Conflict situation– this is a situation in which participants (opponents) defend their goals, interests and the object of the conflict that do not coincide with others. Conflict situations may concern the very personality of the doctor - internal conflicts, or be part of the doctor’s interaction with others: colleagues, the patient, his relatives - external conflicts. Moreover, any conflict situations affect the doctor’s internal state.

Norwegian cardiologist Margrethe Aase conducted a study that included interviews with cardiologists and general practitioners. The study showed that the fears that a professional doctor may experience are largely associated with his high sense of responsibility for the quality performance of his duties. The study also showed that doctors feel more vulnerable when they make a mistake or make a decision alone.

The most striking example of a conflict between a doctor and a patient is a complaint. Complaints from patients are quite common and require special analysis. What could cause the conflict? And what are the ways to solve it?

Let's consider specific situations:

Situation 1. On July 20, 2007, an emergency doctor on call found a man intoxicated lying in the entrance of a house. The examination did not reveal any indications for hospitalization. The doctors took him into the apartment and brought him to his senses. The patient died that night. As the autopsy showed, it was from a closed head injury. The relatives blamed the doctor for not taking him to the emergency department.

A possible cause of the conflict could be the professional incompetence of the doctor. On the other hand, making an accurate diagnosis in the absence of specific diagnostic methods can be difficult. In this regard, overdiagnosis could serve as one of the probable options for doctors to act in order to save the life of the patient and protect themselves from unfounded accusations, since the patient could have been injured after the emergency doctors left. Thus, doctors could deliver the patient to the hospital emergency room, where a serious injury, if present during the arrival of the ambulance team, could be diagnosed.

Situation 2. An ambulance transported a 16-year-old motorcyclist injured in an accident with a crushed foot to the hospital. Due to the severity of the injury, surgeons were forced to amputate it. After some time, the young man’s parents sent several complaints to “higher” authorities: they blamed the doctors for the fact that their son became disabled - they say they didn’t want to bother.

It is important to take into account here that the patient is a minor, and consent to medical intervention should have been, if possible, sought from the boy’s parents or other legal representatives (Article 27 of the Law “On Health Care”), the decision had to be made by a council of doctors in consultation with specialists in the field of reconstructive medicine.

Situation 3. The patient went to the 18th city clinic to see a dentist to have a tooth removed. Previously, I bought two ampoules of the painkiller “Ultracaine” at the pharmacy. But the doctor refused to use them, saying that he would numb the pain with his own drug. Two injections were given, but they had no analgesic effect. The tooth was removed almost “on the spot.” Was the doctor right in this situation?

The doctor is right in this situation, and the cause of the conflict could be the patient’s ignorance of his responsibilities, since medical specialists are not allowed to use medications purchased by citizens on their own (letter of the Ministry of Health dated June 29, 2005 No. 5/AH-1867). On the other hand, when carrying out treatment, the doctor must be attentive to the patient’s reaction, control the situation if possible, and ask the patient how this or that treatment affects his condition.

In some cases, a patient may not act in accordance with the norms of ethics and law, and then the main task of a medical organization is to make it clear to such an “extremist” patient that his claims are unfounded, not within the scope of legal regulation and cannot be satisfied. This should be done exclusively in writing, with references to the rules of law, existing medical practice and with detailed reasoned justification for one’s position, requiring the patient to provide written (!) justification for his claims and requests. This is explained by the fact that such conflict correspondence is ultimately prepared not for the conflicting parties, but for the judicial authorities, which, when the conflict moves into the trial phase, will need to assess the correctness of each party based on its argumentation.

In some cases, the conflict may actually be based on a violation of the patient's rights. According to Russian authors, doctors of various positions most often violate the following: patient rights:

1) medical registrars, nurses - the patient’s right to respectful and humane treatment, to directly familiarize himself with medical documentation and receive consultations on it from invited specialists;

2) emergency or ambulance doctors - to choose a medical institution (in case of emergency hospitalization), to informed voluntary consent to medical intervention, to respectful and humane treatment;

3) by attending physicians of an outpatient clinic or hospital - to choose a medical institution (when referred for consultation, hospitalization), to informed voluntary consent to medical intervention, to respectful and humane treatment, to keep information about the patient confidential, to receive information about their rights and responsibilities, to directly familiarize themselves with medical documentation, to conduct a consultation and consultations with other specialists at the patient’s request.

