Conflict Management and Team Development in the Healthcare Sector. Healthcare System in Nigeria

CONTENTS

Defining Conflict

Theories of Conflict

Conflict Types

Etiology of Conflict

Consequences of Conflict
Positive Implications of Conflict
Negative Implications of Conflict
Risk Factors to Conflict

Phenomenon of Team

Leadership and Team Development
Deciphering the Role of Leadership in Leading team
Theoretical Models in Team Development
Leadership style and Stages of Team Development
Communication and Team Development

Healthcare System in Nigeria
Healthcare Workers and Nigeria Healthcare Institutions
Impact of Team Work in Healthcare Institution
Barriers to Team Development

Conflict and Nigeria Healthcare Sector

Conflict Management
Conflict Management Styles

Conclusion/Recommendation

Reference

ABSTRACT

The subject of conflict is gaining more interest among stakeholders in all spheres of life. There’s been various perspectives owing to the roles often played by conflicts at the national and international levels. The focus of this work; however, is limited to conflicts within an organization – specifically the healthcare organization in Nigeria.

Team development has been studied and characterized by organizational theorists and administrators as it concerns organizational performance. In the healthcare setting, maintaining highly functional teams have been advocated for many reasons including (a) prevention of avoidable adverse events partly due to inadequacy of communication channels among clinicians (b) Avoidance of unnecessary waste and cost due to a lack of clarity in purpose. (c) Decreasing the risk of medical errors as a result of the incompetence among the team of healthcare professionals. In the Nigerian context, experts have also identified some of the barriers to effective team development.

The Nigerian healthcare sector has perennially suffered from the outcomes of conflicts among various stakeholders that make up the overall healthcare system. In view of this negative consequences of such conflicts (for example industrial action leading to termination of healthcare services every year); there’s been a rise in the phenomenon of medical tourism among certain privileged segment of the Nigerian society, leaving the majority of the population vulnerable.

In a bid to understand the concept of conflict in relation to the Nigerian healthcare setting and to seek solutions in meeting the goal of optimal patient care; this work spotlighted several empirical thoughts on team development and conflict management.

Defining Conflict

Since time immemorial, conflict has been narrated as an ‘irrepressible and inevitable’ nature (Shapiro, 2003; Aminu and Marfo, 2010). As such, it is typically advanced as a ‘continuous, autonomous process’ within the construct of social interaction of humans linked to the pursuit of specific interests and goals by individuals or group of persons, often culminating in bitter rivalries, threats and violence (Nwaomah, 2009; Edinyang, 2012).

The social phenomenon – conflict, not only transcends every sphere of life; its occurrence appears ubiquituous as people socially interact with themselves (Benedict-Bunker et al., 1995; Morgan, 1997; Kolb, 2007; De Dreu and Gelfand, 2007; Spector, 2008).

The term ‘conflict’ has been used interchangeably in myriad of literature with others words like “quarrel”, “controversy”, “dispute”, “violence” (Almost, 2006). These words however do not aptly delineate the total concept of conflicts as argued by some scholars (Ahmed, 2015). In fact, the diversity of the forms of conflict from different perspectives and life interactions makes it difficult to absolutely provide a perfect definition of the phenomenon (De Dreu and Gelfand, 2007). For the purpose of this essay however, it is important to underscore a few definitions. For instance:

Conflict has been described as “an interactive process which manifests as disagreement, incompatibility and discordance within or between individuals, groups and organizations” (Rahim, 2002; Dickson and Alu, 2012).

Folger et al. (2009) opined that “conflict is the interaction of interdependent people who perceive incompatibility and the possibility of interference from others as a result of this incompatibility.”

In a formal environment such as in the healthcare industry; conflict could arise between workers performing interdependent tasks, who perceive the other party as being at fault and act in a manner that creates problem for the organization.

