the joint solution of the problem (“not opponents, but partners”). Develop new solutions that best meet the needs of everyone.

Adequately assess one's own actions and the actions of the opponent, avoiding a false perception of one's own and his actions, a double standard of assessment. Look at the situation through the eyes of the opponent in order to understand (not necessarily accept) his point of view. Do not make value judgments about the actions and statements of the opponent, so as not to cause his aggressive reaction.

Involve even an incompetent opponent in the discussion of controversial issues in order to make it clear that his position is respected, he is equally involved in the search for a solution and is responsible for it. Personally inform the opponent about his position and interests, so as not to force him to use distorted or false information. Do not allow manifestations of negative emotions in communication with the opponent, if you lose control over emotions, stop the discussion until control is restored, so as not to cause symmetrical emotional reactions from the opponent.

Possible causes of conflicts in medical practice Possible ways of resolving conflict situations in medical practice 1. Insufficient attention to the patient. 1. Education of doctors in the traditions of the medical school. 2. Lack of informed consent of the patient for treatment. 2. Informing the patient about the essence of medical actions. 3. Lack of collegiality in drawing up a treatment plan, lack of coordination in the actions of doctors of different specialties. 3. Collective adoption of the treatment plan; mandatory documentation of examination data so that another specialist - a clinician - can understand it. 4. Professional incompetence of the doctor. 4. Compliance with standards of care. 5. Defects in maintaining medical records. 5. Control over the quality of medical records. 6. Characterological features 6. Express diagnostics of a doctor and a patient. psychological type of the patient's personality

Principles of prevention and prevention of conflicts in the organization The first principle determines the need to resolve the conflict, taking into account the essence and content of the existing contradiction. In this case, it is necessary: to reveal the actual contradiction, to reveal its psychological content; to distinguish the true cause of the conflict from the declared one, to understand the motives for hiding true reason, the degree of awareness of such actions; determine the business basis of the conflict.

The second principle involves the resolution of the conflict, taking into account the true goals of its participants. In this case, it is extremely important to quickly determine the goals of the conflicting parties, to draw a clear line between the features of interpersonal and business interaction. If the true goals are hidden, but are dominant, then it is necessary to understand their essential characteristics. Particular attention should be paid to those opponents whose goals of confrontation are negative (mercenary, unethical) in nature.

The third principle provides for the need to resolve the conflict, taking into account the individual or psychological characteristics of its participants. This principle is one of the most important. It is he who proclaims the importance of the system of internal conditions of opponents, which are the regulator of their behavior and relations. Reliance on this principle is especially important in the case of unconscious motives for conflict and the presence of uncontrolled accentuations among opponents. Knowing these internal conditions allows you to accurately determine the type of influence, choose the right tone in dealing with opponents, especially when analyzing the causes of the conflict.

The fourth principle, according to it, the resolution of the conflict must be carried out taking into account the emotional states of the opponents. This principle is a development and specification of the previous one.

The fifth principle, it provides for the resolution of the conflict, taking into account its dynamics. The conflict develops in certain stages or phases. Naturally, each of them is characterized by typical states, tactics and strategies of confrontation.

The most effective in overcoming conflicts is their forecasting and prevention. Forecasting conflicts consists in a reasonable assumption about their possible future occurrence or development. Signs of social tension can be detected by routine observation. The following methods of predicting a "ripening" conflict are possible: spontaneous mini-gatherings (conversations of several people); an increase in absenteeism; an increase in the number of local conflicts; decrease in labor productivity; increased emotional and psychological background; mass dismissal of one's own free will; spreading rumors; spontaneous rallies and strikes; an increase in emotional tension.

Conflict prevention consists in such an organization of the life of the subjects of social interaction, which eliminates or minimizes the likelihood of conflicts between them. Conflict prevention is their prevention in the broadest sense of the word. Preventing conflicts is much easier than constructively resolving them. Prevention of conflicts is no less important than the ability to constructively resolve them. It requires less effort, money and time.

Objective and organizational and managerial conditions that contribute to the prevention of destructive conflicts: 1. Creation of favorable conditions for the life of employees in the organization (material security of the family, working conditions for family members and education of children; human health; attitude in the family). 2. Fair and public distribution of material wealth in the team, organization. 3. Development of legal and other regulatory procedures for resolving typical pre-conflict situations (humiliation by the boss of the dignity of a subordinate; determining the amount of wages and bonus payments; appointment to a vacant position in the presence of several applicants; dismissal of employees). 4. A calming material environment surrounding a person: a convenient layout of working and residential premises, lighting, the presence of indoor plants, aquariums, the equipment of rooms for psychological unloading, the absence of annoying noises.

In the interests of preventing the emergence of conflicts, it must be taken into account that social interaction is consistent when it is balanced. There are five main balances, the conscious or unconscious violation of which can lead to conflicts: 1. Maintaining a balance of roles during interaction. Each of the partners can play in relation to the other the role of a senior, equal or junior in their psychological status. Psychologically, the most comfortable role of a person is often the role of a senior. But this role is potentially the most conflicting, since it is precisely this role that does not suit the partner. He doesn't want to play the role of a junior. The most favorable for the prevention of role conflict is interaction with others on an equal footing.