An analysis of the reasons why medical workers violate the rights of patients showed that they coincide with the reasons for all other offenses encountered in life (including violations of the rights of a doctor).

Option 1 (the law is not written for the offender). A healthcare worker may simply not be aware of the existence of one or another patient right (this is less common among doctors, more often among middle and junior staff, and almost never among administrators);

Option 2 (the offender “has not read the law”). The health worker has heard about the existence of patients’ rights, but does not clearly understand their content (this option is more common among doctors);

Option 3 (the offender “does not understand the law”). The health worker knows that there is one or another right of the patient, but does not know whether it is necessary or not to observe it in a particular situation;

Option 4 (the offender “understands the law, but not in the right way”). The health worker knows about the existence of the patient’s specific right, but does not comply with it due to the uniqueness of his personal understanding of this legal norm or the peculiarities of its application in a particular situation. The variant is more common among healthcare administrators.

In turn, the patient also needs to be educated and taught so that he protects himself from conflict situations. Most patients, due to their psychophysiological state, initially belong to the “socially vulnerable contingent,” that is, to a group of people whose ability to protect themselves is limited, and whose ability to manage themselves and surrounding circumstances is reduced due to the disease. In this regard, almost each of them is at risk of falling into a conflict situation, and therefore needs special attention and protection. However, in conditions where there is time, strength and opportunity to act in the direction of obtaining better medical care, a number of people exhibit behavioral characteristics that are not caused by their own state of health, a decrease in the level of intelligence or a weakening of volitional characteristics. Rather, they can be attributed to manifestations of a lack of awareness, to the results of insufficient medical and legal culture. It is these patients today who are more likely than others to receive low-quality care or become persons whose rights are infringed or violated.

If you try to reproduce a certain generalized image of a “patient who is particularly susceptible to becoming a victim of conflict,” then such a person, as a rule, will:

– does not know his rights and legitimate interests;

– does not know other people’s responsibilities, professional and official hierarchy in healthcare;

– does not ask doctors questions about what is happening in his body;

– believes that when seeking medical help he “concerned” the health worker with his problems;

– without hesitation, I am ready to pay where they say;

– does not read his medical documents (certificates, medical records);

– does not collect information about where it is best to be examined and treated for his illness;

– is focused not on a critical analysis of what is happening, but on resigned submission to the instructions of “people in white coats.”

Closer acquaintance with the patients of this fairly large group shows that the listed features for most of them are not stable personal characteristics (and therefore difficult to eliminate). Carrying out minimal (if possible individual) medical and legal educational work with such people can make their patients sufficiently literate and, accordingly, more socially protected. The more competent the patient’s attending physician, the less likely it is that such a patient will become a victim of crime and conflict.

Of course, the problem of conflict in medical practice is not only a problem of an incompetent doctor and a victim-patient or a malicious patient and a suffering doctor; This problem is complex and requires solutions at various levels. But, speaking about a doctor, it is necessary to remember that the doctor must clearly know his rights and responsibilities, perform his work professionally and honestly, treat his colleagues with dignity, and at the same time he must have a good team to protect him.

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 health care 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 the modern world, the aggravation of the problem of quality of medical care dictates the need for professional mobility and 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 may be perceived negatively by the women's team.

A person rarely works alone, most often he works together with other people in a work team, and therefore changes are inevitable, 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, as well as find and put into practice the most optimal ways to resolve controversial situations during the reorganization of a medical 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 discontent and lead to various types of 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 bypass 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, and 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 are talking about a business decision, the correctness of which determines the success of the business, 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 on:

• 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 various possible solutions to 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 techniques for their successful resolution. 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 that affect the future lives of employees. 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.

Introduction

Chapter I. Theoretical part. Conflicts.

1 General definition of conflict

2 Types of conflicts

3 Causes of conflicts

4 Types of behavior of people in a conflict situation

5 Boundaries of conflict

6 Forms of working with conflicts and methods for resolving them

7 Team management styles. Mediation

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

1 Conflicts in a medical institution

2 Methods for preventing and resolving conflicts in the medical environment

Chapter III. Practical and research part. Conflict situations in the Prionezhskaya Central District Hospital during the period of reorganization.