Clearly, the concept of conflict is multidimensional in the definitions. A critical observation of these definitions underscores the perception of disparateness between conflicting parties in addition to the presence of psychological and behavioural elements. This may also be suggestive of the fact that conflict could be perceived (subjective or objective) or felt; latent (not expressed) or actively expressed among the parties involved (Dickson and Alu, 2012).

Theories of Conflict

In a bid to understand the concept of conflict, several theories have been developed to investigate the nature of conflict (on the basis of persons, ideas, and groups).

Gurr (1970) in Alao (2012) among others postulated the ‘ relative deprivation theory’ which emphasizes that when people are frustrated, in an attempt to get what they want; there is the likelihood to become angry and then fight the source of the anger.

Also, there is the ‘human needs theory’ which is based on the assumption that when human beings or ethnic groups are denied their biological and psychological needs that relate to growth and development, there is the tendency for group rivalry such as crisis amongst various tribes for natural resources in a geographical location (Alao, 2010).

Meanwhile, as reported in some scholarly works, the ‘survivalist theory’ views conflict as a struggle among individuals or groups over values and claims to scarce resources, status symbols, and power bases (Okai, 2007). Interestingly, this is consistent with the works of Charles Darwin that stressed the idea of "competition of striving to stay" and natural selection; Also, Karl Marx’s position on "class conflict" between ruling class [(bourgeoisie) that control the means of production] and working class [(proletariat) that enable these means by selling their labour power in return for wages]. By this position, conflict could be viewed as a primary positive driver of historical social change (Deutsch, 2006; Robbins et al., 2012; Ahmed, 2015).

Alternatively, conflicts have been defined on the basis of human co-existence could as illustrated interdependence; social identity and socio-cognitive conflict theories.

- Interdependence theory: Rusbult and Van Lange (2003) produced a modified work of Kelley and Thibaut (1959) (Social Exchange Theory) in an attempt to explain how resources can be the cause of conflict at the individual or organizational level. This theory assumes that individuals depend on each other for favourable outcomes. Hence, the choice of their behaviours, the interaction pattern, and the extent to which they reach their goals is predicated by how their interests are perceived to be related. Some researchers therefore suggested in their works that, “an individual’s outcome is maximized when he is uncooperative. On the other hand, collective outcomes are maximized when both parties cooperate. Meanwhile, both parties are worse off when they do not co-operate with each other” (Weber et al., 2004; De Dreu and Gelfand, 2007).
- Social identity theory: This is described on the basis of group discrimination and relationship conflict. It provides insights as to why individuals of a group favour their group in relation to another group. This theory assumes that individuals not only define or think of themselves on the basis of their unique personal characteristics (personal identity) but also on the basis of their perceptions about the groups to which they belong (social identity) (Ellermers et al., 2002). In short, social identity refers to an individual’s perception of him or herself due to his or her perceived membership of the social group(s) (Hogg and Vaughan, 2007).
- Socio-cognitive conflict theory: The theory is predicated on the certain assumptions such as that (a) people have accurate intuitive understanding about themselves, others, the surrounding world and the tasks facing them; (b) people lack relevant information and capability to process information and are also limited in their rationality – all of which culminates into diverse opinions, understandings and beliefs on same issue; (c) people seek general congruity, acceptance and approval of their insights, beliefs and understandings by others and that differences in others’ insights, understandings and perceptions which inadvertently could lead to conflict. In the environment of an organization, cognitive conflict also referred to as (information or task-related conflict) could emerge from beliefs, opinions and insights not shared by others. In short, having dissimilar ideas (De Dreu and Gelfand, 2007).

Conflict occurs when there are real or perceived incompatibilities certain differences between two parties. These differences may arise due to a variety of issues including values, religious or political preferences, resources, or information and opinions (Rahim, 2001; Cox, 2003; Greer et al., 2012; Kaitelidou et al., 2012). The plurality of interests in an organization invariably creates an environment for conflict to thrive.

The healthcare institution like others is inter-professional by nature with diverse teams comprising of individuals with the dissimilar education, ethics, and ideologies that come with each profession. This among other factors makes these teams vulnerable especially to high risk forconflict (McNeil et al., 2013).

