The main goal of the head of the department and the head nurse is to establish effective teamwork among employees and competently manage conflicts.

An important role is given to specialists with secondary medical education, an advanced level of education and higher medical education in the specialty “Nursing”, who make up the largest category of healthcare workers. Therefore, along with other components, the formation of an optimal psychological climate in a team of medical workers is of great importance.

Nursing is an integral part of the health care system, with significant human resources and real potential to meet the population's needs for accessible and acceptable medical care.

The variety of functions that it performs requires understanding:

• factors affecting health;
• causes of diseases;
• methods of treatment and rehabilitation of patients;
• environmental, social and other conditions in which medical care is provided and the healthcare system operates.

The World Health Organization views the nursing workforce as having real potential to meet the population's growing needs for affordable health care.

IN modern world The aggravation of the problem of the quality of medical care dictates the need for professional mobility and the competitiveness of specialists. And without such a concept as competence, this is impossible.

Competence is the ability of a specialist to solve a certain class of professional tasks in a social, professional and personal context.

Employee relations primarily imply the internal psychological climate of the team and the ability to work in a team.

Nature of the conflict

As a rule, nursing specialists are a female team. The female team usually rests on personal relationships. The ideal team for women is one that is built on the family principle, since women tend to project family relationships onto work relationships and expect support, understanding, and emotional warmth from colleagues. Any changes can be perceived women's team negative.

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

The main goal of the head of the department and the head nurse is to establish effective teamwork among employees.

Sometimes difficult relationships develop in a team, which not only interfere with successful interaction, but also provoke conflict situations that can negatively affect the work process.

Management of the department is impossible without conflict management, and this must be taken into account by the head nurse. For effective management it is necessary to study the types, levels, essence of conflicts, and also to find and apply in practice the most optimal ways to resolve controversial situations during the period of reorganization of medical treatment preventive institution.

People working in organizations are different from each other. Accordingly, they perceive the situation in which they find themselves differently. They also perceive their roles in the team differently and have different motivations for work. Differences in perception often result in people facing disagreement and controversy. This disagreement arises when the situation is truly conflicting in nature.

Conflict (from Latin conflictus - collided) is a manifestation of objective or subjective contradictions, expressed in a clash and confrontation between the parties.

Conflict- this is a fact of human existence. There are different levels of conflict in an organization:

• intrapersonal;
• interpersonal;
• intergroup;
• between the individual and the group;
• intra-organizational.

Intraorganizational conflict can take many forms and has a wide range of representatives at various levels. When conflict in an organization is unmanageable, it can lead to confrontation (structural units of the organization or members of the micro- or macro-team stop collaborating and communicating 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 conflict should be avoided whenever possible or resolved immediately as soon as it arises. However, it should be borne in mind that conflict, along with problems, can also bring benefits to the organization, since a variety of points of view provides additional information and helps to identify more alternatives or problems. There are no conflict-free organizations in life: it is important that the conflict is not destructive. However, one should not discount the fact that individual, most often interpersonal, conflicts are destructive. A specialist should also know about this, since joint activities involve people who differ in their professional preparedness, life experience, individual character traits and temperament, etc.

Each conflict has its own cause:

• obsolescence of the organizational structure, unclear delineation of rights and responsibilities - the consequence of this is double or triple subordination of performers. There is neither the strength nor the time to follow the instructions of all the leaders. Then the subordinate is forced: to rank received orders according to their degree of importance; demand this from your immediate supervisor; take on everything. In any case, a conflict situation is obvious. The ripening conflict is eliminated by proper organizational design of the division of labor, improving the procedure for delegation of powers;
• limited resources - even in the largest clinics, resources are always limited. Management decides how to properly allocate materials, human resources and finances among 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 dissatisfaction and lead to various types conflict;
• unequal treatment of members of the work collective - as a result of this, “confidants” and “favorites” appear. This situation always provokes conflict;
• insufficient - in this case, the possibility of a conflict arising is due to the professional unpreparedness of the subordinate. He is not trusted with certain types of work performed by another employee. As a result, some workers are underworked, while others are overloaded with it.

Considering the causes of conflicts, one cannot help but notice that in certain situations the source of the conflict is the head of the department or the head nurse himself. Many unwanted conflicts are generated by the personality and actions of the leader himself, especially if he allows himself personal attacks, is vindictive, suspicious, and does not hesitate to publicly demonstrate his likes and dislikes. The cause of the conflict may also be the leader’s unscrupulousness, his false understanding of unity of command as a principle of management, his vanity, harshness and rudeness in dealing with subordinates. Many conflicts arise precisely due to the fault of such managers who know how to find loopholes and circumvent directives and regulations, continuing to quietly do everything in their own way. The leader’s incontinence, 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 feeling of other people give rise to conflict.

Conflict management

To avoid conflict, it is necessary to clarify the goals and objectives of each department and employee by conveying the relevant instructions orally or in writing.

Conflictologists have developed and continue to develop ways to prevent conflicts and methods for their “painless” resolution.

A leader must not eliminate conflict, but manage it and use it effectively.

The first step in managing conflict is to understand its sources. After determining the causes of the conflict, the leader must minimize the number of participants in the conflict. It has been established that the fewer people involved in a conflict, the less effort will be required to resolve it.

If, in the process of analyzing a conflict, a manager cannot understand its nature and source, he can involve competent persons (experts) for this purpose. 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 arbiter, under certain conditions or for some subjective reasons, may take the side of its opponent. And in such a situation, the conflict does not die down, but intensifies, since the “offended” party must fight against the expert arbiter.

Plays a big role in conflict management.

Avoidance, evasion (low assertiveness combined with low cooperation)- with this strategy of behavior, a person’s actions are aimed at getting out of the situation without giving in, 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 moves 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 generally considers it useless, tries not to get into situations that provoke conflict.

Coercion (adversarial)- in this case, high assertiveness is combined with low cooperation. The leader’s actions are aimed at insisting on his own through open struggle for his interests, the use of power, and coercion. Confrontation involves perceiving the situation as victory or defeat, taking a tough position and showing irreconcilable antagonism in case of resistance from the partner. Such a leader will force you to accept his point of view at any cost.

Smoothing (compliance)- low assertiveness is combined with high cooperativeness. The actions of a leader in a conflict situation are aimed at maintaining or restoring good relationships, at ensuring the satisfaction of the other person by smoothing out disagreements. For the sake of this, he is ready to give in, neglect his own interests, strives to support the other, not to hurt his feelings, and take into account his arguments. His motto: “There is no need to quarrel, since 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 manager’s actions are aimed at finding a solution that fully satisfies both his interests and the wishes of the other person through an open and frank exchange of views about the problem. He tries to resolve disagreements by conceding something in exchange for concessions from the other side; in the process of negotiations, he looks for intermediate “middle” solutions that suit both sides, in which no one particularly loses anything, but no one gains anything either.

Among most managers, there is a belief that even if you are fully confident that you are right, it is better not to “get involved” in a conflict situation at all or to retreat than to enter into outright confrontation. However, if we're talking about about a business decision, on the correctness of which the success of the business depends, such compliance results in management errors and other losses.

According to management experts, choosing a compromise strategy is the best way to eliminate contradictions. Through collaboration, the most effective, sustainable and reliable results can be achieved.

The collaborative style is the most difficult, but also very effective, and, nevertheless, each of all styles gives positive results only under 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 character of the individuals. At what cost was victory achieved and what does defeat represent for the other are extremely difficult questions for a leader, since it is important that the opponent’s defeat does not become the basis for the development of a new conflict. For all the correct words about cooperation, for all the criticism of unconstructive approaches to conflict, there are cases when agreement, compromise or avoidance of conflict is the only possible course of action. Sometimes it is important to simply understand, accept and help a person, and not succumb to his aggression.

For managers of nursing staff, it is important to have leadership qualities, that is, not only to be able to organize the work of subordinates, but, most importantly, to lead, infecting them with enthusiasm. The microclimate in the team depends on the style of personnel management, and therefore the likelihood of developing conflict situations.

Methods for preventing and resolving conflicts

In the work of a medical institution to prevent conflicts, it is necessary to use management methods to prevent them:

1. clear formulation of requirements, rules, evaluation criteria;
2. an unambiguous hierarchical structure and coordinating mechanisms (everyone knows who is in charge, who is responsible for what, who makes decisions in case of disagreement);
3. establishing common goals, forming common values;
4. a reward system that eliminates clashes between different units or group members.

The main task of the nurse organizer is not only to prevent conflicts that are potentially possible in all communication situations, but to be able to recognize the conflict and manage it in order to obtain the best result.

Cooperation is a behavioral strategy that puts first priority:

• satisfying the interests of all parties to the conflict;
• finding ways to involve all stakeholders in the conflict resolution process;
• the desire for benefit for everyone together and each individual.

This strategy requires more time-consuming work than other approaches to conflict. The goal of cooperation is to develop a long-term mutually beneficial solution. It is necessary to spend some time searching for the hidden interests and needs of the parties, listen to each other and develop different possible options solving the problem.

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 negate all treatment efforts. Therefore, medical personnel of any profile need to be able to correctly analyze conflict situations and master the techniques for successfully resolving them. This is the most effective way to save a healthcare professional's time, money and mental health.

One of the ways to eliminate conflicts in a team should be for employees to be informed by management about problems in the team, which allows them to reduce tension and effectively solve existing problems together.

One of the main tasks of a nurse organizer in a team is to prevent conflict, especially during the period of reorganization. To do this you need:

• promptly determine the individual psychological characteristics of your employees, understand how they will react in various situations;
• have knowledge of psychological laws and mechanisms of conflicts;
• correctly organize work with specific conflict situations;
• ability to listen and understand people.

In a team, during a period of reorganization, it is very important to find optimal solutions, on which the future lives of employees depend. It is important for the sister organizer to remember the three conditions for competent conflict resolution. Firstly, almost any controversial situation can be resolved without conflict. Secondly, you must really want to resolve contradictions without conflict. Thirdly, we must strive to resolve the conflict with minimal negative emotions towards the opponent and to reduce them on the opposite side.

When we are possessed by negative emotions, we cannot correctly and objectively assess the conflict situation. It’s not for nothing that an ancient Chinese proverb says: “Don’t give in to anger, otherwise in one day you can burn all the wood you’ve collected for many weeks.” It is especially important to maintain a favorable psychological environment in the medical team, which is responsible for the health and life of patients.

Abstract of the dissertationin medicine on the topic Conflicts in medical institutions: causes, conditions, social consequences

As a manuscript

Popova Ekaterina Georgievna

CONFLICTS IN TREATMENT AND PREVENTIVE INSTITUTIONS: CAUSES, CONDITIONS, SOCIAL CONSEQUENCES

dissertation for the degree of candidate of medical sciences

Volgograd -2005

The work was carried out at the Department of Public Health and Healthcare of the State Educational Institution of Higher Professional Education Volgograd State Medical University

Scientific supervisor:

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

Official opponents:

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

Doctor of Sociological Sciences, Professor Olga Vasilievna Baidalova

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 and 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 a basic need and an inalienable human right. This value setting is a socio-psychological guideline 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 potential 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 reform, 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 fact that conflict is an inevitable phenomenon in the life of society, the collective 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 arises in subjects of conflict interaction complicates interpersonal communication, reduces the effectiveness of treatment, negatively affects the psycho-physiological state of medical workers, and increases social tension among providers and recipients of medical services.

Conflicts in health care institutions (health care facilities) are only superficially local in nature. Functionally, they are closely related to those processes and contradictions that constitute the main content of social changes 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 for the industry and the inability to provide patients with medical care using modern medical technologies and in accordance with the high standards of its provision, the emotional background is reduced, the state of internal anxiety and professional dissatisfaction is maintained. Low wages for employees of medical institutions reduce the motivation to perform their professional duties well. Often, social and everyday problems are extrapolated by the parties to the conflict to the process of interpersonal communication, which contributes to the growth of conflict in health care facilities.

At the same time, with the financing of hospitals and clinics inadequate to real expenses, a search is underway for new forms of organization and remuneration of medical workers. The intensification of the work of doctors 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, study of the causes of occurrence, dynamics of processes of conflict interaction and their consequences, as well as the development of adequate social technology for conflict management in health care facilities, during the period of reforms in the industry, will not only allow timely identification of problem areas of ongoing reforms and adapt them to the realities of practical healthcare, but also 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 patterns of emergence and development of conflict situations in health care facilities in the context of the establishment of market relations and reform of the country’s health care system;

Sociological characteristics of participants in conflicts in health care facilities;

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

Assessing the consequences of interpersonal conflicts in health care facilities on quality and efficiency medical care population;

Development of a classification of conflicts in medical institutions;

The object of the study is the professional activities of employees of municipal healthcare institutions (hospitals, outpatient clinics) and private diagnostic and treatment centers in the cities of Volgograd and Volzhsky.

Research hypothesis. The transitional society in today's Russia has become an arena of deep contradictions in all spheres of life. Radical reorganization economic relations led to rapid social differentiation and sharp polarization of 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.

In the extremely difficult conditions of reforming the health care system, the humanity of the mission and professional ethics requires a medical worker to fulfill his professional duty, but 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 where one of its parties is a sick person will have negative consequences, since it will indirectly affect the health of its participants.

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

The methodological basis of the study was the scientific principles of objectivity and systematic approach to the analysis of the problem posed. The work was carried out using classical methods of sociology (Zborovsky G.E., Osipov G.V., Yadov V.A.) and sociology of medicine (Volchansky M.E., Reshetnikov A.V., Tatarnikov M.A.). The research was carried out in the tradition of the conceptual concepts of the “general theory of conflict” by K. Boulding, the “conflict model of social development” by R. Dahrendorf, and the theory of “conflict functionalism” by L. Coser. 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 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 period of 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 transformations, the number of medical workers who receive satisfaction from their work is decreasing.

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

5. The classic classification of conflicts, adapted by the author to the conditions of the professional activities of health care providers, makes it possible to predict the occurrence of conflict situations in healthcare institutions, control the process of their development and choose the most rational methods of resolution, 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 provide a comprehensive sociological description of the causes of conflicts in health care facilities in the conditions of the formation of market relations in the economy and reform of the health care system. A new proven social technology for conflict management in healthcare institutions is proposed.

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

Acts of implementation for the questionnaires and interviews developed by the dissertation candidate, “Regulations on the work of the conflict commission in health care facilities” were drawn up.

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

Structure of the dissertation. The dissertation consists of an introduction, three chapters, a conclusion, conclusions and appendices, 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 and 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; the main provisions submitted for defense are stated; The theoretical and practical significance of the study is highlighted.

The first chapter - “Literature Review” - consists of three paragraphs.

