Zapping Conflic
In the Health Care Workplace
By Judith Briles
www.MileHighPress.com
© 2003, 2008 The Briles Group, Inc. All rights reserved. No part of this book may be reproduced in any written, electronic, recording, or photocopying form without written permission of the publisher. The exception would be in the case of brief quotations embodied in critical articles or reviews and pages where permission is specifically granted by the publisher.
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Also by Dr. Judith Briles
Stabotage! Dealing with Pit Bulls, Snakes, Scorpions & Slugs in the Workplace (2008)
Money Smarts—Personal Financial Success in 30 Days!
The Confidence Factor—Cosmic Gooses Lay Golden Eggs
Stop Stabbing Yourself in the Back
Woman to Woman 2000
The Briles Report on Women in Healthcare
10 Smart Money Moves for Women
Smart Money Moves for Kids
Divorce—The Financial Guide for Women
GenderTraps
The Confidence Factor-How Self Esteem Can Change Your Life
When God Says NO
Money Sense
The Money $ense Guidebook
Raising Money-Wise Kids
Woman to Woman
Judith Briles’ Money Book
Faith & $avvy Too!
Money Phases
The Woman’s Guide to Financial Savvy
The Workplace
Self-Confidence and Peak Performance
Co-Authored Books
The SeXX Factor
The Dollars and Sense of Divorce
The Workplace
Table of Contents
Part I: What’s What in the Workplace
2. The Survey Speaks—What Respondents Say About Conflict
3. The Survey Speaks—What Repondents Say About Sabotage
4. The Workplace in Conflict Caution: Women (and Men) at Work
5. Why There is So Much Undermining, Undercurrents and Conflict
6. Conflict Creators, Saboteurs, Bullies & Other Toxic Co-Workers
Part II: Thriving in the Workplace
7. Shift Happens—Change is Work
8. Speak Up, Speak Out or Speak Not
10. Not Everyone’s Friend Material
11. Red Ink Behavior—the Curse of the Workplace
14. Star Teams—Their Players & Employers of Choice
15. The Round Up—10 Steps to Zapping Conflict
Speakers and Consultants Who Deliver Results
Preface
We all know it exists. Most of us have experienced it. And, some of us practice it. Conflict, sabotage, backstabbing, backbiting, gossip, and other undermining behaviors are alive and well in the workplace. That’s the problem. Exposing these toxic behaviors and outlining how we can stop them is the purpose of this book. In today’s workplace, Conflictitis is spreading.
For many years, I have been asking women and men to tell me about their experiences with sabotage at work. My primary interests are in learning more about women’s experiences and how women stop destructive patterns. I have found as I crisscross the country, speaking to approximately 20,000 plus healthcare professionals a year, is that women (and men) working in a variety of professions consistently report that they have been undermined more by other women than by men. They also report a substantial increase in the amount of conflict and sabotage as well as a reported shortage of personnel in many areas.
The increased levels of conflict and sabotage that the studies used for this book reports are key contributory factors to personnel shortage.
Why might this be so? I believe that sabotaging is a learned behavior. In itself, a misplaced attempt at workplace survival, and is not a genetic trick of nature. I also believe that with education, awareness, and commitment, sabotage cannot only change, it can be eliminated. Once sabotage ends and real support begins, women and men benefit emotionally, physically, and financially. Their coworkers do likewise.
Conflict. It exists and is normal in a workplace. What is abnormal is ignoring it, hoping it will go away. It only festers. Conflictitis can be defused and resolved.
In this book, I turn once again to women and men employed in health care, one of the most female-dominated work settings globally. The healthcare industry provided over 12 million jobs post 2000 in North America alone. Over 70 percent of those positions—7,000,000 plus jobs—are held by women. Over 2.5 million nursing positions are available, with 93-97 percent filled by women. In dentistry, staff and hygienists will fill an estimated 1,000,000 jobs. What might a look inside the healthcare industry tell us about surviving and thriving in any work setting? Read on.
The Origins of This Work
In the winter of 1992, 1 had just completed the second presentation of a two-part program at the Glens Falls Hospital, in Glens Falls, New York. After the evening program, several organizers and participants and I met at a restaurant in neighboring Sarasota Springs. The house specialty was pizza. It was delicious, but the conversation that followed was even spicer.
My dinner companions held various positions within their hospital. They were clinical specialists, staff nurses, and nurse executives. While sharing food and stories that evening, Kathleen Kennedy, the vice president for nursing at the time, encouraged me to undertake the study that would become the basis of my first healthcare book, The Briles Report on Women in Healthcare (Jossey Bass, 1993).