Can organisations be free from conflicts?

As viewed in various scholarly works on conflict; it was found that there may be strong association between conflict, work and organizations. This hence resulted in the suggestion that conflict cannot exist without people being interdependent for their task achievements; hence the assertion that there is no organization without conflict (Pffefer, 1997; De Dreu et al., 2002; Anderson et al., 2004; De Dreu and Gelfand, 2007; De Dreu, 2008; Spector, 2008).

As mentioned earlier, conflict is multidimensional in nature, may be reported recurrently throughout the life span of organizations. In this light, the role, extent and consequences at all levels within organizations have been categorized as immediate and long-term (De Dreu, 2008); beneficial and detrimental (Simons and Peterson, 2000; De Dreu and West, 2001; Lovelace et al., 2001; De Dreu and Weingart, 2003; Jehn and Bendersky, 2003; Anderson et al., 2004; De Dreu, 2006).

Accordingly, a brief analysis of the dynamics of conflict emergence at this juncture could provide a fundamental comprehension of the chain of events associated with conflict. As such, it is note worthy to stress that several concepts on the multidimensional nature of conflict have been debated. For instance; the Kreitner and Kinicki model of conflict dynamics in addition to other studies have postulated that conflict as a process can be described in distinct phases. These stages include: “the antecedent conditions; perceived conflict phase; manifest behavior; conflict resolution or suppression and the resolution aftermath” (Greenberg and Baron, 1997; Kreitner and Kinicki, 1997; Dove, 1998; Jehn and Mannix, 2001). These stages lend credence to the time dimension of conflict since it reveals that conflict evolves over time. The Kreitner and Kinicki conflict model is illustrated below in figure 1.

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Figure 1: The conflict process (Milton, 1981).

Aminu and Marfo (2010) added that the consequences (positive and negative) of conflict in an organization often reflects the extent of conflict perception and management capability of organizations.

As pointed earlier, health care organizations are hierarchical in nature with with several independent units which may inadvertently fuel the conflict process (Brief et al., 2005). In another way, this susceptibility to conflict have also been found to be indicative of pressures confronted from within and outside the healthcare workplace exists concurrently with their roles of providing quality healthcare to the public (Tyler-Evans and Evans, 2002).

Scholars therefore argue that conflict is ‘the life of the organization’ suggesting that organization without a conflict essentially do not exist (Farrell 2001: Taylor 2001; McKenna et al. 2003; Ahmed, 2015). Some studies even estimate that managers spend part of their time as leaders and administrators (over 20%) resolving intra-professional and interprofessional conflicts (Thomas, 1992; De Dreu et al., 2003).

In the Nigerian case, the health care sector like any other sector in the country has witnessed spates of industrial action at local, state and national levels with various degrees of negative impact on the Nigeria public (Obinna, 2011; Ojeme, 2012; Okafor, 2012).

Conflict Types

Arguably, conflict is multifaceted in nature. There has been various attempt to categorise conflict on specific criteria such organizational structure, the behaviours of the conflicting parties and several others.

Previous works have suggested that conflict may be grouped based on ‘size of human interaction’ that is, personal, group and organizational levels (Barki and Hartwick, 2004; Conerly and Tripathi, 2004; Zimmerman, 2004a; Zimmerman, 2004b; Bell and Song, 2005; Yew, 2005).

Organizational conflict, whether it be substantive or affective (Rahim, 2002; De Drue and Weingart, 2003), can be further divided into intraorganizational and interorganizational. Interorganizational conflict occurs between two or more organizations. For example, when different businesses are competing against one another. Intraorganizational conflict occurs within an organization (for instance; department, work team) (Rahim, 2002).

De Dreu and Gelfand also discussed the nature of conflict based on the structure of an organization depending on criteria such as individual / collective levels, and the local/national culture (De Dreu and Gelfand, 2007). As such, when aligned with the illustration of the conflict process by Milton (1981); De Dreu and Gelfand (2007) noted that each level within an organization are typically faced with varying antecedents, triggering events, conflict processes and consequences of conflict with cross-level interactions.