The first paragraph - “Social conflicts: the evolution of views, the current state of the problem” - provides an analysis of the essence of social conflict, examines the causes, place and role of social conflicts in the system of social relations.

The author proceeds from the methodological position that the functional basis of any social clash is the objective contradiction that arises between the warring parties. Based on the theoretical concepts of K. Boulding, R. Dahrendorf and L. Coser, the dissertation examines social conflict as an integral element of development. social systems. Being an irreducible type of social relations, processes of conflict interaction are determined by the nature of the organization of the social system in which they arise and develop. Consequently, determining the essence of social conflict presupposes 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; study of its characteristics and components, study of the dynamics and functions of the conflict. This allows us to consider the features of the process in specific social and 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 an organization: concept, essence, structure, conflict management and their consequences” - the causes of occurrence, features of the dynamics of development and specific forms of manifestation of conflicts in organizations are identified and disclosed. The author emphasizes that the knowledge of the conflict participants about 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 beneficial effect on the dynamics of the development of conflict interaction. On the contrary, insufficient awareness of the volume of real contradictions and the desire for violent action to resolve the conflict increase the destructive potential of conflict.

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

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

In the third paragraph - “Features of conflicts in healthcare institutions” - the dissertation student emphasizes that the system of knowledge about human health is not limited to medical aspects, but assumes a social and humanitarian approach, that is, the study of the entire set of relationships between doctor and patient ranging from traditional care for mental health 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, identifies problem areas of innovation, and analyzes legal support medical activities in specific socio-economic conditions.

Healthcare develops not only taking into account the health needs of the population, but also in accordance with the capabilities of society to meet these needs. The processes of economic reform as a whole inevitably affect the development of all sectors of the national economy. A sharp reduction in budget expenditures on healthcare and limited compulsory medical insurance funds leads to an expansion of the list of paid medical services, which are not available to everyone. The formal legal basis for the functioning of healthcare comes into conflict with the real possibilities of economic regulation of medical activities in the context of 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 workers.

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

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

Chapter 2. “Materials and research methods.”

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

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

The complexity of the object under study made it necessary, for its more objective description, to use various methods of collecting and analyzing information obtained as part of a sample study with the calculation of the permissible sampling error and statistical indicators of the reliability of the description. The composition of the sample population was determined by the stated objectives of the study and was as close as possible to the corresponding proportions in the general population. In the study, the reliability of the data is ensured by representation in the sample of health care institutions, gender, age, socio-professional and socio-economic composition of the respondents, using the principles of uniformity of time and place of data collection.

The author presents a program of comprehensive medical and social research conducted in 1997-2004, consisting of six blocks, in each of which the tasks were solved in several stages.

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

medical appointment), questionnaire, testing and interviewing. All accounting and reporting documentation used for analysis in scientific work has undergone preliminary testing expert assessment reliability, its availability in full and completeness of data registration. Participant observation was carried out in conflict commissions. The feasibility of creating conflict commissions was assessed by questioning people whose complaints were examined at their meetings.

Summary data on the scope and methods of the study are presented in Table. 1.

Table 1

Summary of the scope and methods of the study

No. Research method Number of observations

1. Questionnaire to study the intrapersonal conflict potential of medical personnel. 246 doctors 98 m/nurses

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

3. Questionnaire to identify latent intragroup conflict in health care facilities. 268 doctors

4. Timing of the duration of a medical appointment at the 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 care facility. 208 incidents

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

7. Interviewing hospital patients, participants in conflicts (complaints) to compile a social profile of a conflict-prone personality. 205 people

8. Analysis of the number of requests to health care facilities before and after the conflict by patients who made complaints and temporary disability of medical personnel in the same situation. 208 patients, 208 doctors

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

Analysis of the study results was carried out using various techniques statistical processing. To determine the correspondence of 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 clarifies the presence of a cause-and-effect relationship between the accounting signs. In order to establish the share of influence of the analyzed factor characteristic - the duration of admission, on the effective characteristic - 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 for the same period of time in the control group was carried out using the method of cross-contingency tables and the Yule association coefficient (0. Statistical reliability (E proven with using the determination of the Pearson agreement coefficient. The probability of the influence of socio-demographic, socio-economic characteristics, as well as the health status of the medical worker and the patient on the conflict behavior of their behavior in conditions of direct interaction, was determined by calculating the Spearman rank correlation coefficient (p).

The third chapter - “Results of the conducted 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 conditions of transition to a market economy, the entire previously existing system of values ​​is destroyed, the socio-psychological motivation of the professional work activity 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 care facilities and the nature of communication with patients, we conducted questionnaire surveys of employees of municipal medical institutions and private treatment and diagnostic centers with a research interval of 7 years (1997 and 2004). The data obtained indicated that the majority of doctors (regardless of which medical institutions they worked in) considered their work socially significant (in 1997 - 91.4% and in 2004 - 90.2%).

At the same time, in 1997, 59.2% of doctors working in municipal health care 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.

niyah. Respondents deciphered job satisfaction in open-ended questions, noting the effectiveness of their work for patients, a decrease in morbidity in the areas, and a decrease in the initial incidence of disability. Dissatisfaction with the results of their work was mainly expressed in connection with the inability to provide treatment with high-quality, modern, expensive medicines, timely and free of charge to perform various diagnostic tests for patients using modern medical technologies, problems of prolonging the treatment of chronic patients in the out-of-hospital period. Over the 7 years that have passed between studies, respondents have not noted any dynamics in this matter.

In 1997, 76.2% of doctors in municipal medical institutions and 22.4% of doctors in private medical centers believed that the amount of work they performed was excessive and did not correspond to the appropriate workload norm. In 2004, this figure increased and amounted to 87.4% and 37.2%, respectively. At the same time, in both 1997 and 2004, all respondents from municipal hospitals and clinics noted that the main factor reducing the efficiency of using working time is the registration of a large number of 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 the discrepancy between wages and labor costs, pointing to low wages, which forces 38.9% doctors 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 increase the level of income per family member to an average of only 2,000 rubles. Problems were identified 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 severity of the emerging contradictions is aggravated by the difficulties of adapting to the high pace of change in society and the practical healthcare system. Reducing the zones of state paternalism and guaranteed minimum living goods worsens the economic, social and moral condition of the prevailing part 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 to doctors and patients), but also to be a kind of buffer when various social contradictions arise at the time of providing medical care, mitigating the negative consequences of the industry’s 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 municipal healthcare facilities under study were combined into two groups: low-conflict healthcare facilities (with isolated cases of employee dismissal with the wording “at their own request”); high-conflict health care facilities (with staff renewal over the last 2-3 years by more than one third).

44.8% of respondents worked in low-conflict healthcare facilities, 43.3% in high-conflict healthcare facilities, and 11.9% of respondents in private clinics. 59.5% of doctors were dissatisfied with their work in their specialty in high-conflict healthcare institutions, and 50.0% of respondents in low-conflict healthcare institutions. The largest share in these groups is made up of local therapists of municipal outpatient clinics who would like to work as “narrow” specialists. Free-form explanations for the answer to the proposed question indicated the problems that local therapists and other specialists face when it is necessary to provide medical care to patients at home. In a private medical center, 31.3% of doctors are dissatisfied with their specialty. Here the situation is somewhat different and is mainly associated with differences in wages for doctors in therapeutic and surgical specialties. Three-quarters of doctors in high-conflict health care institutions (72.4%) are not satisfied with working conditions; in low-conflict health care institutions and private clinics their number is small - 16.7% and 6.2%, respectively. About half of the employees of high-conflict health care facilities (43.9%) and only 16.7% of doctors in low-conflict hospitals and clinics 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 a focus of our research. To the question about relationships in the team, the answers were distributed as follows: in low-conflict health care facilities, the bulk of the team of doctors is satisfied with the microclimate in the institution; only 15.0% of employees experienced problems. In private clinics and high-conflict health care facilities there are slightly more such individuals - 25.1% and 27.6%, respectively. A significant difference is noted in the answers to the questionnaire about the relationship between doctors and heads of healthcare 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 health care facilities and 3.1% in a private treatment and diagnostic center would like to change their place of work. The motivating reason for this in low-conflict health care 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 health care facilities, negative answers were given mainly by women 40-45 years old with 11-20 years of work experience, having the highest qualification category and additional employment in the form of part-time work in their specialty for 0.5-1 pay. In high-conflict health care facilities, this contingent was almost identical, but doctors of the first qualification category prevailed. In a private medical institution, the difference was that the majority of doctors did not have additional workload in the form of part-time work. Thus, with an unstable socio-psychological climate in health care facilities (we have identified these institutions as high-conflict institutions), preconditions arise, and then conflict situations arise within the team. They can be identified as intra-group and inter-group depending on the characteristics of the subjects of conflict interaction.

In the third paragraph - “The conflict-generating potential of various payment schemes for medical workers in outpatient clinics” - the patterns of emergence and development of interpersonal conflicts in the “doctor-patient” system are studied.

We investigated conflict situations that arise in the provision of medical services in outpatient clinics that pay medical workers according to a single tariff schedule (ETC) and the “end result” (CR), their relationship with the function of the medical position and, accordingly, with the average duration of the appointment , as well as the ability to comply with all the requirements imposed by regulatory organizations for the quality of treatment and documentation.

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

tu" and 2.4 times more than when working with payment via ETC. An analysis of the quality of medical care and completion of documentation, carried out after time-lapse studies, revealed that even with such a significant increase in the time for seeing one patient, only in 82% of cases the experts did not identify defects in the prescribed examination, treatment and execution of primary medical documentation.

Written complaints from patients about medical care in clinics were also analyzed. Of the 208 written complaints from patients recognized as justified, 26.4% were made regarding treatment issues, 31.7% - regarding drug supply, 41.8% - regarding issues of ethics and deontology. Complaints arose 1.7-1.9 times more often in clinics working with the “final result” form of payment. The average rating of satisfaction with the appointment in clinics working with payment according to the “final result” was 3.4 points, while when working with payment according to ETC it was 3.8 points (on a 5-point scale).

A certain pattern was identified in the ratio of the number of complaints, the degree of patient satisfaction with medical care from various specialists and the time spent on them at the appointment. Thus, with a reduction in reception time of only 2.9 minutes, the number of recorded complaints almost doubled.

A reduction in the duration of a medical appointment, which is inevitable given existing forms of remuneration and extremely low prices for medical services in the compulsory medical insurance system, inevitably leads to a decrease in the quality of medical care provided at outpatient clinics 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 classic typological classification of conflicts, adapted to the conditions of the professional activities of medical workers, and given a detailed commentary on it.

The fifth paragraph - “Social characteristics of participants in conflict interaction in health care institutions” - reveals the features of the social portrait of subjects of conflict interaction in health care institutions. The study showed that conflict behavior among patients of medical institutions is more characteristic of people of pre-retirement or retirement age, with a low level of education, an unsettled personal life, and having little comfortable living conditions.

technical conditions. Among them there is a significant proportion of those who, despite poor health, are forced to work, sometimes even beyond the normal workload established by specialty or age. The subjects of conflicts in health care facilities are often citizens with low incomes, which limits their ability to receive paid (or partially paid) types of medical care and quality treatment medicines. The socio-economic characteristics of medical workers and their partners in conflict interaction - patients - are almost similar. The differences were identified in the fact that doctors with high professional qualifications often enter into conflict. Despite the conscious choice of specialty and significant experience working with people, low wages, corresponding only to the subsistence level, are one of the main factors determining the psychological discomfort of medical personnel and influencing 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 research proves that total quantity Patient visits to health care facilities in 6 months after the conflict occurred are significantly higher than before it occurred (Fig. 1,2).

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

a 6 c d e f

0 main group Ш control group

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

6 months before the conflict: a) did not apply to health care facilities; b) contacted once; c) contacted twice; d) contacted 3 times; e) contacted 4 times; e) contacted 5 times

a b c d e c

B main group 0 control group

Rice. 2. Frequency of visits to health care facilities by patients in the main and control groups within 6 months after the conflict: a) did not apply to health care facilities; b) contacted once; c) contacted twice; d) contacted 3 times; e) contacted 4 times; e) contacted S times

The seventh paragraph - “Social subjects of conflict management in medical institutions” - indicates the need to organize monitoring of latent conflict in health care institutions, which would allow predicting the occurrence of conflict situations, as well as the feasibility of creating conflict commissions in health care institutions on a functional basis, the purpose of which is to stabilizing the social well-being of providers and consumers of medical services, improving the quality of medical care provided to patients. This collegial body can provide significant assistance in the timely consideration of citizens’ appeals to health care institutions in the manner established 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, make measures to eliminate them.

We analyzed the work experience of conflict commissions created in seven treatment and preventive 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 resolved pre-trial. In 4.6% of cases, the intervention of higher health authorities was required to finally resolve the problems that arose. The structural distribution of complaints considered in conflict commissions is presented in Fig. 3.

For questions:

And treatments

PI of drugs, provided. 0 organizations honey. obs. Ethics and deont. ■ other

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

The result of considering complaints and appeals from patients to conflict commissions was the adoption of management decisions on the organization of the work of structural units of health care facilities, making adjustments to the work schedules of doctors in clinics, conducting classes on ethics, deontology and the psychology of the treatment process with doctors and nursing staff.

The positive impact of collegial consideration of complaints on the quality of medical care in the clinic was noted by 81.4% of respondents.

Medical workers involved in conflict situations also highly appreciated the work of the commissions. In this group, 92.4% of respondents indicated that discussing 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 resolution.

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 increase in conflict potential of interpersonal communication in the dyads “doctor (nurse) - head of the institution (unit)”, “doctor (nurse) - doctor (nurse)”, “doctor (nurse) - 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 wages of most medical workers and the need to work part-time lead to a feeling of chronic fatigue and have a significant impact on the potential for conflict in their communication with colleagues and patients.

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

7. The collective portrait of a conflict participant - a visitor to a health care 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 in state-owned enterprises (58.3%), and having additional employment in the form of part-time work (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 conflict commissions in them, on a functional basis, in accordance with the methodological recommendations set out in the “Regulations on the conflict commission in health care facilities.”

3. Territorial health care authorities should review the workload standards for doctors at outpatient clinics, taking into account the real time costs associated with the introduction of the compulsory medical insurance system and preferential drug coverage.

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

1. Sabanov V. I. Quality of medical care and conflict potential in the “doctor-patient” system depending on the form of remuneration in outpatient clinics / V. I. Sabanov, E. G. Popova // Healthcare Economics. - 2004. - No. 5-6. - P. 52-55.

2. Shipunov YES. Ensuring the quality of medical care is the main function of healthcare institutions / D.A. Shipunov, V.F. Zadorin, V. A. Danilov, E.G. Popova // Issues of economics and management for healthcare managers. - 2004. - No. 3. - P. 42-45.