The health field would provide quite a laboratory, we reasoned, when so many employees—especially those at the bottom rungs of the career ladders—are female. Here inside our hospitals, clinics, doctors’ and dentists’ offices, and the like, how did women (and men) really work together? Would they support each other because they saw themselves as caretakers with a vital, indeed, a life-anddeath-public trust? Would the service aspect of working in healthcare make a difference? The question—would levels of conflict that I had found in other work settings be repeated in healthcare? Would women workers in healthcare undermine each other more than my earlier work in the generic workplace had found?
Several of the women sitting around the table eating pizza and talking about their work experiences that night in 1992 said they thought that backstabbing and undermining behavior had increased over the past few years. Terms like abuse and assault were used openly and freely. Neither of those words had surfaced in my previous interviews or surveys of the general workplace undertaken in the 80s. I made a note to ask other women about this, too.
That note became the seed for that first book on the health care field, and as I left my colleagues in New York that night, I was determined to begin a new nationwide study of working women, one focused on healthcare professionals. Over the next year, I continued to talk and listen to women in healthcare. I conducted interviews, a survey, and numerous workshops. The results of that study were the subject of the first book that exclusively focused on conflict, sabotage and workplace behavior, The Briles Report on Women in Healthcare (Jossey Bass, 1994).
Almost a decade later, it made sense to readdress the topic and take a pulse as to where the healthcare workplace was today. Over 3,000 women and men participated in the two studies used for Zapping Conflict in the Health Care Workplace. To offer a quick overview, let me say that I found sabotage and conflict had increased, and that there were basically two reasons for the increase in behavorial sabotage: women were more aware of what sabotaging and undermining behavior was and were willing to identify it; and, women are the least likely to have seniority or authority in their workplaces, and so any reorganizing or changes within the organization will be likely to affect them first.
The reasons for the reported levels of increased conflict varied—depending if you were staff or a manager. Managers viewed the primary reason for the increase in both as “change.” Staff disagreed—they felt that the primary reason was that management didn’t communicate clearly, timely or effectively; and that goals and objectives were indistinct. Staff also felt strongly that the significant reductions in training budgets were contributory factors; management didn’t think it was a big deal.
The second part of the book offers tools and strategies to help stop conflict and sabotage and enable women (and men) to work together in a healthy environment.
It’s Not the Shortage of Nurses . . . Stupid!
In 2002, the Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention was released by VHA, Inc., a Texasbased health alliance that represents 26 percent of the nation’s community hospitals. The study included 1200 health care professionals—nurses, physicians and executives at various VHA facilities. Not only did respondents report that they had observed disruptive behavior by physicians toward nurses (92 percent), 30 percent of the nurses within the survey knew of at least one nurse resigning her position because of the behavior.
The VHA study found that disruptive physician behavior and the underlying institutions’ responses were key factors to a nurse’s morale and her decision as to whether to stay in her position or not.
Since the early nineties, I’ve known from my previous studies and from the thousands of health care professionals interviewed and trained, that a large percentage of nurses had left employment because of sabotaging behavior and workplaces riddled with conflict. At every presentation and speech I made, nurses approached me and shared that they had left a previous workplace because of abusive behaviors. They had quit their jobs because they couldn’t stand the level of undermining behavior from co-workers and managers. Yes, physicians could be a pain in the tush, but they weren’t the primary reason why they quit.
My experiences and interviews didn’t reflect what the VHA report had. Although the first edition of this book was at the printers when the study was released, I felt it was important to do a follow-up survey of my own relating to terminating employment and the cause. The presses were stopped to process a new survey and referenced below (a costly venture for any publisher).
Over a two-week period in August of 2002, 1338 health care professionals replied to the survey generated from my website. The largest sector came from nursing (62 percent), followed by managers/administrators (28%), health care educators (4 percent) and dentistry (6 percent). The questions and responses were—
• Have you ever resigned from an organization or transferred to another department because of abusive behavior? —45 percent said yes.
• Was the behavior bullying, sabotage, harassment, other, or all of the above? The majority said all of the above (48 percent).
• Was the behavior generated from managers/administrators, co-workers or both? Forty-seven percent said it was from managers/administrators; 17 percent from co-workers and 31 percent from both (5 percent didn’t answer).
• Would you consider working for the organization again if the abusive parties were terminated? Fiftytwo percent said yes and 48 percent said no.
• Of the 48 percent who said no, a variety of reasons were given. The majority (41 percent) reported that the problem was too invasive in the organization; 24 percent felt the problem was poor leadership and management couldn’t manage; 22 percent said that it wasn’t worth it; and the remainder was split between the erosion of their confidence, tarnishing their reputation and the damage to their credibility.
These responses are incredibly telling. First, the reported nursing shortage is not a true shortage because of lack of personnel—nurses are choosing not to work in nursing. Second, if leadership of an organization would acknowledge that there is conflict, sabotage and bullying within their organization, they could work at resolving it. And third, if they choose not to address it, deal with it and put an end to it, their organizations will continue to lose good people. The cost—millions of dollars a year in replacement and training costs.