In another way, macro (higher) level factors and events have been found to influence the nature as well as facilitate or inhibit the degree to which conflict occurs at micro (lower) levels and vice versa (De Dreu and Gelfand, 2007). For example, the macro level factors and events denotes national and organizational cultures, leadership change, restructuring, merger and acquisition, and downsizing could lead to certain kinds of conflicts (for example; value and relationship conflict) as well as facilitate occurrence of conflict at micro levels. Similarly, individual factors like certain personalities (example, competitive personality) can result in certain conflicts (for example resource-based conflict).

Conflict has also been perceived to occur in various forms such as hierarchical, functional, line staff, formal and informal conflict (Luthan, 1998). Luthan also described the various nature of conflict from macro to microlevel and also, from organizational to intra-personal levels (ibid) as depicted in figure 2. In this context, when conflicting parties at different levels of the organization’s formal chain of command, it is called hierarchical conflict. Functional conflict is often resource-based or due to communication breakdown or role and goal disparity between two groups while formal and informal conflict occur between formal and informal organizations.

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Figure 2: Conflict levels (Adopted from Luthan, 1998).

Conflict in organizations has also been categorized in relation to the sources of the conflict. For instance; Robins (2005) classified conflict on the basis that characterizing (identifying) conflict sources would be instrumental to effective conflict resolution. The researcher further categorized conflict into (a) task conflict, dealing with the content and goals of the work to be done; (b) relationship conflict, involving the relationship between individuals and groups; and (c) process conflict, dealing with how work gets done.

On the basis of the sources of conflict in a healthcare organization; conflict types have been classed into five namely (Moore, 2003): (a) data conflict relating to variations in information and data interpretation (b) interest conflict referring to content or procedural issues, (c) relationship conflict referring to poor communication or misconceptions, (d) value conflict dealing with differences in goals and evaluation criteria and (e) structural conflict involving unequal resource distribution, authority or control.

In the healthcare settiing, conflict have been found to arise based on the aforementioned sources in diverse circumstances (Moore, 2003). For instance; Greer et al. (2012) mentioned that among interprofessional teams in a hospital or healthcare setting; conflict and its effect on team dynamics could categorized as task, relationship, and process conflicts.

Etiology of Conflict

Since the foundational theories of conflict has been laid including its presence in various setting in an organization or the diverse forms it could occur, it is important to determine the root causes of conflict whether at an individual level or organizational. Such knowledge will contribute to the effective administration of conflict management tools in various circumstances in the healthcare industry (Havenga, 2005; Moore,2006).

A number of studies have been able to associate certain sources of conflict amongst health workers with: gender differences; gaps in education and socio-economic status, interprofessional overlaps in responsibility (Morgan & McCann, 1983; Tabak and Koprak, 2007; Okhakhu and Cletus, 2015). In addition, individual perceptions, values, beliefs and attitudes have been known to play a central role in the conflict process (Whitworth, 2008).

Moss (2000) for instance described conflict as a kind of social behaviour. To this effect, personality type is in fact an underlying cause of individual behaviour and individual differences (Whitworth, 2008).

McNeese-Smith & Nazarey (2001) attributed stress from work and pressure (resulting from carrying out one’s responsibilty in a healthcare organization) to be a major factor in the etiology of conflict. This assertion is also in agreement with a later work by Vivar (2006) on the importance of managing conflict in a positive manner.

Onyekwere (2013) mentioned that team cohesion can be threatened simply by the diverse, multiprofessional nature of most healthcare institutions. Ineffective time management, inaccessibility to adequate basic resources, low supply of labour (personnel needed in the healthcare setting) were also implicated to be a source of conflict (ibid).