3. Popova E.G. Some causes of conflicts in outpatient clinic practice / E.G. Popova, M.E. Volchansky // Sociology of medicine - health care reform: Materials of the first All-Russian scientific and practical conference, Volgograd, June 18-19, 2004 - Volgograd, 2004. -S. 57-62.

4. Popova E.G. The influence of personal and reactive anxiety of medical personnel on the emergence and development of conflicts in outpatient clinics / E.G. Popova // Medical-biological and psychological-pedagogical aspects of human adaptation and socialization: Materials

ly of the 3rd All-Russian Scientific and Practical Conference, Volgograd, October 1-3, 2004. - Volgograd, 2004. - pp. 141-143.

5. Popova E.G. Experience in resolving interpersonal conflicts in the “medical worker - patient” system by conflict commissions of medical institutions / E. G. Popova // Medical-biological and psychological-pedagogical aspects of human adaptation and socialization: Materials of the 3rd All-Russian Scientific and Practical Conference, Volgograd , October 1-3, 2004 - Volgograd, 2004. - pp. 143-145.

6. Shipunov D.A. Standardization of the quality of medical care as a targeted method of management in healthcare / D.A. Shipunov, V.F. Zadorin V.F., V.I. Savinov, E.G. Popova // Issues of economics and management for healthcare managers. - 2004. - No. 9. - P. 59-63.

7. Popova E.G. Modern system of medical care in Russia and public health: problems and conflicts / E.G. Popova // World of politics: current problems of political science / Ed. prof. N.I. Pershina. - Volgograd. - 2004. - P. 75-81.

Popova Ekaterina Georgievna

CONFLICTS IN TREATMENT AND PREVENTIVE INSTITUTIONS: CAUSES, CONDITIONS, SOCIAL CONSEQUENCES

Signed and stamped 04/05/2005

Circulation 100 yu. Office paper Academic ed. l. 1.5.

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

INTRODUCTION

Chapter 1. LITERATURE REVIEW.

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

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

1.3. Features of conflicts in healthcare institutions.

Chapter 2. MATERIALS AND METHODS OF RESEARCH.

Chapter 3. RESEARCH RESULTS.

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

3.2. Intragroup conflicts in medical institutions

3.3. Conflict potential of various remuneration schemes for 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 institutions.

3.7. Social subjects of conflict management in medical institutions.

Introduction of the dissertationon the topic "Sociology of Medicine", Popova, Ekaterina Georgievna, abstract

Relevance of the research topic. The program of socio-economic development of the Russian Federation for the medium term (2003 - 2005) in the section “Health care reform” declares as the state goal “improving the health status of the population based on ensuring the availability of quality medical care,” while pointing out the need to achieve “balance of volumes 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 healthcare 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 and its various social groups. The emerging political system and social stratification of the population determine the actual content of medical care provided to various social strata. That is, in the process of ongoing reforms, state policy in the industry objectively diverges from the actions being taken. In a country with extremely high mortality, including in working age (in 2002 - 15.3 per 1000 population), negative natural population growth (according to forecasts of the Center for Demography and Human Ecology of the Institute of National Economic Forecasting of the Russian Academy of Sciences, the population of Russia by 2050 may amount to 87 million people), unsatisfactory healthy life expectancy (according to the World Health Organization (WHO) - 60 - 61.9 years) and low income levels 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 care indicator is its component. The World Health Organization, recognizing the multifactorial conditions on which health depends, also lists the level of medical care as 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 to ensure public health, in the context of continued funding on a residual basis, for more than 10 years of ill-conceived reforms, healthcare is in crisis. The discrepancy between the management and economic mechanisms of the functioning of the healthcare 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 ten years of reform of the industry, it represents a system that is uncontrollable either vertically or horizontally, into which inherently contradictory insurance and budgetary methods of financing are built in, which causes disintegration and destruction components Russian healthcare".

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

In this situation, it is logical to openly compare the interests of all groups of people involved in the provision and receipt of medical services. Their social interaction takes on a conflict-generating character.

The above requires the adoption of a set of measures to create 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 of the development of social systems. Being an irreducible type 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 health care institutions (HCI) are an indicator of problems that have not yet been resolved by the reforms carried out in the health care system.

The issue of conflicts in healthcare during the formation of a market economy has not been sufficiently studied in domestic sociology. It becomes an objective necessity 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 prediction, identification, reduction and resolution, is relevant.

The sociology of medicine has a sufficient set of methods that allow a comprehensive analysis of 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 period of reforms, assess the significance of innovations for society, study the social frustrations of the medical worker and the patient, their impact on the treatment process and the psychological climate in health care 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 increasing 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 health care facilities in the context of reforms, when the social status of healthcare institutions, the economic situation of medical workers, the nature of interaction in medical teams are changing significantly, previously absent new relationships in the “doctor-doctor” systems appear, “doctor - patient”, etc.

The goal 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 the 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;

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

The object of the study is the professional activities of employees of healthcare institutions (hospitals, outpatient clinics (APU), private treatment and diagnostic centers) in 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 care 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 sharp polarization of 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 for a number of objective and subjective reasons it has not been possible to fully achieve the stated goals.

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

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

Conflict in health care facilities - as an extreme case of aggravation of contradictions, requires modern identification, quick and effective intervention while minimizing its negative consequences.

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

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

The methodological basis of the study was the scientific principles of objectivity and systematic approach to the analysis of the problem posed. The work was carried out 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, the “conflict model of social development” by R. Dahrendorf, and the theory of “conflict functionalism” J1. Kosera. The heuristic potential of domestic conflictology is applied in the normative field of bioethics, medical law, conceptual models of the relationship between a medical worker and a patient, and the main provisions of 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 was carried out during the period of the formation of market relations in Russia and the implementation of healthcare reform.

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

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

A social portrait of a conflicting patient has been drawn up, allowing the doctor, during the treatment process, to individualize a medical-deontological approach to the patient, in order to create a favorable psychological atmosphere during interpersonal communication.

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

The feasibility of testing medical workers in order to identify potentially high-conflict individuals in order to optimize the personnel policy of health care facilities and stabilize the psychological climate in them has been proven.

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

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 the implementation of reforms in healthcare, the presence of latent ongoing intrapersonal conflicts is characteristic, complicating communication and reducing its constructiveness in the “manager” systems 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 care facilities and objectively increases the conflict level of interpersonal communication in professional conditions.

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 transformations, the number of medical workers who receive satisfaction from their work is decreasing.

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

5. The classic classification of conflicts, adapted by the author to the conditions of the professional activity of doctors in medical institutions, makes it possible to predict the occurrence of conflict situations in healthcare institutions, control the process of their development and choose the most rational methods of resolution, reducing the destructiveness of their consequences

6. A generalization of the empirical material of the study made it possible to determine the nature of the dependence of morbidity and patient visits to medical institutions on 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 preventing and resolving 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 the emergence of conflicts in health care facilities in the process of providing medical services to the population, in the conditions of the formation of market relations in the economy and reform of the health care system.

The results of the study can be used to improve the quality of health care 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 materials and conclusions of scientific work in advanced training courses for managers of medical institutions on conflict management in health care facilities.

Approbation of work. The dissertation materials were presented and reported at medical conferences in health care facilities that were part of the study; at the First All-Russian Scientific and Practical Conference “Sociology of Medicine - Health Care Reform” (Volgograd, June 18-19, 2004); at the 3rd All-Russian Scientific and Practical Conference “Medico-biological and psychological-pedagogical aspects of human adaptation and socialization” (Volgograd, October 1-3, 2004); The author has published 6 scientific articles and 1 textbook (as part of a team of authors).

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

Structure of the dissertation. The dissertation consists of an introduction, three chapters, a conclusion, conclusions and appendices, illustrated with 8 figures and 10 tables. The literature index includes 233 sources, including 9 foreign ones. The total volume of the dissertation is 136 pages of typewritten text.

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 health care system.

2. Increasing latent intrapersonal conflict among employees of medical institutions, in the context of reforming the health care system, is a manifestation of personality disintegration, expressed in a clash of conflicting internal motivations, against the backdrop of a widening gap between consumer expectations and value orientations of medical personnel.

3. High level 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 healthcare system and increases conflict in health care facilities.

4. The increase in conflict potential of interpersonal communication in the dyads “doctor (nurse) - head of the institution (unit)”, “doctor (nurse) - doctor (nurse)”, “doctor (nurse) - 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 wages 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 potential for conflict in their communication with colleagues and patients.

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

7. The collective portrait of a conflict participant - a visitor to a health care 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 in state enterprises (58.3%), having additional employment in the form of part-time work (67, 7%) and at the same time the income per family member is below the subsistence level (92.9%).

8. The classic typological classification of conflicts, adapted to the conditions of 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 health care facilities after the conflict, leading to an increase in both their personal costs and costs in the compulsory medical insurance system.

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

1. In order to limit the destructive consequences of conflicts in health care 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 health care institutions.”

3. Territorial health care authorities should review the workload standards for 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 coverage.

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

5. Include issues of conflict management in teams into the training and development program for managers of medical institutions. 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 the clinic (hospital) (filled out by survey participants independently)

229. The survey 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 will be anonymized during the analysis process. The confidentiality of the survey is guaranteed by the administration of the medical institution.

232. When answering the questions asked, 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 to be socially significant, important for maintaining the stability of the state and society? - yes. □ - not really. Ts - no. Ts - difficult to answer.| |other.□

235. Do you think that medical care in your clinic (hospital) meets generally accepted standards? - yes.□ - not really. Ts - no. Ts - hard to answer. Ts - other.□

236. Do you think that the clinic (hospital) where you work is sufficiently provided with modern diagnostic and treatment equipment? - yes. □ - not really. C - no. □ - difficult to answer. □ other.□

237. Are you satisfied with the organization of the work of the clinic (hospital) as a whole? - yes.□ - not really. .□- no.□- I find it difficult to answer.I Iother.□

238. Do you consider it convenient for yourself to organize work in a clinic (hospital)? - yes.□ - not really. C - no. P - difficult to answer. I Iother.□

239. Does your current job Your professional capabilities? - yes.□ - not really. C - no. P - I find it difficult to answer. I Iother.□

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 really. O- no. PI- I find it difficult to answer.| |other.□

241. Do you think that your salary corresponds to labor costs? Yes, in full. Not at all, it is higher than my labor costs. Not at all, it is lower than my labor costs. No. Not sure. Other.□

242. Are you satisfied with your salary at the present time? - yes.□ not at all. O - no. Difficult to answer.| |other.□

243. Do you consider it possible for yourself to increase the duration of working hours in order to increase material remuneration for your work? yes.□ no. Not sure.|~1other.□

244. What, in your opinion, is the main factor that reduces the efficiency of using 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 really. C - no. C - difficult to answer. C other. P

246. Are issues of career growth of employees resolved in the clinic (hospital)? - yes.□- not really. Ts - no. Ts - difficult to answer.| |other.□

247. Would you like to change your place of work? - yes.□ - not really.□ - no. P - difficult to answer.| |other.□

248. From your point of view, the introduction of a compulsory health insurance system: made the work of medical staff easier. It did not affect the work of medical staff. It increased the workload. I’m not sure. Others. .□

249. The introduction of a compulsory health insurance system, 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. Not sure. Other. About

250. Do you experience problems when prescribing paid medical services to patients? (If yes, please explain why).yes.□not always.No.Difficult to answer.Other.□

251. The volume of paid medical services provided in your medical institution: excessive. P - corresponds to the necessary needs. Below the needs of patients. I find it difficult to answer. P - other. From/

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

253. If yes, then indicate its volume). I do not have additional employment. I have additional employment. P0.25 rate. .□0.5 bets.|š0.75 bets. .□1 bet.Pmore than 1 bet.P

254. Indicate how long you have been working part-time. Constantly, for many years. About 1 year. Up to 6 months a year. Not more than 1-3 months a year. Not working part-time.

255. Does it satisfy you? moral and psychological climate in your clinic (hospital)? yes. not really. no. hard to answer otherwise.

256. You experience the greatest difficulties in communicating with: patients. Junior medical staff. Nursing staff. Fellow doctors. Heads of departments. Heads of the clinic. I don’t experience any difficulties. It’s hard to answer. Other.□O

conflicts in medicine

The process of providing medical care includes various types of relationships in the triad “doctor-patient-society” (informational, economic, legal, ethical, etc.), as well as various types of social interactions - competition, cooperation, conflict, taking into account the set of functions of each of them. One of the forms of implementation of relationships between social actors in the medical field is conflict, which acts as an interpersonal way of developing the social institution of medicine.

The subjects of medical practice involved in conflict situations are medical workers, patients, medical teams in general, support groups taking the side of the patient and other participants within the scope of medical practice.

The level of conflict in the relationship between doctor and patient depends on:

material and technical base of the medical institution;

qualifications of medical personnel;

quality and cost of services provided;

patient assessments of objective and subjective components of medical care.

2.5. Parties and subject of conflict in medicine

The parties to the conflict in medicine are:

in interpersonal: doctor – patient; doctor - doctor; doctor - administrator;

in intergroup cases: administration of a healthcare facility - patient, doctor - relatives of the patient, administration of a healthcare facility (legal entity) - patient (plaintiff in court).

The subject of conflict in medicine is:

objective reasons (independent of the doctor): organizational, technical, financial (economic);

subjective reasons (depending on the doctor): informational-deontological, diagnostic, treatment-and-prophylactic, tactical.

The most common ways to resolve conflicts in medical practice:

pre-trial : conflict resolution at the primary level of doctor - patient, head of department, administration of health care facilities, KEC, ethical committee;

judicial : bodies of state jurisdiction; bodies of non-state jurisdiction - specialized arbitration courts.

Conflict resolution methods lead to corresponding typical conflict resolution results:

a) conflict resolution at the pre-trial level;

b) execution of a court decision.

Conflict behavior among patients is typical for people of pre-retirement or retirement age, with a low level of education, an unsettled personal life, and poor living conditions. Among them there is a significant proportion of those who, despite their unsatisfactory state of health, are sometimes forced to work even beyond the normal workload established by their specialty or age.

The subjects of conflicts in medical practice are often citizens with low incomes, which limits their ability to receive paid (or partially paid) types of medical care and treatment with high-quality (and therefore effective) medicines.

The socio-economic characteristics of medical workers and their partners in conflict interaction - patients - are almost similar. The differences were identified in the fact that doctors with high professional qualifications often enter into conflict. Despite the conscious choice of specialty and significant experience working with people, low wages, corresponding only to the subsistence level, are one of the main factors determining the socio-psychological discomfort of medical personnel and influencing the nature of intersubjective relationships at the time of medical care.