2. Maintaining a balance of interdependence in decisions and actions. Everyone ideally strives to do what he wants, when he wants. However, the freedom of each of us cannot be ensured at the expense of the freedom of those with whom we interact. Too much dependence of a person on a partner limits his freedom and can provoke conflict. In the course of communication, interdependence is necessary.

3. Violation of the balance of mutual services in the interaction of a dyad of people is fraught with tension in their relationships and possible conflict. If a person rendered a non-normative service to a colleague, and in return did not receive services of approximately the same value over time, then the balance of services is disturbed.

4. Maintaining a balance of damage. If a person is harmed, then he feels a desire to inflict retaliatory damage on those people through whose fault he suffered. Damage disrupts the balance of interpersonal or intergroup interaction and can become the basis of conflict. 5. The fifth balance, the maintenance of which contributes to the prevention of conflicts, is the balance of self-assessment and external assessment. In the process of social interaction, people constantly evaluate a friend. A person is characterized by self-assessment of his behavior, and he more often chooses the positive aspects of his personality as the basis for assessment. When evaluating the work of a subordinate by a boss, he often evaluates by what the subordinate failed to do compared to regulatory requirements.

Unresolved or unconstructively resolved conflicts not only worsen professional interaction and the psychological climate in a medical institution, but also undermine patients' trust in staff, worsen their emotional state, and can nullify all treatment efforts. Therefore, medical personnel of any profile simply need to be able to correctly analyze conflict situations and master the techniques for their successful resolution. This is the most effective method save time, money and mental health medic.

An analysis of the state of practical medicine indicates an increase in the number of conflict situations between a medical institution and a patient, between a doctor and a patient. The medical staff of a medical institution is in a constant state of risk of conflicts, which can be divided into two groups: conflicts that occurred due to medical errors, and conflicts that arise due to the personal characteristics of the doctor and patient.

The objective causes of medical errors include:

* the inconstancy of individual postulates, as a result of which the diagnosis of the disease and its treatment change;
* imperfection of medical equipment and applied technologies;
* insufficiently clear organization of the work of the medical institution.

Subjective causes of medical errors:

* lack of sufficient experience of the doctor;
* non-improvement by the doctor of his knowledge;
* errors related to communication.

These subjective causes of medical errors, as well as the personal characteristics of some patients, are the causes of conflicts in which the purely medical actions of the doctor are secondary, not of decisive importance. Even if the doctor did everything right from the point of view of medicine, legal and psychological errors in interaction with the patient can lead to serious consequences for the doctor and the entire medical institution.

Most often, doctors in their practice are faced with interpersonal conflicts. Interpersonal conflict - a conflict between two, less often three or more personalities (where everyone is "for himself"). Interpersonal conflicts are vertical, in which the subjects of the conflict are on different steps of the hierarchical ladder, therefore, have different rights and powers, and horizontal - between opponents of equal status.

Intrapersonal conflict occurs when a person faces the problem of a choice that he cannot make. This is a struggle of needs and social conditions, desires and restrictions, necessity and opportunities, this is a dispute between “I want” and “I can’t”, between “should” and “I don’t want”. With disability due to injury or serious illness, intrapersonal conflict can be expressed in a growing discrepancy between needs and reduced opportunities. If a nurse is simultaneously given conflicting instructions by the head nurse, the doctor and the head of the department, this can cause emotional stress. Each of us is faced with the dilemma of staying late at work, as required by the need for production, or rushing to the institute, where your presence is required? Should you take a job that pays a lot but leaves no time for your family? If the pros and cons are equal for you and it is difficult to make a choice, you are faced with an intrapersonal conflict. The inability to resolve intrapersonal conflicts leads to an increase in emotional tension, aggression. With the development of auto-aggression, a person “leaves” into a disease, or, directing aggression outwards, discharges himself on others (then an intrapersonal conflict develops into an interpersonal one).

If an interpersonal conflict is not resolved in one way or another, its participants seek support, recruit supporters for themselves, and the conflict develops into an intergroup conflict or into a conflict between an individual and a group.

A conflict between an individual and a group as a result of an interpersonal conflict arises when one of the participants has found support for his position: this may be a conflict between the patient and the medical staff or the doctor and the patient's relatives, etc. This type of conflict can also arise when a person does not accept group values, does not adhere to the norms of behavior adopted in a group, institution, does not meet the social expectations of the group, that is, he comes “with his charter to a strange monastery.” Examples are a young doctor who makes one of the typical mistakes when applying for a job. new job when a new employee transfers his old stereotypes to new conditions: “But we were taught that way!”, “Your methods are outdated!”, or a patient who insists on changing the rules established in a hospital or clinic. At the same time, unfortunately, the conflict arises regardless of whether the "reformer" is right or not.

The cause of the conflict between the individual and the group may also be the conflict between the leader and subordinates, when the former takes an authoritarian position, regardless of the opinions, desires, needs of employees. Usually, at first, such a conflict proceeds in a latent form, breaking through with separate, local outbreaks. If the management does not notice and does not take measures to clarify and resolve this situation, the conflict can lead to disastrous consequences.