A plethora of studies have been conducted on the sources of conflict. A previous study by Almost (2006) categorized the sources of conflicts into (a) individual characteristics such as disparities in opinions, beliefs, values and attitudes, personality differences, educational status and demographic disparities like age and gender; (b) interpersonal factors such as ineffective communication, intimidation, reciprocated trust or distrust, and personal dislikes; and (c) organizational factors such as organizational structure, task interdependence, relative power position.

It is important to note that in related literature, these sources of conflict have been classed as antecedents or prior conditions required for conflict to occur (Milton, 1981; Stroh, 2002; Robbins et al, 2003). Researchers have investigated that these ‘prerequisites’ of conflict if not effectively resolved could initiate a cyclical process which will generate more negative consequences in an organisation (Milton, 1981; Stroh, 2002; Robbins et al, 2003; Brief et al., 2005).

Furthermore, De Dreu and Gelfand (2007) have pinpointed three root causes of conflict found across levels in organizations. They include: (a) scarce resources, (b) the quest to project positive view of the self, and (c) the need to hold a socially approved and conscentious view of the world. It describes how the ‘mixed-motive’ characteristic of social interdependence in organizations lays the foundation for conflict to occur. Consequently, task interdependence could lead to resource conflict which is more likely to increase progressively from individual to organizational level. This view is augmented by Spector et al. (2007) and Friedman et al. (2007) who acknowledged the existence of scarce resources as the cause of stress, competition and increased levels of job dissatisfaction among professionals in healthcare settings.

Vecchio (2000) studied the importance of communication in the etiology of conflict in the healthcare industry. A critical examination of the health care institution evinces its intricate nature with respect to its highly heterogenous multi-level services and work force (comprising of individuals with varied education, ethnic background, age, communication styles, gender amongst other variables) which makes them highly prone to conflict (Marshall & Robson, 2005).

Several scholarly works have been able to link the likelihood of conflict arising in the clinical environment to lack of clarity in job description, incompatible roles, scarce resources, referral system, professional values, leadership struggle, salary differences, working conditions, unionism, poor hospital management style, socio-economic policies of government, stress and poor communication (Marshall & Robson, 2005; Tenglilimoglu & Kisa, 2005; Keung & Chair, 2006; Moore & Kordick, 2006; Wilmot & Hocker, 2007; Nayeri & Negarandeh, 2009; Osabuohien, 2010; Brinkert, 2011; Brown et. al., 2011; Greer et al., 2012; Kaitelidou et al., 2012; Gehlert & Browne, 2012).

The aggressive tactics directed from an actual or perceived superior towards someone of lower rank, also known as vertical violence is frequently reported (Buback, 2004). It’s often regarded as a source of tension and conflict in specific circumstances such as surgery theatre (Lingard et al., 2002).

In terms of changing dynamics in organizational structure with the health care industry; it is argued that one of the most affected industry that has suffered due to brain drain is the healthcare industry. Researchers have noted that to the globalization of economies and the large scale migration of work force affects both the composition and the way organizations conduct their activities which further poses an increased risk of conflict ensuing (De Dreu & Gelfand, 2007).

Davies and Lynch (2007) linked increase in interprofessional conflict to the creation of more opportunities for certain professionals in the healthcare environment. For example; the creation of additional opportunities in the nursing profession such as Clinical Nurse Specialist (CNS) and Nurse Practitioners (NP), and Nurse Managers among others.

In the Nigerian context, the incidence of conflicts (in form of Industrial action) appears to be characterized by a plethora of issues including poor working conditions, infrastructural challenges, wages and management / administration inadequacies (Onka, 2010; Ogunbanjo, 2015).

Consequences of Conflict

Globally, there has been a steady increase in cases (reported or unreported) of conflict amongst co-workers in healthcare organization, and thus a serious cause for concern among the stakeholders and the general populace (Farrell, 1997; Farrell, 1999; Buback, 2004; Almost, 2006; Espeland, 2006; Robinson et al. 2007). The implications of conflicts have been analysed in various reports with researchers arguing in favour of one end of the spectrum (e.g. positive or negative) over the other.