For different branches of medical activity, different types of conflicts are leading:

reducing the duration of a medical appointment is the main factor of conflict in the system of relationships “medical staff - patient” at an outpatient clinic;

in forensic medical practice, the situation of conflict interaction between subjects of medical practice is formed by the results of the examination;

in dental practice, the main conflict factor is the discrepancy between price and quality of service;

in pharmacy, a conflict between a doctor and a pharmacist is a conflict between professionals, which can be positive, and a 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 better informing the patient;

Of the types of conflicts that exist in medical science, conflicts in clinical trials have the greatest social significance, since they provoke risks for the subjects.

When studying the personal profiles of medical workers as a result of the use of observation and standardized questionnaires, the tendency to conflict and the tendency to avoid conflicts was revealed as follows: 8.5% - a very high degree of conflict; 25% - high degree of conflict; 58% - pronounced degree; 8.5% - low degree of conflict. The tactics of behavior in conflict depend on the degree of conflict and the level of conflict potential of the medical worker.

Avoiding conflicts is methodologically flawed and practically unrealistic. In the transition to a patient-oriented system of relations in healthcare (S.A. Efimenko), there is a need to activate the positive function of conflict based on a collegial model of the relationship between doctor and patient. Other models of relationships (contractual, technical and paternalistic) contain risks of negative development of the conflict.

Topic 3

CONFLICT RESOLUTION TECHNOLOGIES.

3.1. Methods for resolving interpersonal conflicts

One of the first steps in resolving interpersonal conflicts is the fact of recognizing the contradictions that exist between opponents. When both parties recognize the existence of contradictions, it is necessary:

determine the subject of the dispute;

outline the boundaries of mutual claims;

identify the positions of the parties.

All this opens up the next stage in the development of the conflict - the stage of a joint search for options for resolving it. A joint search for a way out of a conflict situation requires compliance with a number of conditions:

Separation of the real causes of the conflict from the incident (the formal reason for the start of the clash);

Focusing on existing problems rather than on personal emotions;

Act according to the “here and now” principle – i.e. solve problems that directly caused this conflict, without remembering other controversial events and facts;

Create an environment of equal participation in the search for possible options for resolving the conflict;

Speak only for yourself; be able to hear and listen to others;

Maintain a respectful attitude towards the opponent’s personality - talk about facts and events, and not about the qualities of a particular person;

Create a climate of mutual trust and cooperation.

3.2. Psychological prevention of conflicts in a team

Many organizational conflicts are easier to prevent than to resolve. Since the central figures of conflicts in an organization are specific individuals, such prevention should be person-oriented. Let us dwell on some particularly significant organizational and managerial conditions that help reduce personality conflict.

We believe that one of the main strategies for preventing conflicts in organizational teams is, first of all, reducing the level of conflict among those people who are prone to inciting them. Work to implement this approach can go in two directions:

correction of subjective (internal) conditions of a conflicting personality during individual work;

creation of organizational and managerial conditions that help reduce manifestations of conflict.

Let us dwell on some particularly significant organizational and managerial conditions that help reduce personality conflict.

1. Verified personnel policy

First of all, we should mention a verified personnel policy. Proper selection and placement of personnel, taking into account not only qualification “profile” indicators, but also the psychological qualities of personnel, significantly reduces the likelihood of hiring conflict-ridden individuals and those prone to getting involved in conflicts. The basis of psychological support is psychological diagnostics of personnel during recruitment and placement. Currently, psychological diagnostics are carried out mainly through testing.

With the help of psychological diagnostics, individuals predisposed to conflict behavior, their psychological internal conditions, and the level of conflict are successfully and accurately identified. This will allow not only to “weed out” them when applying for a job, but, if necessary, to carry out psychological correction aimed at reducing their conflict potential. Psychological diagnostics will help predict possible forms of behavior of conflicting individuals, determine ways to effectively interact and communicate with them.

An important factor in reducing personality conflict is the high authority of the leader. Psychologically, an authoritative person is always perceived as having undeniable advantages, which contributes to the formation of vertically oriented relationships. This necessitates a concern for authority. The high authority of the leader, formed on the basis of his personal, professional and moral qualities, is the key to the stability of relationships in the team.

Increased authority is facilitated by developed skills to resolve conflicts constructively and fairly. Such skills are formed with experience and special socio-psychological training of managers, teaching them skills of non-conflict interaction, techniques of conflict-free communication, developing their skills to constructively overcome emerging contradictions.

A person becomes authoritative only when he has clear advantages that allow him to achieve significant, primarily socially positive, results. These advantages can be intellectual, volitional, characterological, related to professional skills or competence. The main thing is that thanks to them useful results are achieved. Therefore, it is very important for any leader to have his own individual program for advanced personal and professional development. Its absence and reluctance to grow one’s professionalism create fertile ground for the emergence of pseudo-authority. Practice shows: in organizations where the leader has high authority, conflicts do not arise often, and conflicting individuals behave very restrained.

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Introduction

The work of a doctor is a special type of professional activity, characterized by a state of constant psychological readiness, emotional involvement in the problems of patients related to their health, in almost any situation involving active interpersonal interaction. Thus, conflict potential is an objective pattern of functioning of a healthcare institution and is characterized by the presence of three groups of organizational conflicts:

2) emotional (problems of power, balance of formal and informal relationships, approval; high level of conflict business communication doctors and patients);

All these manifestations determine the phenomenon of dysfunctional conflict. The causes of dysfunctional conflict are associated with incompatible differences in the value and motivational characteristics of various employees and their groups. To form a comprehensive program for the prevention of destructive conflicts, it is necessary to optimize the organizational culture of the institution. Optimizing the organizational culture of an institution begins with diagnosing the moral and psychological climate and formulating organizational conditions that provide socially and psychologically favorable conditions for the implementation of the organizational strategy.

Organizational culture is a set of behavior patterns that are acquired by an organization in the process of adapting to external environment and internal integration, which have shown their effectiveness and are shared by the majority of members of the organization. Stress is a nonspecific (general) reaction of the body to an impact (physical or psychological) that disrupts its homeostasis, as well as the corresponding state nervous system organism (or the organism as a whole).

One of the indicators of the effectiveness of organizational culture is the degree of conflict. The stronger and more positive the organization's culture, the lower the value of this indicator. In the process of developing organizational culture, HR specialists need to diagnose the degree of conflict and stress factors in the organizational environment. Organizational conflict increases the level of social tension and seriously aggravates social and labor relations. To solve problems of conflict management in an organization, a manager needs to learn how to identify conflict and map organizational conflict. Prevention and management of conflicts in an institution are one of the most important areas in the professional activity of the head of a medical institution. The satisfaction of employees and the attractiveness of work for them directly depend on the socio-psychological climate in the work team. In turn, scientists consider the general level of conflict and organizational stress to be one of the most important indicators of the favorableness of the socio-psychological climate. The head of a medical institution needs to have information that allows him to objectively assess the level of stress and conflict in the organizational environment.

1. Objectives and system of program activities for conflict management in medical institutions

1.1 Relevance of the project topic

The main goal of a manager at any level is to establish effective teamwork among employees. However, sometimes difficult relationships develop in a team, which not only interfere with successful interaction, but also provoke conflict situations. If a person is not at peace with himself, a problem arises in the relationship 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.

Managing an organization is impossible without conflict management, so the topic of conflict management is relevant for the head of any organization. And for effective management, one should study the types, levels, essence of conflicts, as well as find and put into practice the most optimal ways to resolve controversial situations.

There is an opinion that conflict should be avoided whenever possible or resolved immediately 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 an organization or work collective, then something is wrong there. There are no conflict-free organizations in life: it is important that the conflict is not destructive. The organizer’s task is to design a constructive, solvable 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 the diversity of points of view provides additional information and 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 know about this, since joint activities involve people who differ in their professional preparedness, life experience, individual character traits and temperament, etc. These differences inevitably leave their mark on assessments and opinions on issues that are significant for the individual and the organization, and 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 recede into the background: all the thoughts of those in conflict are aimed at struggle, which becomes an end in itself, which negatively affects the development of the organization. It is these problems that determine the relevance of the topic of this project.

Conflicts are an integral element of the development of social systems. Being an irreducible type 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. Conflicts in medical institutions are an indicator of problems that have not yet been resolved by reforms carried out in the health care system.

The issue of conflicts in healthcare during the formation of a market economy has not been sufficiently studied in domestic sociology. It becomes an objective necessity 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 medical institutions, including their prediction, identification, reduction and resolution, is relevant.

The sociology of medicine has a sufficient set of methods that make it possible to comprehensively analyze 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 period of reforms, assess the significance of innovations for society, study the social frustrations of the medical worker and the patient, their impact on the treatment process and the psychological climate in medical institutions and, ultimately , on the state of public health.

The object of study of the project is the professional activities of employees of medical institutions.

The subject of the project's research is conflict situations that arise in the process of providing medical care in medical institutions.

1.2 Project goal and objectives

The goal of our project is to develop practical recommendations for managing conflict situations in medical institutions based on a study of their causes, conditions of occurrence, content and social consequences.

To achieve the goal, the following tasks were solved:

b identification of patterns of emergence and development of conflict situations in medical institutions in the context of reforming the country’s healthcare system;

b sociological characteristics of participants in conflicts in medical institutions;

b assessment of the consequences of interpersonal conflicts in medical institutions on the quality and efficiency of medical care for the population;

b development of a classification of conflicts in medical institutions;

Expected effect of the project: adaptation of the proposed practical recommendations in medical institutions for the purpose of effective conflict management and their prevention.

1.3 Characteristics of the situation

Health is a basic need and an inalienable human right. This value setting is a socio-psychological guideline that determines the motivational behavior of individuals, social groups and society as a whole, which is reflected in the social policy of the state. 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 potential 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 reform, which indicates trouble in this socially significant sphere.

Despite the fact that conflict is an inevitable phenomenon in the life of society, the collective 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 arises in subjects of conflict interaction complicates interpersonal communication, reduces the effectiveness of treatment, negatively affects the psychophysiological state of medical workers, and increases social tension among providers and recipients of medical services.

Conflicts in medical institutions are only superficially local in nature. Functionally, they are closely related to those processes and contradictions that constitute the main content of social changes in society. Levels of conflicts in medicine, as well as in other industries, occur at three levels of contradictions (high, medium and low): Health care system - society; Health care institutions (administration) - medical personnel; Medical personnel - patients (and their relatives).

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

At the same time, with the financing of hospitals and clinics inadequate to real expenses, a search is underway for new forms of organization and remuneration of medical workers. The intensification of the work of doctors 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, study of the causes of occurrence, dynamics of processes of conflict interaction and their consequences, as well as the development of adequate social technology for conflict management in medical institutions, during the period of reforms in the industry, will not only allow timely identification of problem areas of ongoing reforms and adapt them to realities practical healthcare, but also influence the quality of medical care provided to patients, public health, and reduce the severity of social contradictions.

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 sharp polarization of 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.

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 accumulated contradictions and psycho-emotional stress in the process of providing medical care can at any time lead to a conflict situation.

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

Conflict in medical institutions, being an extreme case of aggravated contradictions, requires modern identification, quick and effective intervention in order to minimize its negative consequences. To do this, it is necessary to clearly understand the patterns of occurrence and the dynamics of development of conflict interaction, that is, be able to predict it, and therefore prevent it. It is necessary to promptly determine its functions and possible consequences, as well as choose the optimal regulatory tactics.

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

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 the implementation of reforms in healthcare, it is typical to have latent ongoing intrapersonal conflicts that complicate communication and reduce its constructiveness in the “head of institution - doctor", "doctor - doctor", "doctor - patient".

Severe personal anxiety is interconnected with a high level of reactive anxiety in a certain group of medical personnel of medical institutions and objectively increases the conflict level of interpersonal communication in professional settings.

The reforms carried out in the healthcare system have a destabilizing effect on the socio-psychological climate in medical institutions and, in the process of ongoing transformations, the number of medical workers who receive satisfaction from their work is decreasing.

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

Causes and types of conflict situations.

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 occur as a result of medical errors, and conflicts that arise due to the personal characteristics of the doctor and the patient.

Objective reasons for medical errors include:

* inconsistency 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 as a doctor;

* failure of the doctor to improve 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 and not of decisive importance. Even if the doctor did everything correctly from a medical point of view, 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 encounter interpersonal conflicts. Interpersonal conflict is a conflict between two, less often three or more individuals (where everyone is “for himself”). Interpersonal conflicts can be vertical, in which the subjects of the conflict stand on different steps hierarchical ladder, therefore, have different rights and powers, and horizontal - between opponents of equal status.

Intrapersonal conflict arises when a person is faced with the problem of a choice that he cannot make. This is a struggle between needs and social conditions, desires and restrictions, necessity and possibilities, this is a dispute between “I want” and “I can’t”, between “I must” and “I don’t want.” In case of loss of ability to work due to injury or serious illness, intrapersonal conflict can be expressed in a growing discrepancy between needs and decreased capabilities. If a nurse is given conflicting instructions by the head nurse, the physician, and the department manager at the same time, this can cause emotional stress. The inability to resolve intrapersonal conflicts leads to an increase in emotional tension and aggression. With the development of auto-aggression, a person “goes” into illness, or, directing aggressiveness outward, discharges himself on others (then the 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, and the conflict develops into an intergroup conflict or a conflict between an individual and a group.

A conflict between an individual and a group as a consequence of interpersonal conflict arises when one of the participants found support for his position: this could be a conflict between a patient and medical staff or a 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 accepted in a group or institution, does not satisfy the social expectations of the group, that is, he comes “with his own charter to someone else’s monastery.” Examples include a young doctor making one of the typical mistakes when applying for a new job, when a new employee transfers his previous stereotypes to new conditions: “But that’s how we were taught!”, “Your methods are outdated!”, or a patient who insists on change procedures established in a hospital or clinic. At the same time, unfortunately, conflict arises regardless of whether the “reformer” is right or wrong.

The cause of the conflict between an individual and a group can also be a conflict between a manager and subordinates, when the former takes an authoritarian position, regardless of the opinions, desires, and needs of employees. Usually, at first such a conflict occurs in a hidden form, breaking out in separate, local outbreaks. If management does not notice and take action to clarify and resolve this situation, the conflict can lead to catastrophic consequences.

Intergroup conflicts also occur in medical institutions. 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 one 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 poorly caring for patients, or small groups within the same team make similar complaints against each other.

TO special occasions intergroup conflict includes conflicts between two participants in which claims are made not to a specific patient or doctor, but in his person to an entire social or professional group (“You doctors only want money, but you don’t know how to treat”, “There is never order in your hospital “,” “You, patients, don’t take care of your health yourself, and then demand a miracle from doctors.”) The difficulty of resolving such a conflict lies in the fact that one person is not able to answer for the entire team, and in order to isolate a specific problem from generalized claims, It takes time, good communication skills and stress tolerance.