Meet in medical institutions and intergroup conflicts. These are religious and national conflicts, as well as conflicts between scientific schools or employees of various departments in the hospital. Intergroup conflict arises between groups and between microgroups within the same team, for example, between different formal groups, between formal and informal, between informal groups. Thus, the day shift of medical personnel may accuse the night shift of badly caring for the sick, or small groups within the same team make similar claims to each other.

Special cases of intergroup conflict include conflicts between two participants in which claims are made not to a specific patient or doctor, but to an entire social or professional group (“You doctors only want money, but you don’t know how to treat”, “In your hospital there is never order”, “You, patients, don’t take care of your own health, and then you demand a miracle from doctors.”) The complexity of resolving such a conflict lies in the fact that one person is not specific problem, it takes time, good communication skills and stress resistance.

The causes of conflict situations in medical practice can be very diverse. In the case of a conflict of values, disagreements concern the value-semantic aspects of interaction. For example, its participants may understand the meaning and goals of joint activities in different ways. For example, for a doctor, the patient's health is valuable and significant, and the patient's health is this moment he is more concerned about his performance, that is, the need to be at work, to perform professional functions to the detriment of his own health, and he is looking for symptomatic treatment. Or for one hospital employee, the profession of a doctor is a real vocation, so he works enthusiastically, constantly improves his skills, strives to treat patients as qualified as possible, and the other doctor is not interested in self-realization, therefore he is not initiative, although he does the prescribed amount of work. The contradictions here do not affect the norms of behavior, but the value-semantic aspects of being. This does not mean at all that different value orientations inevitably lead to conflicts. People can successfully interact and have good relationships, despite the difference in their value ideas. Conflict arises when someone begins to intrude into the sphere of values of another person, not recognizing the freedom of personal choice. Usually conflicts of values between the doctor and the patient are resolved by adherence to bioethical principles.

In the event of a conflict of interest, there are two options. If the interests coincide, and the participants claim some limited material factors (place, time, premises, monetary reward), then such a conflict can be called a resource conflict. Each party is interested in obtaining the resource it needs (financing, new equipment) or a more profitable (in terms of quantity or quality) part of the resource. They strive for the same thing, they have the same goals, but due to limited resources, their interests contradict each other. This type of conflict includes all situations involving problems of distribution or arising out of competition for the possession of something.

Another option arises when colleagues have conflicting interests. Due to the interaction of people in this situation, they voluntarily or unwittingly become an obstacle to each other in realizing their interests. (For example, part of the clinic team agrees to improve their skills outside of working hours, and some doctors do not want to sacrifice family and personal interests.) A discrepancy between the interests of the doctor and the patient seems impossible, since both should be interested in the patient's recovery or alleviating his suffering , but this, unfortunately, is ideal.

Participants in the interaction may share common values and common goals (interests), but have different ideas about how to achieve them. A means conflict occurs when a patient, for example, agrees with a diagnosis, is ready for treatment, but does not agree with the treatment plan developed by the doctor. If you focus on what there is agreement on, resolving the conflict of means to an end is much easier. Sometimes people coexist peacefully, even having different values, but if the methods of achieving the goals chosen by one of them cause damage general interaction or one of its participants, problems arise. You can calmly relate to the fact that someone next to you performs his duties differently than you do, but when he tries to shift part of his work to you, a conflict situation arises.

Conflicts of inconsistency related to the potentials of the participants in the interaction and their compliance with the requirements placed on them can take various forms. This is possible when someone, due to incompetence or, for example, physical inability, cannot make the necessary contribution to the common cause. Situations of this type are well known: one or more employees, not coping with their duties, make mistakes, which makes it difficult for the entire team to work. Another variety of these conflict situations is associated with a significant gap in the intellectual, physical or other potentials of different participants in the interaction. Situations of this type arise due to the fact that the overall result of the activity is the sum of individual efforts, and the “weak link” either worsens the overall result, the image of the clinic, or even becomes an obstacle in some actions.

There may be conflicts of interaction rules associated with any violation of the accepted norms or established rules by any of the participants, if this violation damages the normal interaction or relations of people. This includes situations of disagreement due to non-fulfillment by people of obligations to others, violation of generally accepted etiquette or norms adopted in this group, excess by someone of their rights.

Such conflicts can also arise from the desire of one of the participants in the interaction to revise the rules and norms or redistribute power or duties: increase the rights of some and reduce the rights of others, change the rules in the current system, etc.

Conflict situations in medicine. Causes and types of conflict situations in medicine

Dissertation abstractin medicine on the topic Conflicts in medical institutions: causes, conditions, social consequences

Dissertation Introductionon the topic "Sociology of Medicine", Popova, Ekaterina Georgievna, abstract

Conclusion of the dissertation researchon the topic "Conflicts in medical institutions: causes, conditions, social consequences"

List of used literaturein medicine, dissertation 2005, Popova, Ekaterina Georgievna

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