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

2 Organization and research methods

3 Processing of research results

Conclusion

Bibliography

Applications

A person who is lucky is a person who

did what others were just about to do

Jules Renard, French writer

Introduction

One of the priorities of the state policy of the Russian Federation is the preservation and strengthening of the health of citizens. This goal can be achieved by developing a healthy lifestyle and increasing the availability and quality of medical care. An important role is assigned to specialists with secondary medical education, an advanced level of education and higher medical education in the specialty “Nursing”, who constitute the largest category of healthcare workers.

Nursing is a critical component 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 performed by nursing personnel requires an understanding of the factors influencing health, the causes of diseases, methods of their treatment and rehabilitation, as well as the environmental, social and other conditions in which medical care is provided and the health care system operates. The World Health Organization (WHO) views the nursing workforce as having real potential to meet the population's growing needs for affordable health care.

Modernthe socio-economic situation, 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.

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

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

Women's groups are a fairly common phenomenon in our healthcare system. Modern researchers note that women more often than men show sensitivity to the psychological climate in the team and the desire to work in a psychologically comfortable atmosphere for themselves. When they arrive at a new place, they usually first try to establish emotional connections with colleagues and only then become fully involved in their work. Satisfaction with relationships with colleagues and management is becoming one of the main factors determining women's satisfaction with their workplace. Sometimes this factor outweighs all others: salary level, growth prospects, etc. The female team is usually weakly hierarchical and is based 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 may be perceived negatively by the women's team.

A person rarely works alone, most often he works together with other people in a work team, and therefore changes are inevitable, 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).

homeThe 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.

Subject thesis - conflict situations and ways to resolve them that may arise during the reorganization of health care facilities.

Object of study - the team of a medical institution (polyclinic) as a functioning system of human relations during the period of reorganization.

Subject of study - conflict situations arising in health care facilities during the reorganization process.

Target thesis:

.Definitionthe level of conflict among the medical staff of the clinic;

Revealing causesconflict situation during the period of making a decision on the reorganization of the clinic;

Determining ways to resolve and overcome conflict situations in the process of reorganizing the institution;

Improving the socio-psychological climate in the medical team;

The role of the nurse organizer in conflict management in the institution during the period of reorganization;

Within the framework of the problem posed, the following were solved:tasks :

· analysis of literature on the research topic;

· selection of research methods;

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

· analysis of the obtained data;

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

If a person is not at peace with himself, 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. The main postulate of the work is hypothesis that unresolved conflict among employees inevitably leads to interpersonal disagreements, which leads to even greater tension during the period of reorganization of health care facilities.

Research methods :

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

Test "Assessing Conflict"

Test “Need for Achievement Assessment Scale”

Questionnaire for patients “Evaluation of the work of clinic staff”

Document analysis method: local media publications about the clinic

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

· Karelia weekly “Gubernia” No. 29(843) dated 07/18/12

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

· Karelia weekly “Gubernia” No. 32(846) dated 08/08/12

· newspaper "Prionezhye" No. 29 dated 09/28/2012

Managing an organization is impossible without conflict management, and the sister organizer must take this into account in her work. And for effective management, it is necessary to study the types, levels, essence of conflicts, as well as find and put into practice the most optimal ways to resolve controversial situations during the period of reorganization of health care facilities.

conflict controversial team behavior

Chapter I. Theoretical part

.1 General definition of conflict

In everyday speech, the word “conflict” is used in relation to a wide range of phenomena - from armed clashes and confrontation between various social groups to work or marital disagreements. 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. The most general definition of conflict (from the Latin conflictus - clash) is a clash of contradictory or incompatible forces. Conflict is a fact of human existence. There are different levels of conflict in an organization: intrapersonal, interpersonal, intergroup, between an individual and a group, intraorganizational.

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. 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. The conflict model is shown in Fig. 2.