The causes of conflict situations in medical practice can be very diverse. In a conflict of values, disagreements concern the value-semantic aspects of interaction. Its participants may have different understandings of the meaning and goals of joint activities. For example, for a doctor, the patient’s health is valuable and significant, but the patient is currently more concerned about his ability to work, that is, the need to be at work, 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 calling, so he works passionately, constantly improves his skills, strives to treat patients as professionally as possible, while another doctor is not interested in self-realization, therefore he is uninitiative, although he does the required amount of work. The contradictions here affect not the norms of behavior, but the value-semantic aspects of existence. This does not mean that different value systems inevitably lead to conflicts. People can interact successfully and have good relationships despite their different values. A conflict arises when someone begins to invade the sphere of values ​​of another person without recognizing the freedom of personal choice. Typically, value conflicts between physician and patient are resolved by adherence to bioethical principles.

In case of a conflict of interest, two options are possible. If the interests coincide, and the participants lay claim to 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 from competition for the possession of something.

Another option arises when colleagues have interests that contradict each other. Due to the interaction of people in a given situation, they, willingly or unwillingly, become an obstacle to each other in realizing their interests. (For example, part of the clinic team agrees to improve their qualifications during non-working hours, and some doctors do not want to sacrifice family and personal interests.) The discrepancy between the interests of the doctor and the patient seems impossible, since both should be interested in the patient’s recovery or alleviation of his suffering , but this, unfortunately, is the ideal option.

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

Conflicts of inconsistency associated with the potentials of interaction participants 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 several employees, unable to cope with their responsibilities, make mistakes, thereby complicating the work of the entire team. Another type 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 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 in the rules of engagement associated with any violation accepted standards or established rules by any of the participants, if this violation causes damage to normal interactions or relationships between people. This includes situations of disagreement due to people’s failure to fulfill obligations to others, violation of generally accepted etiquette or norms accepted in a given group, or someone exceeding their rights. Such conflicts can also arise from the desire of one of the participants in the interaction to revise rules and norms or redistribute power or responsibilities: increasing the rights of some and decreasing the rights of others, changing the rules in the current system, etc.

Types of conflicting personalities.

Psychologists identify 5 types of conflicting personalities.

1. Conflict personality of demonstrative type

The subject wants to be the center of attention and likes to look good in the eyes of others. His attitude towards people is determined by how they treat him. He finds it easy to deal with superficial conflicts and admires his suffering and resilience. Rational behavior is poorly expressed. There is emotional behavior. Plans its activities situationally and poorly implements it. Does not shy away from conflicts, feels good in situations of conflict interaction. Often turns out to be a source of conflict, but does not consider himself to be such. Give such a person maximum attention, and if a conflict is brewing, try not to avoid it, but to manage it.

2. Conflict personality of a rigid type.

This man is suspicious. Has high self-esteem. Confirmation of your own importance is constantly required. Often does not take into account changing situations and circumstances. Straightforward and inflexible. He has great difficulty accepting the doctor’s point of view and does not really take his opinion into account. Expressions of respect from others are taken for granted. An expression of hostility on the part of others is perceived by him as an insult. Uncritical of his actions. Painfully touchy, hypersensitive to imaginary or real injustices. It is necessary to show maximum patience and attention to his opinion, speak and act “authoritatively”.

3. Conflict personality of an uncontrollable type

Impulsive, lacks self-control. The behavior of such a person is difficult to predict. Behaves defiantly and aggressively. Often in the heat of the moment does not pay attention to generally accepted norms. Characterized by a high level of aspirations. Not self-critical. He tends to blame others for many failures and troubles. Cannot competently plan his activities or consistently implement plans. From past experiences (even bitter ones) little benefit is derived for the future. Try to avoid any discussions and arguments with him, do not convince him of the correctness of your point of view. Act confidently, but be prepared for trouble.

4. Conflict personality of the super-punctual type.

He is meticulous about everything. He makes increased demands on himself and others, and does it in such a way that people think that he is finding fault. Has increased anxiety. Overly sensitive to details. Tends to attach undue importance to the comments of others. Sometimes he suddenly breaks off a relationship because he thinks he was offended. He suffers from himself, experiences his own miscalculations, failures, and sometimes even pays for them with illnesses (insomnia, headaches, etc.). Doesn't have enough willpower. He does not think deeply about the long-term consequences of his actions and the reasons for the actions of others. Be extremely attentive and polite with him.

5. Conflict-free personality.

The subject is unstable in his assessments and opinions. Has easy suggestibility. Internally contradictory. There is some inconsistency in behavior. Focuses on immediate success in situations. Doesn't see the future well enough. Depends on the opinions of others, especially leaders. Excessively strives for compromise. Doesn't have enough willpower. Does not think deeply about the consequences of his actions and the reasons for the actions of others. He is easily persuaded by the doctor, but when he leaves the office, he will listen to others and may feel that he has been deceived. Patiently prove to him that his choice, made together with you, is the most correct one.

2. Tools and conditions for achieving the set goals and objectives

To ensure the stable operation of medical institutions and prevent and eliminate conflict situations, it is necessary to adhere to the following principles and strategies for conflict management.

Principles and strategies of conflict management.

Managing interpersonal conflicts in the field of medicine is rightfully considered as the ability of the head of a medical organization to master the “conflict algorithm”: to notice a conflict situation in time, understand its true causes, competently resolve the conflict and prevent the occurrence of similar conflicts in the future.

Leading domestic researchers in the field of conflict management A. Antsupov and S. Baklanovsky name the following basic principles of conflict management:

Competence - intervention in the development of a conflict situation must be carried out by people with the required theoretical training and relevant experience (psychologist, lawyer, mediator);

Radicality - the degree of intervention of a specialist in a conflict should not exceed the depth of knowledge of the issue (some analogue of the professional medical commandment “do no harm”);

Cooperation and compromise - it is preferable to ensure that the methods of resolving the dispute are the least conflicting, not allowing for their active confrontation.

In our opinion, the latter provision is of particular importance for medicine, since the actions of the doctor and the patient, by their nature, are initially united by a common motivation - restoration of health.

From this follow four main strategies for the behavior of the parties to the conflict:

A normative strategy is a line of behavior based on reliance on the normativity of a position combined with respect for the personality of the opponent (set out in various documents- instructions, orders, codes);

Confrontational strategy - active use of threats, psychological pressure, blocking actions;

At the same time, conflict actions themselves can turn from a means of achieving set goals into the ultimate goal - causing maximum damage to the opponent;

Manipulative strategy - achieving set goals through indirect psychological influence on an opponent, aimed at changing the direction of his activity;

Negotiation strategy is the implementation of the desire to find a compromise, to discuss a problem, to resolve a contradiction through concessions (unilateral or mutual), as well as to find a solution that suits both parties.

In order to optimally resolve conflicts that arise during the provision of medical care, from our point of view, normative and negotiation strategies are in demand.

Thus, conflict management is not just an activity with a clearly understood goal of resolving it, but an activity specially organized by a third party or parties to the conflict at the stages of emergence, development of the conflict and its completion, requiring special knowledge and skills.

Also, there are certain mechanisms of behavior in conflict situations that every leader should know about.

Mechanisms of behavior in conflict.

Human behavior in a conflict is characterized by a high degree of tension, both physical and psychological, because a clash, even a hidden one, requires the concentration of forces and the focus of large spiritual and psychological resources to get out of the current situation. The more complex and significant a conflict situation is for a person, the greater the effort required to resolve it. If it is not possible to withstand tension, emotional breakdowns occur and accepted boundaries of communication and behavior are violated. Then comes regret, a feeling of guilt for losing control over oneself, living the situation in one’s thoughts, talking it out. Negative emotions arising as a result of a conflict can quickly be transferred from the problem to the personality of the opponent, which will complement the conflict situation with personal opposition. There are various ways to reduce emotional stress when dealing with conflict. There is no panacea, but there is a set of methods from which you can choose the one that is suitable for a particular person and situation.

Active methods are based on physical activity. They are based on the fact that adrenaline, a companion of tension, is consumed during physical activity. From sports activities The types that most quickly relieve aggressiveness are those that include strikes: boxing, tennis, football, hockey, volleyball, golf, etc. It is easier to cope with resentment by doing cyclic exercises: running, swimming, aerobics, dancing or just brisk walking. Instead of sports, you can do something useful that requires physical activity. Work that involves dissecting a whole is very suitable: digging the earth, preparing firewood, mowing, chopping vegetables. Sometimes it’s enough just to sort things out on your desk - this action both relieves emotional stress and frees you from unnecessary papers and things.

The logical method is acceptable for purely rational people who prefer logic to everything else. The main thing for such a person is to get to the bottom of the phenomenon. It is more expensive for him to forget about the conflict, so it is better, postponing other matters, to focus on the conflict situation until a way out of the current situation is found. This analytical work itself is calming, as it takes up a lot of energy, and, in addition, mental concentration dulls emotions.

If it is urgent to reduce the emotional intensity, since the situation requires a quick solution, you can “take a break” and count from 10 to 0 or perform several breathing exercises. The main thing is to switch your attention. Some traditional ways Relieving tension - a glass of vodka or cognac, a cigarette or something sweet - are also effective, but after a short time this method of emotional release turns into addiction and becomes the cause of new conflicts.

It is important to remember that no two people are the same, so any method can be ideal for one and completely contraindicated for another, be it members of the same family or employees of the same team. You can look at the conflict from the outside, mentally imagine the whole picture of the current situation, consider different ways to solve it - visualization techniques; You can carry out emotional relief: use auto-training, go in for sports, play any game that allows you to throw out aggression, take a break, etc. You can try to retell each position in the first person.

To increase the efficiency of conflict resolution and prevention, you can, for example, use the rules of conflict-free behavior proposed by O. Gromova.

1. Adequately evaluate your own actions and the actions of your opponent, avoiding false perceptions of your own and his actions, a double standard of assessment.

2. Look at the situation through the eyes of your opponent in order to understand (not necessarily accept) his point of view.

3. Do not make value judgments about the actions and statements of your opponent, so as not to provoke his aggressive reaction.

4. Involve even an incompetent opponent in the discussion of controversial issues in order to make it clear that his position is respected, he participates on equal terms in the search for a solution and is responsible for it.

5. Personally inform your opponent about your position and interests, so as not to force him to use distorted or false information.

6. Do not allow the manifestation of negative emotions when communicating with your opponent; if you lose control over emotions, stop the discussion until control is restored, so as not to cause symmetrical emotional reactions on the part of your opponent.

As project our group offers the following practical recommendations on managing conflicts that have already arisen and preventing them. These mechanisms can be adapted in a medical institution of any profile.

1. Creation and maintenance of organizational culture in an institution as a system of conscious ideas, values, rules, traditions shared by all members of the team. Formation of value-normative organizational consciousness adequate to the goals and objectives of the institution.

2. Correct selection of personnel, taking into account not only professional, but also individual personal qualities of a person. In order to improve the quality of medical care to the population, optimize personnel policies and stabilize the psychological climate in medical institutions, carry out preliminary testing of medical workers in order to identify potentially high-conflict individuals.

3. Improving the system of motivation and stimulation of personnel activities. Translation by management of organizationally significant motives and stereotypes of organizational behavior to employees. Achieving the goals set for the organization involves the creation, dissemination and implementation of a system of organizational behavior. Such systems exist in every organization, but in different forms. Management activities require managers to adopt a particular leadership style, use their communication skills and knowledge of interpersonal and group dynamics to achieve a high quality of work life in the organization. Solving this problem allows you to motivate employees to achieve the goals of the organization. An effective system of organizational behavior allows us to achieve a high level of employee motivation, which, in combination with the qualifications of personnel and their abilities, allows us to get closer to the goals set for the organization, as well as individual job satisfaction.

4. Creation of a favorable moral and psychological climate. The relevance of this problem is determined, first of all, by the increased requirements for the level of socio-psychological involvement of people in the team, in their work activities. The formation of a favorable moral and psychological climate in a team is, first of all, the task of demonstrating the psychological and moral potential of both the individual and society as a whole, creating the most complete way of life for people. Improving the moral and psychological climate in the workforce of a medical institution is one of the most important conditions in the struggle to improve the quality of medical services provided. Also, the moral and psychological climate is an indicator of the level of social development, both of the entire team and of individual workers in particular, capable of more promising production. The overall socio-political and ideological situation in society, as well as in the country as a whole, largely depends on the level of optimality of the moral and psychological climate in each individual work collective. Relationships in a team are one of the most complex and at the same time most subtle areas of social activity. This is interaction between each other in various spheres of human activity, and man is a complex and multifaceted being, each with his own views, values, moral and psychological foundations.

5. Development of a code of ethics and ethics cards that specify the institution’s ethical code for each of its employees. The ethical factor is traditionally of great importance in medicine. The medical Hippocratic Oath has been known since ancient times. The development and adoption of the Code of Ethics for Medical Workers confirms the general historical pattern, being an important stage in health care reform in our country, the main goal of which is to establish the autonomy and self-sufficiency of this profession. The Code should be drawn up taking into account new ideas that have determined the content of medical ethics over the past two to three decades, as well as on the basis of international and Russian legislation, international documents on medical ethics. As for ethics cards, this is a set of ethical rules and recommendations that specify the organization’s ethical code for each employee. They also contain the name and telephone number of the institution's ethics consultant. This method is actively used in Japanese companies.

6. Formation of corporate standards. Corporate standards are the principles and rules governing the activities of an institution, and regulatory documents establishing these rules. Why are corporate standards needed? What will change in the organization with their appearance? Corporate standards allow you to reproduce a given work technology, help identify common errors, and form the desired corporate culture. Employees receive ready-made solutions for typical tasks, and managers of medical institutions receive clearly formulated, formalized requirements for the results of employees’ activities. Regulatory documents - procedures and regulations - describe the main processes existing in the organization; they can be called operating standards. They provide answers to the questions: what to do? When? who does it? Where? what is needed for this? We can highlight standards that determine the attitude towards the patient, colleagues, and partners of the organization, regulating the performance of professional duties, and the design of the workplace. The standard formulates the skills and competencies that a person occupying a certain position must have. In addition, the quality level is recorded duties performed, and describes the external circumstances in which the quality of his work will be assessed.

7. Providing advisory assistance to employees of the institution in order to increase their individual stress resistance. Providing ethical advice from competent independent business ethicists. Stress, if not dealt with, invariably leads to diseases. Any medical institution can develop a program to increase stress resistance and self-regulation of the psychological state of workers, which may include various trainings to increase stress resistance and relaxation techniques. Similar programs have been operating for a long time in organizations of various profiles. Also, the manager can use the services of a psychologist or personally provide appropriate assistance to the employee. As for the ethics of business relations, more and more attention has recently been paid to it. Employers pay great attention to issues of ethics in business and personal relationships when selecting and hiring personnel, as well as in the process of employees directly performing their professional roles. Compliance with ethical business relations is one of the main criteria for assessing the professionalism of both an individual employee and the organization as a whole.