Organisational conflict for example have been reported to cause increased risks of burnout, medical errors, high employee turnover (Lambert et al. 2004; Silen et al., 2008). It also leads to decreased work satisfaction and team performance (Cox, 2003).

Accordingly, a review of several literature reveals several consequences of ineffective conflict management approaches in various healthcare settings including huge financial cost, medication errors, patient injuries, increased mortality (Kohn et al. 2000; Tammelleo, 2002; Page, 2004; Arford, 2005; Almost, 2006).

Garardi (2004) argued that the implications of these workplace conflict could be seen as direct and indirect. Briefly, the direct costs of conflict were grouped under “ligation costs, lost management productivity, employee turnover costs, disability and worker compensation claims, regulatory fines or loss of contracts or provider status, increased care expenditure to handle adverse patient outcomes and intentional damage to property.”

In contrast, the indirect implications of conflict are enlisted as “lack or decrease in team motivation, lost opportunities to manage future-oriented projects, costs to patients, cost to reputation, loss of market position, increased incidence of disruptive behaviors by organizational insiders and emotional costs.” (Manderino & lBerkey 1997; Watson & Steiert, 2002)

Persistent, unmanaged conflict in most cases results in “…absenteeism, lesser coordination and reduced efficiency” (De Dreu et al. 1999).

Guerra et al. (2005) noted that most of the studies on conficts in organization focus on the consequences of task and relationship conflicts at individual and organizational levels.

In spite of the negative costs of conflict as highlighted in the literature; there are growing reports on positive outcomes of conflicts. Some scholars reported that conflict could lead to an increase in individual and organizational performance and innovativeness rather than being a harmonious setting (Carnavale & Probst, 1998; Anderson et al., 2004).

Tjosvold (2007, 2008) noted that the progression and outcomes of conflict are not dependent on the type or source, but rather on the conflict resolution strategy. Task-related conflict if effectively managed could improve team relationships and hence improve the effectiveness of organizational functions.

Change is inevitable and conflict could be seen as a propelling force for change. Conflicting parties may be involved in a destructive or constructive deliberation depending on the degree of commonality of their goals.

In a review article by Almost (2006), the implications of conflict notably grouped into several levels in an organizational setting: (a) individual effects, (b) interpersonal effects (c) organizational effects. First, individual effects of conflict including stress, psychosomatic complaints, low self esteem and self-efficacy, low levels of job satisfaction and commitment, increasedresignation, absenteeism, and a desire to quit the profession particularly among nurses (Warner, 2001; McKenna et al., 2003; Lambert et al., 2004; Nayeri & Negarandeh, 2009).

Second, interpersonal effects may result in aggression and escalation, increased turnover and stress, group innovativeness, performance, commitment and satisfaction or the contrary. Third, the organizational effects which relates to improved or reduced effectiveness of an organization (Spector & Jex, 1998).

In health care organizations, conflict could lead to direr consequences due to the delicate nature of such organizations. For example, in healthcare organizations (not limited to Nigeria) (Kennie, 2009), conflict between staff union and the management on core issues such as staff wages, working conditions amongst others has resulted into temporary cessation of heathcare services with detrimental cost on the health of the general populace and also on the long run stunts the country’s economic growth (Otobo, 2005; Obinna, 2011). In fact, unresolved conflict has been implicated as one of the main causes of massive emigration of skilled health workers in Africa (Osabuohien, 2010).

In Nigeria, Industrial actions (marked by local and nation-wide protests) have become a perpetual phenomenon among employees notably the members of professional associations in the healthcare industry such as Nigerian Medical Association (NMA), Joint Health Workers Union of Nigeria (JOHESU) (Adesina, 2003; Dauda, 2007; Rennie, 2009; Osakede and Ijimakinwa, 2014).

At this juncture, it is important to stress that although industrial action in the healthcare industry is quite rife globally; the impact of such decision often produce more devastating effects in developing countries faced with the challenge of poor infrastructure and general lack of viable alternative means of obtaining healthcare (Bloomsbury, 2002; Bankole, 2003; Ogundele 2005; Stuart, 2010; Osakede and Ijimakinwa, 2014).