Rice. 2 Conflict model

Model (nature) of conflict ↓

Base of conflict (conflict situation) ↓

Incident ↓

Possibility of conflict escalation ↓

Reaction to a conflict situation↓ ↓

Presence of conflict Absence of conflict↓↓Conflict managementNo consequences of conflict↓

Functional and dysfunctional consequences of conflict

What is the nature of the conflict? The basis of any conflict is a situation that includes either opposing positions of the parties on some issue, or opposing goals or means of achieving them in given circumstances, or a divergence of interests, desires, inclinations of opponents, etc. A conflict situation, therefore, necessarily includes objects and subjects of conflict. This is the basis of the conflict. For a conflict to begin to develop, an incident is necessary when one of the parties begins to act in a way that infringes on the interests of the other. An incident can occur either on the initiative of the subjects of the conflict (opponents), or independently of their will and desire - due to objective circumstances or accident.

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

1.2 Types of conflicts

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

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

Interpersonal conflict . This type of conflict is perhaps the most common. Most often, this is a manager’s struggle for limited resources, labor, finances, etc. Everyone believes that if resources are limited, then he must convince his superiors to allocate them to him and not to another person. Interpersonal conflict can also manifest itself as a clash of personalities, i.e. people with different characters and incompatible temperaments are simply unable to get along with each other.

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

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

People working in an organization where there is constant change or uncertainty may experience interpersonal conflict of greater intensity than people working in a stable environment due to constant high stress.

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

.3 Causes of conflicts

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

The reasons that give rise to conflicts can be grouped as follows:

Ø obsolescence of the organizational structure, unclear delineation of rights and responsibilities- the consequence of this is double or triple subordination of the performers. Naturally, 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 the proper organizational design of the division and cooperation of labor, the elimination of rigid standards, and the improvement of the procedure for delegation of powers.

Ø limited resources - dEven in the largest organizations, 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 discontent and lead to various types of conflict.

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

Ø contradiction between functions and type of work activity- This contradiction is especially acute when the manager adheres to bureaucratic procedures.

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

Ø Uncertain growth prospects- if an employee does not have prospects for growth or doubts its possibility, then he works without enthusiasm, and the labor process becomes painful and endless for him. In such conditions, the likelihood of conflict is most obvious.

Ø unfavorable physical conditions- extraneous noise, heat or cold, poor workplace layout can also cause conflict.

Ø lack of benevolent attention from the manager- the cause of the conflict may be staff intolerance to fair criticism, inattention to the needs and concerns of clients, public “bashing”, etc.

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

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

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

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 leader himself, especially if he is inclined to introduce a lot of petty things into the fundamental struggle of opinions, allows himself personal attacks, is vindictive, suspicious, 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 bypass 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 around themselves. 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.

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.

1.4 Types of behavior of people in a conflict situation

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

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

Ultra-precise - these people are usually conscientious workers. They are especially scrupulous in approaching all employees from a position of inflated demands and subjecting anyone who is not satisfied to sharp criticism. They are distinguished by increased sensitivity to the assessments of others, anxiety, which borders on suspicion.

Critical and categorical - These are people who have a ready-made and “only correct” judgment about everything. They always know what to do in this or that case, they are ready to teach everyone how to behave, think and speak, without noticing that this infuriates others.

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

Demonstrative - people who always strive to be in the center of attention, to enjoy success, even for the sake of this they can go into conflict in order to be in full view of everyone.

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

"Rigid" - people belonging to this type are distinguished by ambition, high self-esteem, unceremoniousness, reluctance and inability to take into account the opinions of others. Once and for all, their established opinion clearly comes into conflict with changing conditions and leads to conflict. These people reason like this: “if the facts do not suit us, so much the worse for the facts.”

"Weak-willed" - people do not have their own beliefs and principles. The danger of this type is that They have a reputation for being kind people, and no tricks are expected from them. Therefore, the performance of such a person as the initiator of the conflict is perceived by the team in such a way that “the truth is spoken through the mouth.” A weak-willed person can become a weapon “in the hands” of the person under whose influence he finds himself.

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

Individuals with undeveloped communication skills - these are people who have poor command of the generally accepted rules of communication: they do not say hello when meeting, do not look into the eyes of the interlocutor, do not show their interest during the conversation, and so on.

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

The main sign of a person with personality deformation - this is a disharmony of personal organization, which leads to an inadequate perception of oneself and the people around them. They are characterized by bitterness towards others, uncritical assessment of their own actions, and a sharp discrepancy between their ideas about themselves and their true personal appearance.