8. Development and introduction in the institution of various corporate events, holidays, trainings that expand the professional and business capabilities of staff and reduce professional stress. With the help of such events, the tasks of creating and maintaining a favorable moral and psychological climate in the workforce are solved. Corporate events help unite employees of different departments; maintaining a positive image of the institution among staff; creating a positive image of the institution among new employees. Every manager must know that a corporate holiday is not just an entertainment program, it is primarily an intangible way to motivate employees. In addition, it is a tool for the formation and development of corporate culture. When planning a corporate event, you need to understand what goal should be achieved. That is, it is necessary to work out the issue from an ideological point of view. If fun becomes the main goal of the event, then it hardly makes sense to talk about the effectiveness of the holiday. Ideological components corporate holiday may be different, but they are the ones that determine the content and format of the holiday.

With the help of corporate software you can solve many problems, for example:

b getting employees to know each other, which is especially important for large medical institutions;

l familiarization with the development plans of the medical institution;

b increasing employee loyalty to your organization;

b speeding up the adaptation process of new employees.

9. Timely information by management of employees about upcoming organizational innovations. Every manager is interested in ensuring that the work of employees of a medical institution and the results of their work meet the requirements of the institution. In maintaining this compliance, informing the organization’s employees plays an important role. Information communicated properly and within the required time frame to a specific employee has the greatest value. Otherwise, the utility effect is reduced. Often, poor internal information becomes the cause of such problems as the decision-making by managers and specialists of medical institutions due to loss or distortion of information; ineffective use of manager’s time, errors in staff work, disruption of events. It is necessary to correctly determine the content and volume of information that must be communicated and collected from personnel; specific recipients of information; time, timing of obtaining information, frequency; adequate methods of conveying information to specific performers; forms for providing information from employees to management, because errors in their definition can lead to loss and distortion of information. The information system assumes two-way communication. On the one hand, management informs staff, and on the other, it receives information from employees. Organizational personnel must be informed of the following:

Strategy and development prospects of the organization, its mission, long-term and short-term goals;

Corporate values ​​of a medical institution; the image that the organization seeks to create;

All significant events in the life of the organization (assessments of influential persons, anniversaries, victories in competitions);

Achievements of the organization;

Personnel movements (major appointments and dismissals), new functions;

Information about personnel (training opportunities and its results, internal competitions for filling vacant positions, criteria and results of certifications, incentive indicators and criteria, etc.), as well as information about social guarantees for personnel and the possibility of receiving them;

Internal administrative documentation;

Innovations and their preliminary discussion (the opportunity to make proposals before a final decision is made);

Regulatory documents (documented and informal rules and procedures, regulatory documents, etc.) and other information.

Now a few words about obtaining information from employees. We are talking about two types of information: the first is factual data, the second is staff opinions on various issues or feedback. So, the manager should collect the following information from employees:

About the current state of affairs;

Opinions on changing the established procedure;

Attitudes towards innovation;

Expert opinion on various issues.

Various methods of informing and obtaining information from personnel are possible. They are selected depending on the content of the transmitted information, and also depend on the size of the medical institution.

10. Formation of conflict management competence of the head and employees of the institution. Development of emotional competence of the manager and employees of the organization, and first of all its leaders. The conflict management competence of a leader is an integral part professional competence and is included in the structure of professionalism of personality and activity. A high level of conflict management competence allows managers, in many cases, to exercise conflict-free management of the system and thereby increase its effectiveness. Back in 1912, German psychologist William Lewis Stern proposed measuring a person's intellectual abilities using the now widely known IQ (Intelligence Quotient). 83 years later, American psychologist Daniel Goleman (Goleman D.) created a real sensation by declaring that EQ (Emotional Quotient or Emotional Intelligence) - an emotional indicator of intelligence - plays a more important role than IQ. This is due to the fact that control over one’s own emotions and the ability to correctly perceive other people’s feelings characterize intelligence more accurately than the ability to think logically. According to Daniel Goleman's definition, " emotional competence“is the ability to be aware and acknowledge one’s own feelings, as well as the feelings of others, for self-motivation, for managing one’s emotions within oneself and in relationships with others.” Developed emotional competence is the most important quality of a good leader. If a person has a high IQ, but his EQ is very low, he is unlikely to be a successful manager. After all, 90% of a manager’s job consists of communication, the success of which directly depends on the emotional intelligence quotient.

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Psychological characteristics team - complex system consisting of many interconnected groups of people and individuals. Features of the leader's personality and leadership styles. The emergence of conflict situations and methods for resolving them.

Introduction

1.1 Definition of conflict

1.2 Types of conflicts

1.3 Causes of conflicts

1.4 Consequences of conflicts

2.2 Conflict prevention

Conclusion

Introduction

This work is devoted to conflict management in the healthcare sector. Conflict is an integral element of the functioning of any organization, including in the healthcare sector. However, the specifics of healthcare institutions differ significantly from other institutions and areas, which entails specific features for regulating emerging conflicts.

All activities of healthcare institutions are strictly regulated regulatory documents and acts, which forces management to strictly adhere to them and subject activities to certain rules, to comply job descriptions.

There are units at different levels in healthcare institutions: from those involved in direct patient care to service and support units.

This situation requires workers from senior to junior level with different education and skill levels. This entails the presence of different social groups with different levels of material security, development and age composition, and the predominance of female employees. There is a shortage of personnel at all levels everywhere.

Against the background of these features, the possibility of conflicts of different types and levels emerging is obvious.

Problem situationfor a healthcare institution is the difficulty of choosing methods for conflict management and coordinating the entire complex structure. Conflicts of any kind can affect a decrease in the services provided, a decrease in the prestige of an individual and the institution as a whole, cause staff turnover, and a decrease in performance. Due to the nature of their work, each employee is forced to communicate with both colleagues and patients. The chosen style of behavior in conflict situations depends on individual behavioral characteristics, such as temperament, communication and organizational skills, and the level of aggressiveness in relationships. This shows relevance of the chosen topiccourse work. Very little attention is paid to the study of the problem of conflicts in relation to the healthcare sector in the literature, so this course work is based on my personal experience.

As objectResearch in the course work is performed by a team of medical workers in the surgical department of the municipal health care institution of the Sysert Central District Hospital.

SubjectThe study of this work is the management of conflict situations in the surgical department of the Sysert Central District Hospital.

Purposecourse work is to analyze the conflict potential of the team to develop recommendations for conflict resolution and prevention.

Based on the goal, the following are identified: tasks:

consider the essence, structure and functions of the conflict;

highlight the essence of the concept of conflict management;

consider methods, styles and models of conflict resolution and regulation, as well as features of prevention and stimulation

determine the relationship between conflict situations and the effective work of the organization, draw a conclusion and propose measures aimed at improving this process.

To conduct the study, a survey method was used.

Monographs, textbooks for university students, popular science publications, such authors as: Dmitriev A.V. are used as sources of information in this work. "Fundamentals of Conflictology", Grishina N.V. "Psychology of conflicts", Kozyrev G.I. "Fundamentals of conflictology", Zdravomyslov A.G. "Sociology of conflict", Petrovskaya L.A. “On the conceptual scheme of socio-psychological analysis of conflict” and others.

The course work consists of an introduction, 3 chapters, a conclusion, a list of references and applications.

The first chapter is devoted to the study of the structure of conflict, examining the types, causes and consequences of conflict situations. This chapter provides a definition of conflict and provides a brief analytical overview of studies of the emergence of conflict situations.

The second chapter discusses methods, resolution methods, and prevention of conflict situations.

The third chapter conducts a practical study of conflict management using the example of the staff of the surgical department of the Municipal Health Institution "Central District Hospital".

In this work we used survey method personnel.

The results of the study were subjected to statistical analysis and are used in the work of managers to prevent conflict and improve the microclimate in the team of employees of the organization.

management conflict healthcare

1. Structure of conflict in an organization

A work collective is a formal community of people united. People working in organizations are different from each other. Accordingly, they perceive the situation in which they find themselves differently. Differences in perception often lead to people disagreeing with each other. This disagreement leads to a conflict situation. The occurrence of conflicts in an organization is natural and inevitable, since with various goals and tasks facing people, with different levels of awareness of employees, quite often a controversial situation arises, which subsequently turns into a conflict.

Conflictis a lack of agreement between two or more parties. This is a perceived contradiction, which is characterized by confrontation between the conflicting parties.

The manager, according to his role, is usually at the center of any conflict in the organization and is called upon to resolve it by all means available to him. Conflict management is one of the most important functions of a leader.

Conflict, as a social action, gives a brightly colored negative effect, but at the same time performs an important positive function. Conflict serves to express dissatisfaction or protest, informing the conflicting parties about their interests and needs. In certain situations, when negative relationships between people are controlled, and at least one of the parties defends not only personal, but also organizational interests as a whole, conflicts help to unite those around them, mobilize the will and mind to resolve fundamentally important issues, and improve moral psychological climate in the team. Moreover, there are situations when a clash between team members, an open and principled dispute, is more desirable: it is better to warn in time, condemn and prevent the wrong behavior of a work colleague than to condone it and not react for fear of ruining the relationship. Thus, conflict can lead to increased efficiency of the organization, improvement of relationships within the team, and resolution of controversial situations.

1.1 Definition of conflict

The most general definition of a conflict (from the Latin conflictus - clash) is a clash of contradictory or incompatible forces, this is a situation in which the diverging interests of one or more participants collide, pursuing different goals, and the ways and methods of achieving their goals are different.

There are conflicts between firms, companies, associations, within the same organization, etc. A conflict that arises in an organization is called organizational. The result of any action of one (each) of the parties depends on the chosen course of action of the other parties.

Characteristics conflict:

uncertainty of outcome, i.e. none of the participants in the conflict knows in advance the decisions made by the other participants;

differences in goals reflecting both the divergent interests of various parties and the multilateral interests of the same person; mode of action of each party.

Conflict is most often associated with aggression, threats, hostility, war, etc. As a result, there is an opinion that conflict is always an undesirable phenomenon, that it should be avoided whenever possible, and that it should be resolved immediately as soon as it arises (but not resolving the conflict is also a solution).

Conflicts occur in organizations due to the fact that their members do not agree with their position, authority, responsibility and have different attitudes towards the same organizational goals and objectives,

Some types of conflict are harmful, while others are beneficial both personally for the employee and for the organization as a whole.

It is believed that in an organization it is not the conflict itself that is dangerous, but its erroneous, incorrect regulation.

If a conflict helps to reveal a diversity of points of view, provides additional information, helps to find larger number options, makes the decision-making process of the group more effective, provides the opportunity for self-realization of an individual, then this is a creative (functional) conflict in its consequences.

If, as a result of the conflict, the goals of the organization as a whole and the needs of the individual are not met, then it is destructive (dysfunctional) and leads to a decrease in personal satisfaction, group cooperation and organizational performance.

Two positive elements of the conflict need special attention.

. Conflict as a way to identify problems. The emergence of almost any conflict situation indicates that there is a problem (or a set of problems) in relations between people, groups of people, and organizations.

. Stimulating function of conflict. We live in a world of change. Their speed is constantly increasing, and with it our psychological resistance to change is growing. Indeed, the capabilities of the human psyche, which determine the ability of the latter to adapt to ongoing changes, are limited.

That is why individuals and large groups of people resist changes even when it would seem that they should bring them clear benefits.

The basis of the conflictis a conflict situation. Its elements are opponents (warring participants) and the object of the conflict.

An important characteristic of the participants in the conflict is the rank of the opponent. In the process of conflict, opponents tend, as a rule, to maintain or increase their own rank, while simultaneously trying to reduce the rank of their opponent.

Object of conflict, which has given rise to a specific conflict situation, has the property of indivisibility. She could be either physical property object, or a consequence of the interests of one of the opponents.

The nature of conflicts- in the uniqueness of situations, manifestations, properties and qualities of a person, group, team. In order to understand it, you need to know: what started the conflict; background of the conflict; premises from which the parties involved in the conflict proceed.

From the point of view of the causes of a conflict situation, three types of conflicts are distinguished.

First - This is a conflict of goals. In this case, the situation is characterized by the fact that the parties involved have different visions of the desired state of the object in the future.

Second - is a conflict caused by differences in views, ideas and thoughts on the problem being solved. Resolving such conflicts requires more time than resolving conflicts associated with conflicting goals.

Third is a sensory conflict that occurs in a situation where the participants have different feelings and emotions underlying their relationships with each other. Subjects of conflicts can be different assessments, roles, distribution of resources, divergent ideas about exchange relationships, different ideas about competencies and preferred actions.

Sources of conflict can be facts;

value concepts (what should be, how should be done);

competing interests (who will benefit what in the context

specific situation);

intangible sources (fatigue, etc.).

1.2 Types of conflicts

Conflict situations can arise both between the administration of the enterprise as a whole and its personnel, and between an individual manager and his subordinates. Conflicts can be divided into short-term and protracted. The decisive role in choosing one or another type of conflict interaction is played by the experience of previous interaction of the participants in the situation, the experience of relationships. Let's consider the main types of conflicts in an organization: intrapersonal, interpersonal, within the organization. They are all closely related. Thus, intrapersonal conflict can cause an individual to act aggressively towards others and thereby cause interpersonal conflict.

Intrapersonal conflict -it is a conflict that occurs within a person. In the case of intrapersonal conflict, we are talking about the internal state of a person, which is characterized by psychological tension.

Interpersonal- this is a conflict that arises due to antipathy, personal hostility based on the discrepancy between values, norms, and attitudes, both in the presence and absence of objective reasons for the conflict.

Conflict between individual and group - uhusually a clash between parts or all members of a group that affects the performance of the group as a whole. Conflict arises when expectations

groups are in conflict with the expectations of an individual, and also when the position taken by an individual is in conflict with the position of the group.

Intergroup conflictrepresents a confrontation or clash between two or more groups. It occurs in organizations consisting of many formal and informal groups. Since various groups There are goals that are different from other groups; conflicts are inevitable even in the most effective organizations, which may have a different basis.

Intraorganizational conflict -There are four types of such conflict: vertical, horizontal, linear-functional, role. IN real life These conflicts are closely intertwined with each other, but each of them has its own rather specific features.

Vertical conflictis a conflict between levels of management in an organization. Its occurrence and resolution are conditioned by those parties

life of the organization, which influence vertical connections in the organizational structure: goals, power, communications, culture, etc.