Conflicts in healthcare organisations are also often associated with “differences in opinions, interest and background; unrealistic working expectations; discriminatory behaviour (example; sexism, racism); non-compliance with organizational norms or values” (Bloomsbury, 2002; Bankole, 2003; Otobo, 2005).

In Nigeria, there has been calls for establishing a system of trade dispute settlement in order to protect the interest of the general populace particularly during industrial actions (Bankole, 2003; Ogundele, 2005).

Positive Implications of Conflict

A review of available literature reveals a disproportionate degree of arguments in favour of the negative role of conflicts in a typical health care organization. In spite of this, a number of studies have also referred to the positive aspects of conflict.

Essentially, when conflicts are resolved effectively, researchers have emphasized that they led to personal, communal and professional growth (Alao, 2012). It is also noteworthy to emphasize that the differences between the beneficial and adverse outcomes of conflict is predicated on the nature of conflict resolution proffered (Manktelow & Carlson, 2012).

From an historical perspective, it is observed that social change is propelled by change (characterized by periods of conflict) followed by periods of stability (Pardeck & Yuen, 1999; Robbins et al.,2012).

Negative Implications of Conflict

It is a well-accepted fact that it could be unquestionably difficult to achieve maximum level of creativity, efficiency and productivity in the midst of turmoil. Hence, the need for teams within health organisations to adopt creative ways for dealing with conflict (Whitworth, 2008).

Findings from various scholarly works suggest that one of the underlining factors contributing to the continuous shortage of healthcare personnel is the high level of job dissatisfaction as a result of workplace conflict (which has been described as “pleasant, stressful and unproductive” (Taylor, 2001; Wheeler, 2001; McKenna et al., 2003).

From available literature, certain negative consequences have been tied to conflicts in the healthcare sector including reduced motivation and professional productivity, increased medical error, psychological disturbances, psychosomatic complaints, high death rate (Gandhi, 2005; Sutcliffe et al., 2004; Baldwin and Daugherty, 2008; Spector and Burk-Lee, 2008; Greer et al., 2012).

Risk Factors to Conflict

As already discussed, one common denominator of conflict at the fundamental level is perception - a disparateness of interests, goals, values among others. It is thus imperative to note that managing conflicts effectively is linked to identifying and understanding factors that increase the risk of conflicts.

Various studies have underscored several risk factors of conflicts including personality traits (Wilmot & Hocker, 2000); gender differences (Gjerberg and Kjolsrod, 2001); cultural variation (Shteynberg et al., 2005; De Dreu and Gelfand, 2007; Okhakhu and Cletus, 2015).

Briefly, with respect to the correlation of cultural variation with conflicts; first, it is important to state that culture defines the actions and reactions of individuals in many communities. It represents shared beliefs, values, behaviours and ideas that have been internalized and form the norms of any society or environment.

Healthcare organizations are highly heterogenous in nature and are composed of various workers with the distinct cultural backgrounds. The cultural differences hence have been profiled to be platform that could trigger the likelihood of conflict (De Dreu and Gelfand, 2007; Billing et al., 2014; Jackson-Hayes, 2015; Okhakhu and Cletus, 2015).

Shteynberg et al. (2005) argued that conflict could be ignited when the fundamental cultural issues are neglected. They added that the interplay between individual / group tendencies and the culture of the environment in which organizations are located determines the type of conflict occurring in such organizations and the levels at which it occurs. This claim was also supported in the works of Gelfand et al., (2002), Chen & Li (2005), Triandis et al., (2001), Valenzuela et al., (2005).

The preceding sections characterized the nature of conflicts, risk factors and etiologies in the context of the health sector. One of the most important highlights within many studies is the non-homogeneity of a typical healthcare organization. Such attribute to the institutions of health presents potential challenges involving the process of team development and the administration of conflict management techniques.

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