ZAP Tip The key factor to the nurse shortage
is NOT that there aren’t enough nurses. The key factor is that there is too much bullying, sabotage, undermining and conflict in their workplaces. Until management, and nurses themselves, confront the abusive behavior and create a no tolerance zone, the shortage will only continue to increase. It’s not the lack of nurses; it’s the accepted and tolerated rotten behavior of co-workers, managers, and administrators. The health care toxic workplace must be changed. ZAP it . . . Now.
The Next Study
In 2007, another study was undertaken for Stabotage! Dealing with Pit Bulls, Snakes, Scorpions & Slugs in the Workplace (Mile High Press 2008). Preliminary results of over 1,000 respondents (93 percent female) show that over 50 percent state that sabotage and abusive behavior has increased in the past five years; 70 percent said the abuser was a woman and most likely to be a manager.
This means conflict is alive and well. It’s at a higher level than the two studies that were initially used for this book. It is also disheartening to hear that the percentages for the perpetrator to be from management were higher than previous studies reflected.
When abusive behavior is present, the recipient loses respect for the organization, management, her productivity declines and she actively begins to look for other work. Of those who left their workplaces, over 50 percent said that they wouldn’t return to the previous workplace, even if the offending party was terminated.
None of this is good news for the health care workplace. Until management deals with abusive behavior and creates a no-tolerance zone for both managers and staff alike in its creation or choosing to ignore it, excellent employees will exercise their walking papers. Good pay does not offset a toxic environment.
Audience
This book is written for several audiences, including men. Employees and managers in all fields will recognize themselves and their colleagues. They will want to change their workplaces—for themselves and for others. By recognizing conflict creating, sabotaging and other unacceptable behaviors in others (and in themselves), the reader will identify appropriate ways to change destructive interactions. It is they who will start the true transformation of the toxic workplace into a thriving community.
Judith Briles
Fall 2007
Part I: What’s What in the Workplace
I didn’t want to believe it was happening. It was one of those times in my life that I didn’t listen to myself. I kept pushing it down, saying, “This isn’t true. It can’t be happening. She’s really not like this.” When I finally opened my eyes and ears, I found that everything she did was for her own benefit. There really wasn’t any effort to do anything as a team member or a partner.
Brenda, a Midwest RN
1 Setting the Stage
Conflict and sabotage are flourishing in today’s workplace. The quote from the previous page was from a nurse that was surveyed for my first book that focused exclusively on the health care industry. The topics were sabotage and conflict. A decade later, not much has changed. The comment still holds true. Unfortunately.
Is there more conflict in today’s workplace? Yes. Should (and could) there be less conflict in today’s workplace? Absolutely. Could the workplace be more collaborative? Yes again. And, is there a reasonable, non-costly way to reduce the shortages that many fields under the health care umbrella face today? You bet, and you don’t need to have a PhD in anything to figure it out. What is needed is common sense, willingness to acknowledge the components and players in the problem and a dose of guts to resolve it.
Since the mid-eighties, I’ve researched workplace issues some in a general workplace where there is a fairly equal number of males and females employed and others where one gender is in the great majority. One of the most prominent one-sided workplaces is health care. Within the health care umbrella, nursing is the most female dominated branch; dentistry highlights dental hygienists and assistants as being the most female populated category.
When I first explored that question of conflict and undermining activities in the workplace in the mid-eighties, I created a survey that went to 1,000 women and 1,000 men in 1987. The results were published in Woman to Woman (New Horizon Press). They produced a major brouhaha in working women’s circles. Why?—they showed that when it comes to unethical, undermining, sabotaging behavior, men do not discriminate: they behave unethically toward both sexes, in equal measure. Their style of being unethical is also different from women’s: men are more overt, and very direct; they let you know if they intend to undermine you.
But if a woman is going to be unethical and unsupportive, and if she displays other types of sabotaging behavior, her target is more likely to be another woman, and her style is likely to be covert. Sometimes her target doesn’t even know where the sabotage has come from.
When these results were released to the media, such women’s magazines as New Woman, Working Woman, McCalls, Redbook, Family Circle, Ladies Home Journal and Cosmopolitan ignored these findings. Glamour, to its credit, was different. The editors of Glamour decided to query their readers in a survey of their own. I supplied my data, the results, and the questions asked. They asked similar questions of their readers and their findings were published in June 1988. The editors were surprised. I wasn’t. Glamour’s readers agreed with my study.
With another source confirming my results, I felt that the problem of women’s undermining other women would move from being a taboo topic to being one that could be addressed, discussed, and resolved.