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

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

Doctor of Psychological Sciences N. Obozov identifies three types of behavior in conflict: behavior “practice”, “interlocutor”, “thinker”.Depending on the types of personalities involved in the conflict, it can proceed differently.

"Practician"operates under the slogan “The best defense is attack.” The effectiveness of practical people contributes to increasing the duration of the conflict. His insatiable need to transform the external environment, including changing the positions of other people, can lead to various clashes and tension in relationships. The “practitioner” is less sensitive to minor omissions, so as a result of the conflict, relationships are greatly disrupted.

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

"To the Thinkers"The characteristic attitude is “Let him think that he won!” The “Thinker” is focused on understanding oneself and the world around us. In a conflict, he builds a complex system of proof that he is right and that his opponent is wrong. The “Thinker” thinks through the logic of his behavior well and is more careful in his actions, although less sensitive than the “interlocutor”. In communication, “thinkers” prefer distance, so they are less likely to find themselves in conflict situations, but are more vulnerable in close personal relationships, where the degree of involvement in the conflict will be very high.

People are sensitive to contradictions and conflicts that affect them in different ways. Thus, “thinkers” are most sensitive to contradictions and conflicts in the sphere of spiritual values ​​or ideas. “Practice” is more important than the unity of practical outcomes and goals of joint activity. “Interlocutors” react sharply to assessments of emotional and communication abilities, while assessments of intellectual qualities or practical acumen affect them much less.

In addition, research shows that all employees can be divided into three groups based on their commitment to conflicts:

conflict-resistant;

adhering to conflicts;

conflicting.

The number of the latter group is about 6-7% of the total personnel, and to ensure a favorable psychological climate in the unit, it is necessary to apply the main efforts to only a tenth of the personnel. The remaining 9/10 themselves strive for orderliness. You must understand that among your subordinates there are so-called “difficult” people with whom you need to be able to cooperate.

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

TanksThey are absolutely confident that their advice is the most competent; they do not like aggressive reactions from those with whom they communicate. To achieve in a dispute with tanksany success, you need to give them the opportunity to “let off steam”, and then they often even become tame.

Snipers“shoot” at people with various barbs and witticisms, thereby introducing disagreement into the collective actions of the staff. The most effective method of influencing them is to demand to explain in detail what he wants to express with one or another of his witticisms. But at the same time, the sniper must not lose face, otherwise he will “explode” or hide “with a stone in his bosom.”

Bombers- types who can attack their opponents with abuse, while losing their temper so artistically that one gets the impression that they have been greatly offended. They need to be allowed to throw out accumulated emotions.

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

"Indecisive."These types of people take a lot of tentative steps before doing anything, thereby irritating the staff. Those who are indecisive avoid employees who put pressure on them; the orders imposed by them are carried out without enthusiasm.

"Irresponsible."To some extent, they can be called anxious individuals, but their anxiety does not give rise to avoidance of conflict, but to aggression. If they feel a warm attitude toward themselves, then their behavior will naturally “go within the framework.”

"Know-it-alls."In essence, these are valuable employees, but they behave so defiantly that those around them develop a feeling of inferiority. It should be remembered that they rarely agree to admit their mistakes.

1.5 Boundaries of the conflict

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

Main elements conflict structuresare:

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

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

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

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

From a sociological point of view, participants in a conflict may differ in their social status, strength, and influence. This is especially obvious in the confrontation between the individual and the state.

You can build a hierarchy of roles of conflict participants:

1)individuals speaking independently;

)groups of individuals;

)social strata;

)state.

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

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

1) ideas about themselves;

1. representations of other parties to the conflict;
2. images of the external environment, large and small, in which the conflict unfolds.

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

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

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

1.6 Forms of working with conflicts and methods for resolving them

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

Rice. 3. Manager’s actions when resolving conflicts

Studying the causes of conflict↓

Limiting the number of participants in the conflict↓

Conflict analysis↓

Conflict resolution

There are three points of view regarding the conflict:

1.the manager believes that the conflict is unnecessary and only causes harm to the organization. In this case, eliminate it in any way;

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

.Managers who adhere to the third view believe that conflict is not only inevitable, but necessary and potentially beneficial. For example, it could be a labor dispute, as a result of which the truth is born. They believe that no matter how big or how well an organization is managed, conflicts will always arise and this is a completely normal phenomenon.