Horizontal conflictinvolves parts of the organization of equal status and most often acts as a conflict of goals.

Linear-functional conflictis more often of a conscious or sensual nature. Its resolution is associated with improving relations between line management and specialists, for example by creating task forces or autonomous groups.

Role conflictoccurs when an individual performing a certain role receives a task that is inadequate to his role.

1.3 Causes of conflicts

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

insufficient level of professionalism;

obsolescence of the organizational structure, unclear delineation of rights and responsibilities;

limited resources;

unfounded public censure of some and undeserved (advance) praise of other employees;

the contradiction between the functions included in the employee’s job responsibilities and what he is forced to do at the request of the manager;

differences in behavior and life experiences;

lack of favorable attention from the manager. Considering the above-mentioned causes of conflicts, one cannot help but notice that in certain situations the source of the conflict is the leader himself. Many unwanted conflicts are generated by the personality and actions of the manager 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, and does not hesitate to publicly demonstrate his likes and dislikes.

The cause of the conflict may also be the leader’s unscrupulousness, 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 due to the fault of such managers who know how to find loopholes and circumvent directives and regulations, continuing to quietly do everything in their own way. Without showing proper demands on themselves, they put personal interest at the forefront and create an atmosphere of permissiveness towards themselves and around them. The manager’s incontinence, 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 feeling of other people give rise to conflict.

1.4 Consequences of conflicts

Functional consequences of conflict.

The problem can be solved in a way that is acceptable to all parties, and as a result, people will feel involved in solving the problem, which is a motivating factor. This will eliminate or minimize difficulties in implementing decisions: hostility, injustice and being forced to act against one's will.

2. The parties will be more inclined to cooperate rather than antagonize in future situations fraught with conflict.

Conflict can reduce the possibility of submissive syndrome, where subordinates do not express ideas that they believe contradict the boss's opinion. This leads to improved decision making.

Group members can work through conflict possible problems in execution even before the decision begins to be executed.

Dysfunctional consequences of conflict.

Dissatisfaction, low morale, increased staff turnover and decreased productivity.

Less cooperation in the future.

Viewing the other side as the "enemy"; the perception of one's goals as positive, and the goals of the other party as negative.

Curtailment of interaction and communication between conflicting parties.

An increase in hostility between conflicting parties as interaction and communication decreases.

Shift in focus: placing more emphasis on “winning” a conflict than on solving the real problem. From the above, proper conflict management leads to functional consequences, and if an effective way to manage conflict is not found, dysfunctional consequences may arise, i.e. conditions that interfere with achieving goals.

Today, there are two main approaches to the concept of conflict: sociological and psychological.

Within the sociological approach, conflict is understood as an extreme case of aggravation of social contradictions, expressed in the clash of different classes, nations, states, social groups, communities, institutions, etc.

In modern psychology, conflict is increasingly regarded not as a negative phenomenon, but as a means of development.

2. Conflict management in the organization

A particular challenge for a manager is finding ways to resolve conflicts.

Managing conflict means taking control of a conflict situation and organizing the process of resolving it.

Conflict management- this is a targeted impact on eliminating (minimizing) the causes that gave rise to the conflict, or on correcting the behavior of the participants in the conflict.

2.1 Conflict management techniques

Depending on the personal experience and knowledge of the leader, various methods of conflict management are possible, including:

silencing the conflict (evasion).With this position on the part of the manager, the conflict is resolved without his participation or is postponed for some time. Silence and avoidance of participation in the conflict and its resolution does not eliminate the cause of the conflict and does not contribute to the normalization of relations.

This way of managing conflict is the least effective;

smoothing.This style is characterized by behavior that

is dictated by the belief that there is no point in getting angry because “we are all one happy team, and there is no point in rocking the boat.”

The smoothing style can ultimately lead to serious conflict because the problem underlying the conflict is not resolved. The “smoother” achieves temporary harmony among workers, but negative emotions live inside them and accumulate.

Suppression of conflict (coercion).When suppressing a conflict through coercion and the use of power, the interests of only one of the parties are usually taken into account. At the same time, the causes of the conflict are not analyzed, and the positions of all interested participants are not clarified. Suppressing the conflict by the power of the leader may not eliminate the causes of the conflict; a similar situation will be repeated in the future. It should also be taken into account that the use of forceful methods of conflict resolution can lead to a hidden form of employee protest, sabotage, or a decrease in the quality and productivity of their work. Such tactics are possible only if the authority of the manager is undeniable and the level of trust and respect for him on the part of employees is high. The disadvantage of this style is that it suppresses the initiative of subordinates, creating the danger that when making a management decision, any important factors will not be taken into account, since only one point of view is presented. This style may cause resentment, especially among younger, more educated staff.

objective solution to the problem.To solve the problem that caused the conflict, the manager conducts an active dialogue with all participants, finds out their interests, analyzes the opinions and suggestions of employees, and considers possible options for resolving the conflict situation. This approach is the most preferable. The one who uses this style does not seek to solve his problems at the expense of others, but seeks best option resolving a conflict situation. Emotions can only be eliminated through direct dialogues with a person who has a different view from yours. Deep analysis and conflict resolution are possible, but this requires maturity and the art of working with people. Such constructiveness in resolving conflict (by solving a problem) helps create an atmosphere of sincerity, which is so necessary for the success of the individual and the company as a whole.”

Finding a compromise. The most effective way to resolve any conflict situation, but late stages development of the conflict.

During this period, the causes and grounds for the conflict are already obvious, the interests of the parties have been determined.

2.2 Conflict prevention

The work of managers largely consists of resolving constantly emerging contradictions. Not all contradictions turn into conflicts. The art of leadership lies in the ability to prevent conflicts and resolve them in the bud. Conflict prevention is the creation of objective preconditions that facilitate the resolution of pre-conflict situations in non-conflict ways.

Attitudes to conflicts.A manager's attitude to conflicts of different natures should be different. Destructive conflicts are generated by inept relationships, and it is naturally established that there should be as few of them as possible. Where pressing issues cannot be resolved without conflict, the leader should not hide from it.

Recommended measures. Conflict prevention measures are determined by the causes of conflicts. Constant work to improve working conditions, improve pay, improve the organization of production, and improve the living conditions of workers is necessary. Since these issues are difficult and time-consuming to resolve, workers should be informed of the measures being taken. Subordinates will understand that not all issues depend on the leader, but they are unlikely to want to understand the leader's reluctance to deal with these problems. It is also necessary to strictly adhere not only to the spirit, but also to the letter of labor legislation and compliance with work ethics.

A leader needs to remember that managing people begins with managing oneself.

without respecting a subordinate, you will not achieve respect from him, and lack of respect is already a pre-conflict situation;

nothing is valued so highly or costs so little as politeness;

studying subordinates, interest in them as individuals are necessary for successful work with them, an individual approach is the path to mutual understanding with subordinates.

withholding information creates tension in relationships. The manager must also take into account the expectations of his subordinates. Subordinates expect from the leader:

knowledge of the matter; ability to organize work; perspective approach; ensuring high earnings; polite attitude towards yourself; respect.

To prevent conflict it is necessary:

work to resolve the conflict situation;

be careful and avoid conflicts. If there are several conflict situations and they are not eliminated, then the conflict situation will develop into a conflict. If at least one conflict situation is not eliminated, then the possibility of conflict remains.

The moral attitudes of the participants play a major role in resolving a conflict, since in every conflict there is a situation of moral choice. Therefore, the manager needs to engage in educational work with team members, encouraging desirable behavior.

It should be noted that in the prevention of conflicts, timeliness is important, allowing one to quickly resolve emerging production contradictions.

Timely resolution of the conflict can lead to functional (constructive) consequences and, on the contrary, a delay in resolving the conflict can cause dysfunctional (destructive) consequences of the conflict.

Considering that industrial relations are developing in rather difficult conditions: in competitive environment, in a situation, as a rule, of authoritarian pressure from management, etc., the presence of acute conflicts in production practice is extremely high. Because of this, in production practice in Europe, psycho-correctional methods of working with members of the workforce have long been used. It is noted that the use of these techniques significantly reduces conflict in the workforce.

In Russia, this experience is only just beginning to be comprehended and only partially implemented. A serious approach to the prevention of industrial conflicts should certainly affect the quality of work and the success of the organization.

3. Study of conflict management in the surgical department of the SYSERT CRH

3.1 Characteristics of the enterprise

The municipal health care institution "Sysert Central District Hospital" is a multidisciplinary treatment and preventive institution (HCI), providing qualified medical care to the entire population of the region.

The hospital has existed for 250 years.

The MUZ "CRH" includes district hospitals in the district, as well as paramedic and obstetric centers and general medical practices near the villages and hamlets of the district.

The hospital has a capacity of 275 beds and includes: an emergency department, a clinic, a children's consultation, a dental department, an infectious diseases department, a children's department, a neurological department, a therapeutic department, a gynecological department, maternity ward, surgical, resuscitation - anesthesiology, pathology department and such auxiliary services as: x-ray, clinical, biochemical and bacteriological laboratories, physiotherapy department and blood transfusion department.

Thus, holistically, the central district hospital consists of interconnected and interdependent departments, each of which performs its functions in the overall healthcare system.

Within the management unit there is its own hierarchy, because All departments of the hospital are accountable to the administration.

The medical institution employs 750 employees, which include: doctors, nursing staff, junior medical staff and hospital staff.

The personnel composition consists of groups of different social status, age, and education.

Table 1

Characteristics of the staff of a healthcare institution

Personnel compositionTotalMenWomenAgeUp to 18 yearsFrom 18-35From 35-60Over 60Doctors923260-47810Nurse medical personnel31024286892210-Junior medical personnel225-22516987437Service personnel12311112-1110012

The head of the medical and preventive institution is chief physician. The hospital departments are led by department heads and senior nurses.

The work of department personnel is based on strict adherence to job descriptions approved by the head of the organization.

The medical facility operates around the clock.

The quantitative composition of the staff and the diversity of perceptions lead to disagreements in the workforce.

Often, differences in views and lack of agreement between the parties lead to conflict situations. The causes of conflict may be the following factors:

work schedule;

payroll;

drawing up a schedule of regular vacations;

attitude towards fulfilling official duties;

requirements for working conditions;

personal characteristics of individuals, etc.

Conflict situations in a healthcare institution, as in any other organization, are multi-level in nature. Managers (heads) of departments are responsible for the prevention and resolution of conflict situations, regardless of the nature of the conflicts.

3.2 Analysis of the results of a survey of employees of the surgical department of the Sysert Central District Hospital

This chapter proposes a study aimed at identifying the socio-psychological causes of conflicts and methods for resolving them in a healthcare organization using the example of medical personnel in the surgical department of a central district hospital.

The structure of the study contains a questionnaire aimed at identifying the specifics of conflict in the surgical department of the Sysert Central District Hospital.

A participant survey program has been developed (Appendix 1).

The study was conducted in the primary workforce of the surgical department of the Sysert Central District Hospital, consisting of 25 people, of whom 20 were women and 5 men.

23 people took part in the study, two were unable to participate due to good reason.

The survey was conducted in 2010 in individual anonymous form in the form of questionnaires in order to determine the relationship between conflict situations and the effective work of the department.

Age composition of team members: from 18 to 54 years.

Education: secondary, secondary specialized and higher.

The sample was limited by the number of participants in the experiment (Table 2), the characteristics of the personnel qualifications were selected (Table 3).

Table 2

Summary table of primary data for the sample

No. Position Number of participants Age Gender Education 1 Doctor 535-54 male Higher 2. Paramedic 326-30 femaleSecondary - special 3. Nurse919-35femaleSecondary - special4. Nurse840-54femaleSecondary

Table 3

Characteristics of the qualification level of the medical staff of the surgical department of the MUZ "SCRB"

In terms of educational status in the team, among the respondents, there is a predominance of employees with an average vocational education.

In terms of age, the most numerous was the group aged 30-39 years, and the work experience in this healthcare facility in most cases was 5-10 years.

The personnel composition is dominated by nursing staff.

More than half of the respondents have the highest and first qualification categories.

By gender, there are 4 times fewer men than women.

The analysis of respondents' answers on determining the levels of conflicts and attitudes towards conflicts is summarized in tables and presented in the form of diagrams:

Contingency table of respondents’ answers to the question:

Table 4

“Do you consider yourself a conflict person?” depending on gender:

Answer options Men Women Total definitely, yes (person) 0.002.002.00%0.00100.00100.00% of the array 0.00 8.708.70possibly (person) 1.003.004.00%25.0075.00100.00% of the array 4.35 13.0417 ,39definitely no (person) 3.0010.0013%23.0876.92100.00% of the array 13.04 43.4856.52difficult to answer (person) 1.003.004.00%25.0075.00100.00% of the array 4 .35 13.0417.39Total 21.7478.26100.00

When considering the attitude of health workers towards ongoing conflicts, the following data were obtained: 65% have a negative attitude towards conflicts, 26% are more negative than positive and 9% are positive.

It can be stated that among health workers there is a widespread negative attitude towards conflicts in the team.

A positive attitude is explained by the understanding that conflict is not always destructive, sometimes it has a functional nature that contributes to the development of the organization.

Absolute indicators of answers to the question “What level of conflicts most often occur in your team?” presented in table form, relative indicators are shown in the graph.

Table 5. Assessment of the level of conflicts

Answer options Number of answers (persons) Subordinate - manager 6 Between colleagues 13 Conflicts involving all categories of employees 4 TOTAL: 23

The hypothesis that, despite all the negative attitudes towards conflicts in a team of medical workers, conflicts arise more between managers and subordinates than among colleagues was not fully confirmed.

When considering all the conflicts that arise within the team, the main share was made up of employee-employee conflicts. These conflicts are mainly of a production nature; among them, horizontal, vertical and mixed orientations can be distinguished.

Based on the data obtained, an analysis of the causes of conflicts was carried out.

Indicators of responses to the question: “To what extent do these characteristics, in your opinion, most often lead to conflict?” look like this:

Table 6

Characteristics that Lead to Conflict

Answer options Number of answers (persons) Lack of professionalism 10 Characteristics of temperament 6 Unkind attitude towards people 7 Total 23

Interpolated relative values:

Unprofessionalism is a prevailing factor leading to conflict. In this case, three dominant sub-factors were identified:

more than half of the respondents associate the occurrence of conflicts with an unclear distribution of responsibilities;

% are not satisfied with the salary;

% consider the level of labor organization insufficient;

The remaining indicators of the causes of conflicts were evenly distributed across 5%, respectively: the personal nature of the causes and the causes that were not formed into a specific group.

The main reason in the department under study is the unclear distribution of responsibilities. This means that duties and rights must be balanced.

