It started out a good day, and Bill reviewed the long list of items...

It started out a good day, and Bill reviewed the long list of items that he needed to accomplish that day. He had planned to meet with his managers to discuss the operational budget goals for the department and to initiate discussion about needed capital equipment that had to be projected for the upcoming year. Bill was the director of Medical-Surgical Services and had six direct reports who were nurse managers over the following units: Oncology, General-Medical, Postoperative Surgical, Bariatric, Orthopedics, and Observational (short stay). In addition to the six nurse managers, the medical director for Internal Medicine and the medical director for Surgical Services also reported to Bill. The management team was an eclectic group with very different levels of education and experience, which made for lively discussions in their team meetings. 
 

Each nurse manager brought a list of capital needs to the meeting. It quickly became apparent that there was more need than there was allocated budget, because Bills service line was only one of four for the entire hospital. As the nurse managers began to present their proposed capital needs, the group dynamics began to change from friendly to conflicting and competitive. The Orthopedics department had the longest capital need list with the biggest dollar amount. As the other managers began to defend their list of needs, the nurse manager of the Orthopedics department mentioned that his service line also contributed the greatest amount of revenue as compared to the other departments. He used that fact as a rationale for why his department should receive a larger piece of the allocated budget. Other nurse managers argued fiercely about their contribution to the hospital's bottom line and the value that their department brought to the organization. When the discussions became heated, Bill suggested that they take a recess as a "cooling off period." They agreed to meet again the next day to finalize the capital budget plan.

 The next day the nurse managers came prepared to defend their units' needs, and they had formed a coalition against the nurse manager of Orthopedics. They had met outside of the meeting and agreed that they might have more power in the discussion if they presented their needs collectively rather than individually. 

The nurse manager of Orthopedics also had a strategy. He had met with the chief of the Orthopedics service line and the medical director of Surgical Services. He asked them to join him in the meeting and indicate how important it was for Orthopedics to receive the requested capital budget items. He also presented information about the threat to the hospital's market share if the Orthopedics department did not keep up with state-of-the-art equipment. 

Not long after the meeting started, it was clear to Bill that the cooling-off period had not worked but rather had served as an opportunity to strengthen the conflict. As each of the nurse managers stated their case and rationale for their requests, tempers began to flare, and accusations were made on both sides. Bill realized that further discussion was not going to be helpful in resolving the conflict. Although the capital budget for his department was due in 2 days, Bill decided to stop the meeting once again. He informed the group that he would meet with two representatives from the coalition group and two representatives from the Orthopedics group. Although the others were not happy about this plan, they were also not happy with the group's inability to negotiate a fair and equitable capital budget plan within the overall allocated amount. 

The next day Bill met with the four representatives in a quiet, subdued setting that he felt would facilitate the mediation process and create a favorable environment for open dialogue, negotiation, and resolution. His opening remarks addressed the need for the four representatives to make decisions for the entire team that would be appropriate within the budget limitations. Bill had reviewed in his head the steps of the negotiation process and reminded himself not to take sides or contribute to the discussion until both sides were able to find common ground and begin to develop some realistic solutions.

 Bill led them through a meeting norming process with the participants agreeing to "rules" for the meeting. They agreed that they would (1) respect the person speaking, and only one person would speak at a time without interruption; (2) focus on the common good in contrast to their individual units' needs; (3) create a list of the top 10 priorities for the entire department, and then negotiate the list down to the allocated budget amount; and (4) vote on items until consensus was reached. Needless to say, it was not easy in the beginning, and Bill had to continually remind them that there was a finite amount of money that could be allocated and that they needed to make decisions for the whole based on the allocated budget amounts. With this constant reminder and norming process, the four began to work together using the strategic plan for the department as a foundation for their decision making. They also developed rationale for each of their decisions that could be presented to the whole group. It took a full two days of meetings to finally have a proposed budget that could be presented to the rest of the group. 

Bill called the entire group together and informed them of the decision-making process that led to the proposed budget. Two of the representatives prepared a presentation for the entire group and provided handouts of the proposed budget with a rationale for each item suggested. As it turned out, Orthopedics did receive a greater allocation than the other units, but there was clear justification using the strategic goals for the department as a foundation. Not everyone in the group was happy with the proposed budget, but they did agree that the rationale was sound. After discussion, the group finally decided to adopt the new proposed capital budget and to develop proposals for the hospital's foundation to fund some of the other items that they felt were important to their units. 

Bill submitted his final capital budget on time, but he recognized that there was still some discontent among some managers within the group. He realized that he could not please everyone, but the method that he used to resolve the open conflict resulted in a budget that was supportive of the department's strategic initiatives even though some capital items were not approved, as some had hoped.

 1. Identify the potential causes for the conflict among the managers.

 2. If you were in Mike's position, what might you have done differently to manage and resolve the conflict?

 3. What are your thoughts about why the splintering among the group occurred when they began to form a coalition and bring other team members into the process? 

4. Describe the power imbalances that existed within the group, and discuss how these imbalances affected the group dynamics. 

5. How were the 10 steps to conflict resolution used in developing the final solution to the capital budget plan?