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

Rice. 4. Conflict management

Ways to overcome (resolve) conflicts

PedagogicalAdministrativeConversation, request, persuasion, clarification of work requirements and unlawful actions of those in conflict and other measures of the educational aspect. Forceful resolution of conflict - suppression of the interests of those in conflict, transfer to another job, various options for separating those in conflict. Conflict resolution based on a verdict - a commission decision, an order from the head of an organization, a court decision.

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

Avoidance, evasion(weak assertiveness is 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 his own, refraining from entering into disputes and discussions, from expressing his 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, and 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 this, he is ready to give in, neglect his own interests, strive to support another, not 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 are talking about a business decision, the correctness of which determines the success of the business, 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.

RivalryCooperationCompromiseEvasionCompliance

Having analyzed all the styles of resolving conflict situations (Fig. No. 5), we can draw the following conclusion: style cooperationthe most difficult, but also very effective, and, nevertheless, each of all styles gives positive results only 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 your personality. What is the cost of victory and what does defeat represent for another - 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 one conflict.With all the right words about cooperation,With all the criticism of unconstructive approaches to conflict, there are cases when agreement, compromise or avoidance of conflictare the only possible course of action. Sometimes it is important to simply understand, accept and help a person, and not succumb to his aggression.

Thus, the conflict can be managed in such a way that its negative consequences can be minimized and its constructive possibilities enhanced. This means that conflict is something that can be worked with. Conflict management is a targeted impact on eliminating the causes that gave rise to a conflict or on correcting the behavior of participants.

Solving a problem involves recognizing differences of opinion and being willing to listen to other points of view in order to understand the causes of the conflict and resolve it in a way that is acceptable to all parties. The one who uses this strategy does not try to achieve his goal at the expense of others, but looks for the best solution to a conflict situation. Here are some suggestions for using this management style when resolving conflicts:

ü define the problem in terms of goals rather than solutions;

ü Once the problem is identified, identify solutions that are acceptable to both parties;

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

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

ü During communication, create a positive attitude between those in conflict towards each other, showing sympathy and listening to the opinions of one and the other side, and also minimizing their expressions of anger and threats.

There are other ways to resolve interpersonal conflicts:

coordination- coordination of tactical subgoals and behavior in the interests of the main goal or solution of a common task. Such coordination between organizational units can be carried out at different levels of the management pyramid (vertical coordination), at organizational levels of the same rank (horizontal coordination) and in the form of a mixed form of both options. If coordination is successful, then conflicts are resolved with less cost and effort;

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

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

The main task of a leader is to identify the conflict and “enter” it at its initial stage. It has been established that if it enters into conflict at the initial phase, it is resolved in 92%; in the rise phase - 46%, and in the “peak” stage, when passions are heated to the limit, conflicts are practically not resolved or are resolved very rarely. When all forces are devoted to the struggle (the “peak” stage), a decline sets in and, if the conflict is not resolved in the next period, it grows with renewed vigor, since during the recession period new forces can be brought into the battle and new methods can be applied.

Preventing conflict, sometimes called “prevention” as a way to avoid it at the very beginning, is possible only in the case of a very successful use of manipulation, which gives an effect only for a while, and essentially does not eliminate the conflict, but temporarily drowns it out. In this case, it will manifest itself later, and it is unknown whether this will be more beneficial to the initiator of the manipulation, since then an escalation of the conflict that is destructive in the form of manifestations will follow (and cannot but follow). However, for the head of an organization who expects his rapid career growth (as for other political leaders), sometimes it is “beneficial” to silence the conflict, not allowing it to manifest itself during the period of “activity” in this position. Long-term pseudo-containment of the conflict is also possible. But in this case, significant resources are required. Moreover, this actually means creating a crisis.

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

The term “conflict resolution” is usually used in two meanings: as the cessation of a conflict by the participants themselves and as an external influence on the conflict (the very conditions of conflict interaction, its participants), based on identifying and neutralizing its causes and preventing open clashes between the parties.