To prevent dysfunctional conflicts in the clinic, you need to pay attention to the following recommendations:

draw the attention of senior nurses to shortcomings in organizational issues, i.e. review the real state of affairs and existing job descriptions;

avoid duplication in the distribution of duties, rights and responsibilities;

give employees the opportunity to express their opinions, for this you can hold production meetings and personal interviews;

maintain a healthy psychological climate in the team;

The unclear distribution of responsibilities is closely intertwined with another reason - payroll. These include the following points:

Often, an employee performs work that is not specified in his functional responsibilities; naturally, he rightly believes that he is doing this for a “thank you,” at best.

A common problem is processing additional payments for replacing temporarily absent workers.

Disadvantages in work organization. This means that the workplace is insufficiently equipped. For example, a shortage of good suture material can cause conflict between the operating room nurse and the surgeon.

An analysis of the behavior of the parties to the conflict is given below:

Table 7

Subjective assessment of the behavior strategy of medical workers in a conflict situation in a hospital department.

Behavior strategy Relationships with: manager colleague Absolute frequency Relative frequency Absolute frequency Relative frequency 1. Rivalry 14.3%313.1%2. Fixture 1252.2%14.3%3. Cooperation313.1%1356.6%4. Avoidance 521.7%14.3%5. Compromise28.7%521.7%

As can be seen from the diagram, when interacting with a manager, 52.2% of respondents prefer to give in and are ready to walk away from the conflict. When interacting with a colleague, 56.6% choose cooperation, 21.7% compromise.

However, in conflict resolution, cooperation, accommodation, and compromise prevail over competition and avoidance.

From the analysis of conflict resolution, we can conclude that managers are characterized by a method of objective resolution of conflict situations, which confirms the previously put forward hypothesis.

Processing the analysis of the view of problems in general and in conflict management:

Table 8

“If you were a leader, what real changes would you make in your organization?”

Answer options Would completely change (persons) Certain changes are required (persons) Would keep as is (persons) On the organization of work 887 On the composition of the management 8141 On the main areas of the organization's activities 3515 On the remuneration system 2201

The result is interpolated and presented as donut charts

A visual diagram of combined survey processing:

A visual diagram gives a clear idea that, in general, in the medical institution there is a need for changes in almost all areas of activity: work organization, management composition, and remuneration system.

Thus, during the research, the hypothesis was confirmed that the process of conflict management will be more effective when changing the situation not only in a small team of the department, but in organizing processes in the entire medical institution.

An organization at any level cannot exist without ever encountering the problem of conflict. The negative perception of conflicts is quite justified, because any of them carries a charge of enormous destructive power. The problem is not to prevent conflict in the organization, but to prevent it from developing spontaneously.

Consequently, a leader must not avoid conflicts, but constantly work to resolve them and eliminate the causes. There is no need to regret that the conflict arose at all; it is an inevitable accompaniment of progress and change. It is the manager who bears the responsibility for preventing conflicts in the units entrusted to him and, accordingly, in the organization as a whole.

Conclusion

The purpose of this course work was to study theoretical issues of conflict management. During the study, a definition was given to this phenomenon, its essence was revealed, and the ways in which conflict situations arise were identified. Based on this, ways to resolve conflicts have been identified.

The practical part reveals methods and techniques for eliminating conflicts that arise in healthcare institutions.

To achieve the goal of the study, the following tasks were set:

A number of hypotheses were put forward, which were or were partially confirmed during research in the form of a survey and questionnaire among employees of one of the departments of a medical healthcare institution.

The hypothesis that, despite all the negative attitudes towards conflicts in a team of medical workers, conflicts arise more between managers and subordinates than among colleagues was not fully confirmed. Conflict situations often arise among colleagues.

This conclusion further confirmed the hypothesis that managers are characterized by a method of objective resolution of conflict situations, since it is they who are responsible for the prevention of conflicts in the units entrusted to them.

The hypothesis that in a work team, where business relations dominate over socio-emotional ones, the main reason for the emergence of conflict situations is differences in views on attitudes towards the performance of job duties, competitiveness has been fully confirmed, supplementing it with the reasons for the imperfection of organizational processes in the institution and in health care in general.

The conclusion also confirmed the hypothesis, which was fully confirmed in the conducted research: the process of conflict management will be more effective when changing the situation not only in a small team of the department, but in the organization of processes as a whole in the medical institution.

When confirming the results, tables and diagrams were compiled to clearly show the confirmation of the assumptions.

Abstracts were drawn up - the main points of both the theoretical and practical parts of the work. The conclusion is drawn that the conflict must be managed in order to direct the existing conflict in the right direction and prevent it from leading to destructive consequences.

The course work is based on a generalization of personal experience. Study methods can be used in real everyday practice. The work on studying conflict problems can be continued in more detail by revealing the topic of the negotiation process as a way of resolving conflicts in relation to the healthcare sector - “the role of the manager - the head of the medical institution in resolving a conflict situation.”

In the process of operating a healthcare organization, various factors and methods of resolving conflict situations are used.

Based on the results of the study, the following recommendations can be made to the team and managers of the surgical department:

The best way to resolve conflict is cooperation. You can prevent conflicts by changing your attitude towards the problem

situations and behavior in it, as well as influencing the psyche and behavior

opponent. The main ways and techniques of changing one’s behavior in a pre-conflict situation include:

the ability to determine that communication has become pre-conflict;

the desire to deeply and comprehensively understand the opponent’s position;

reducing your general anxiety and aggressiveness;

ability to evaluate one's current mental state;

constant readiness for non-conflict solutions to problems;

ability to smile;

do not expect too much from others;

resistance to conflict and sense of humor.

To prevent interpersonal conflicts, managers need to evaluate, first of all, what they managed to do, and then what they failed to do:

the evaluator must know the activity well (professionalism);

give an assessment on the merits of the case, and not on the form;

the evaluator must be responsible for the objectivity of the assessment;

identify and communicate to assessed employees the reasons for deficiencies;

clearly formulate new goals and objectives;

inspire employees to take on new jobs.

List of used literature

1.Vikhansky O.S., Naumov A.I. - "Gardariki M-02

2.Dorofeev V.D., Shmeleva A.N., Shestopal N.Yu. "Management" M. Infra - M 08.

.Balint I., Murani M. Psychology of labor safety. - M.: Profizdat, 2008.

.Kolodey Krista. Mobbing. Psychoterrorism in the workplace and methods of overcoming it/Trans. with him. - Kh.: Publishing House Humanitarian Center, 2007.

.Shalenko, V.N., "Conflicts in labor collectives" - M: publishing house - Moscow State University, 2002.

.Zerkin D.P. Fundamentals of conflictology: A course of lectures. - Rostov n/a: Phoenix, 2003

.Romanova, N.P. Mobbing: textbook / N.P. Romanova - Chita: ChitGU, 2007.

.Bolshakov, A.G., Nesmelova, M.Yu. Conflictology of organizations. Textbook / A.G. Bolshakov, M.Yu. Nesmelova - M.: MZ Press, 2004.

.Kravchenko, A.I., “Labor organizations: structure, functions, behavior” - M.: Nauka, 2004.

.Kuliev, T.A., Mamedov, V.B., “Leader and team: interaction” - M.: Nauka, 2006.

.Polyakov, V.G., “Man in the world of management” - Novosibirsk: Science, 2002.

.Popov, A.V., “The Theory of Organization of American Management” - M.: publishing house of Moscow State University, 2003.

.Kovalev A.L., “The path to success: 1600 tips for managers - M.: publishing house - Moscow State University, 2004.

."Social management: dictionary-reference book" - M.: Moscow State University Publishing House, 2004.

.Babosov E.M. Conflictology: Textbook. manual for university students. - Minsk: TetraSystems, 2003.

.Utkin, E.A., “Profession manager” - M.: Economics, 2002.

.Fedtsov V.G., Fedtsova A.V. - M: Prior - published. 2007.

.Diagnostics in conflictology: educational and practical guide / A.I. Fomenkov/ Smolensk: SmolGU, 2003

.Antsupov, A.Ya. Conflictology / A.Ya. Antsukpov, A.I. Shipilov - M.: Unity - Dana, 2004.

.Borodushko, I.V. Organizational behavior: a textbook for universities\I.V. Borodushko. - M.: Unity, 2007.

.Kishkel, E.N. Sociology and psychology of management: textbook. Manual / E.N. Kishkel. - M.: Higher School, 2005

.Pugachev, V.P. Management of personnel of the organization / V.P. Pugachev. - M.: Aspect Press, 2005.

Applications

Appendix 1

QUESTIONNAIRE PROGRAM FOR MEDICAL STAFF OF THE SURGICAL DEPARTMENT OF THE SYSERT CRH

on the topic: "Study of the psychological causes of conflict and methods for resolving them."

Problem situation -lies in the complexity of conflict management and coordination of the entire complex structure. Due to the nature of their work, each employee is forced to communicate with both colleagues and patients. Conflicts of any kind can affect a decrease in the services provided, a decrease in the prestige of an individual and the institution as a whole, cause staff turnover, and a decrease in performance.

Problem -methods for preventing conflicts and improving the microclimate in the team of medical workers in the context of a common health problem in the country as a whole and in the medical field. institution in particular.

Subject of research -conflict management in healthcare organizations.

Object of study -

The purpose of the study isstudy of the psychological causes of conflict among department staff and methods for resolving conflict situations.

identify the causes of conflicts within the team;

determine the level of conflicts;

determine the behavior of participants in conflicts.

Main hypotheses -

Despite all the negative attitudes towards conflicts in the team of medical workers, conflicts arise more between managers and subordinates than among colleagues.

In a work team where business relationships dominate over socio-emotional ones, the main cause of conflict situations is differences in views on attitudes towards fulfilling job duties and competition.

Based on the facts, let us assume that the method of objective resolution of conflict situations is typical for managers, since it is they who are responsible for the prevention of conflicts in the units entrusted to them.

The conflict management process will be more effective when changing the situation not only in a small team of the department, but in organizing processes throughout the medical institution as a whole.

Research method: questionnaire

General population -employees of the surgical department of the Sysert Central District Hospital

Sampling -23 people (5 doctors, 3 paramedics, 9 nurses, 8 nurses. The category of personnel under study differs in rank, qualifications, wages, etc., which allows us to more broadly examine behavior in conflict situations, methods of resolution, functions and effectiveness of conflicts)

Sampling type - mechanical

Method of communication with respondents -anonymous survey by individually filling out and collecting questionnaire forms.

Appendix 2

MUSEUM "SYSERT CENTRAL DISTRICT HOSPITAL"

EMPLOYEE QUESTIONNAIRE

Dear staff of the surgical department!

Your organization is conducting research aimed at identifying the psychological causes of conflict among personnel and methods for resolving them.

The survey is anonymous.

The results of the study are subject to analysis and will be used in the work of managers to prevent conflict and improve the microclimate in the team.

To participate in the experiment, we invite you to answer the questionnaire.

Must be selected and marked required option answer that matches your opinion.

How often do clashes occur in your organization?

a) very often

b) periodically

c) sometimes

d) almost never

d) find it difficult to answer

Do you consider yourself a conflict person?

a) definitely, yes

b) perhaps

c) definitely not

d) find it difficult to answer

How often do you find yourself involved in conflicts at work?

a) this happens very often

b) I periodically find myself in conflict

c) sometimes you have to participate in a conflict

d) I manage to avoid conflicts

d) find it difficult to answer

How do you think the conflicts that arise in your organization are manageable?

a) conflicts are completely manageable

b) sometimes it is not possible to control conflicts

c) control is often impossible

d) in our organization, conflicts are practically unmanageable.

How do you feel about conflicts?

a) negative

b) more negative than positive

c) positive

Which conflict resolution method is most popular in your organization?

Often used Sometimes used Not used 1. Legal (with the help of regulations) 2. Organizational (by changing the organization of work) 3. Psychological (persuasion, threats, manipulation) 4. Force (use of physical force)

What level of conflicts are observed most often in your organization?

More often there is a conflict between...Subordinate - Manager Between the team (employee-employee) With the participation of all categories

What reason most often pits people against each other in your organization? (you can indicate 3 main reasons)

a) unfair distribution of privileges

b) unfair wages

c) high ambitions of some employees

d) improper organization of work

e) antics of managers (including abuse of authority)

f) a feeling of envy among workers towards each other

and) low level professionalism of some employees

h) fight for position

i) unclear distribution of responsibilities

j) your own option

______________________________________________________

Which of the characterological characteristics of a subordinate, colleague, or manager has an impact on the emergence of a conflict situation?

Characteristic featuresSubordinateColleagueLeaderLazinessUnfair attitude to workUnprofessionalismTactlessnessUnkind attitude towards peopleUncertaintyLack of initiativeIndecisivenessLow self-esteemInflated self-esteem

If you were a leader, what real changes would you make in your organization?

Would completely change Certain changes required Would keep it as it is By organization of work By composition of management By the main areas of activity of the organization By the remuneration system

What strategy of behavior of medical workers in a conflict situation in the clinic do you consider the most common?

Behavior strategy Relationships with: manager colleague subordinate 1. Competition 2. Adaptation 3. Cooperation 4. Avoidance 5. Compromise

Have you ever had to defend your colleague from the unfair actions of the following people:

All the timeSometimes Never1. Colleague2. Manuals3. Patients4. Others

Do you have a desire to leave this organization?

a) all the time

c) occasionally

d) find it difficult to answer

What would you suggest to improve relations between employees in your organization?

_____________________________________________________________

If you had an open conversation with your superiors, what would you first of all draw their attention to?

a) to shortcomings in the relationship between management and subordinates

b) to shortcomings in the organization of work

c) to an ineffective reward system

What situation is typical for your organization in the event of a conflict between employees and the manager?

a) workers remain silent and do not interfere in anything

b) workers remain silent, but gradually reduce the quality of work.

c) employees are openly indignant, while maintaining previous performance indicators

d) employees are openly indignant, and this affects work results

e) employees try to get their way by threatening legal action, dismissal, etc.

f) employees complain to higher authorities

How do you assess the socio-psychological climate of your organization?

a) everything is calm with us

b) there are certain areas of tension

c) there are very tense relationships in the team

General information about the survey participant

1. Your gender: ? - male, ? - female 2. Your age: a) up to 20 years old b) 21 - 25 c) 26 - 35 d) 35 - 55 e) 55 or more 3. Education: a) incomplete secondary b) secondary c) specialized secondary d) incomplete higher e) higher 4. Total work experience: a) up to 5 years b) 6 - 10 years c) 11 - 20 years d) 21 - 30 years g) 31 years and above 5. Your work experience in this organization: a) up to 1 year b) 2 - 3 years c) 4 - 6 years d) 7 - 10 years e) 11 - 15 years f) 16 years and above

Tags: Conflict Management in Healthcare Diploma Management