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

1.7. Team management styles. Mediation

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, consequently, the likelihood of developing conflict situations.Many leadership theories have been developed, most of which are built around management styles: authoritarian, democratic, liberal.

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

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

Democratic style is built on the basis of business and personal authority . The manager prefers the active participation of employees in decision making. Takes care of the development of the personality and business initiative of his subordinates, often seeking advice and listening to the opinions of employees; he himself is an innovator, but also supports the initiative of others. Serves as an example in everything, often celebrates successes, praises performers, is approachable, optimistic, and polite. Does not reveal his superiority in any way, reacting correctly to criticism.

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

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

Liberal stylemaintains a steady downward trend in management efficiency. Despite the positive aspects of this style: attention to the person, the opportunity for implementation, the lack of petty control, the negative consequences can be complete anarchy, familiarity, and so on.

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

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

Unofficial mediators- these are people whom you can turn to for help due to their education or extensive experience: representatives of religious organizations, psychologists, lawyers, social educators.

In the role spontaneous mediatorsThere may be witnesses to the conflict, for example, work colleagues, but in this case we cannot talk about professional help.

Conflicting parties should resort to the support of mediators if:

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

the parties initially defend opposing interests;

one of the parties suffered serious damage;

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

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

Mediators can act as:

. "arbitrator"which has the maximum capabilities to solve the problem, not subject to appeal.

. "arbiter"- this is the same thing, but the parties can turn to another person, disagreeing with the decision of the “arbitrator”.

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

. "assistant"organizing a meeting without taking part in the discussion;

. "observer"whose presence only softens the course of the conflict.

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

A mediator can influence conflicting parties in different ways.

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

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

The mediator uses "deal"for negotiations with the participation of both parties.

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

"Shuttle diplomacy"used by a mediator to separate conflicting parties, traveling between them and agreeing on solutions.

One of the common mistakes of a nurse organizer acting as a mediator is allowing some opponents manipulate oneselfthat is, use “emotional weapons” towards oneself, “playing on feelings”, the manifestation of which can be tears, a colorful description of one’s problems.

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

Taking part in the conflict as a mediator, the leader must follow some rules:

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

2.You cannot evaluate the conflicting parties, let the parties to the conflict do this in relation to each other;

.Confidentiality must be maintained;

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 adviser:

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 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 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 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 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. 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 health care facilities, being an extreme case of aggravation of 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.

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 the 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 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.

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 healthcare 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 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 designated 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 the legal support for 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 underwent a preliminary expert assessment of its reliability, its availability in full, and the 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 research results was carried out using various statistical processing techniques. 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 patient 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 to be 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 drugs, to perform various diagnostic tests for patients in a timely manner and free of charge using modern medical technologies, and the problems of prolonging the treatment of chronic patients outside the 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 was the preparation of a large amount 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 majority of the population. Medical personnel of medical institutions have to cope not only with the difficulties of survival in a rapidly changing society (this problem is common 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 are 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 health care institutions. If in low-conflict healthcare facilities and private clinics only 12.5% ​​and 15.6% of doctors experience difficulties in communicating with the administration, then in high-conflict healthcare facilities more than half of them (64.7%) indicated unsatisfactory relations.

At the same time, only 6.7% of doctors in low-conflict 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 health care 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 remuneration 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 during 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 treatment with quality 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 medical care.

In the sixth paragraph - “Social consequences of conflicts in health care institutions” - studies have proven that the total number of patient visits to health care facilities in the 6 months after the conflict occurred is 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 make it possible to predict 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 issues of ethics, deontology and 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 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 protection.

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 institutions, 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 institutions.”

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.

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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 interactions 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 is 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 of the components of 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 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 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 status 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 activities 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. 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 healthcare 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 the clash of conflicting internal motivations, against the backdrop of a widening gap between consumer expectations and value orientations of medical personnel.

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

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 correspond to your professional capabilities? - yes.□ - not really. C - no. P - 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. Not sure.| |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. Difficult to answer.|~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.

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. Other. .□

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. I’m 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. Middle medical staff. Fellow doctors. Heads of departments. Heads of the clinic. I don’t experience any difficulties. I’m not sure. Other.□O

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