Four additional national surveys have been completed since 1987. The latest was completed in 2002 and used as the basis for this work. All focused on women and men in the workplace. The surveys in 1994 and 2002 viewed health care exclusively. The first was generated when several directors of nursing from hospitals in different regions of the United States asked me to do a study that exclusively looked at them—health care and nursing. Those results, from over 1,000 respondents from the nursing sector were upsetting. Over 75 percent stated that they had been undermined by a woman in their workplace, a 45 percent increase from the initial study done in 1987 of the general workplace.
These results were published in The Briles Report on Women in Health Care (Jossey-Bass, 1994), and negative comments surfaced, primarily from nursing-related journals. One in particular, Rehabilitation Nursing, questioned the data and the methodology. The editor, in her column, wrote,
My initial reaction to what I was reading was uneasiness. Can it really be true that nurses sabotage other nurses? We’ve heard for years the saying that “nurses eat their young,” but the undermining behaviors described by Briles were not reserved for the young!
I tried to dismiss Briles’ conclusions by disparaging the study methodology; it’s easy to say that the study wasn’t sound, therefore we can’t trust the conclusions.
The whole book presents a dismal outlook on relationships between colleagues, whether on a peer level or in a supervision/subordinate situation. Can this really be the way things are in nurses’ workplaces?1
She ended her column with a question: “How is it where you work? Your stories will help validate—or refute—the Briles study.”
Taking Off the Rose Colored Glasses
To say that her readers’ responses were overwhelming, and dismaying for her would be an understatement. In the following spring’s journal (1996), she wrote,
Wow! What a response I received to my editorial about Judith Briles’ book on the toxic work environments of women in health care professions. I wanted to believe that things are not as bad as Briles concluded. I asked, ‘Am I wearing rose-colored glasses?’ I urged readers of Rehabilitation Nursing to let me know whether conditions described by Briles are typical of nurses’ workplaces. Apparently—and sadly—they are.
One individual who responded to my editorial assured me that ‘this type of behavior started about 5 to 6 years ago and at this time is beyond belief.’ Another noted, ‘I could provide countless examples of backstabbing, undermining and manipulation.’ Still another wrote, ‘We both see and experience evil deeds by rogue nurses in the workplace.’
I read these accounts with a growing sense of disbelief that nurses in particular, or women in general, could be in the way described. But, I kept returning to example after example. Not once did I note a positive example!2
The editor went on to say—get Briles’ book and follow her suggestions and recommendations for dealing with sabotage and conflict in the workplace. Good news to any author. As a side note, I contacted the national office for this nursing group the same year, referred to the editorial and offered to waive my speaking fee and come to their annual meeting and do a hands-on workshop for their members. They said, “No, your topic doesn’t fit with our program.”
Another survey in 1996 contained the voices of 5,000 women; women who stated that being undermined by another woman and conflicts created by them in their workplaces were the third greatest problem they encountered (prejudice and miscommunications were numbers one and two.3 These same results were reflected from another survey involving 5,000 respondents in Woman to Woman 2000—Becoming Sabotage Savvy in the New Millennium in 1999.4
No other industry has gone through the dramatic changes that health care has over recent decades. The words health care and change are synonymous. When change is in play, a greater degree of conflict surfaces and is energized in the process. Most people aren’t thrilled with lots of change and certainly not with an organization that is riddled with conflict—going to work is not a joy.
Health care has a problem—a major one. In the midnineties there was almost a slash and burn mentality— departments downsized, or were eliminated; mergers of facilities and departments at the drop of the hat (with many breaking up at a later date because of the wrong fit); administrators and executives replaced by bean counters; and for nurses—lay-offs were common-place.
Today, many look back and acknowledge mistakes. The wrong people were let go; certain departments weren’t synergistic with each other; fancy names created by PR and marketing groups for the new marriage never took; as for nurses—more, please send more. During the Olympics of 2002, Johnson & Johnson rolled out a $20,000,000 campaign supporting nursing, encouraging viewers to choose nursing as a career. Nurses everywhere cheered, “Bravo!”
The field of dentistry wasn’t blessed with a $20,000,000 boost in advertising from a pharmaceutical company as nursing was—there, too, a shortage exists, especially with support staff. Shortages are expected to grow over the next decade as more and more support staff (including dental hygienists, assistants and clerical) are choosing part time over full time work.
Summing Up
My speaking, training, consulting and writing in the health care field told me that lots had to be done in order to attract bright and dedicated women and men to nursing. I too exclaimed a “Bravo” to the folks at J&J, but nursing, dentistry and health care in general need more. Daily, I get e-mails from women (and men) nurses who are choosing to leave the profession. Why? Simply this—they can’t stand the level of conflict and sabotage within their workplaces . . . from co-workers as well as supervisors. They love their work; they hate their workplaces.
From the beginning of my study of this national problem, the growing areas of conflict and sabotage needed to be addressed. As the pioneer of the topic of sabotage among women in the workplace, my first book focused on it, Woman to Woman—From Sabotage to Support (New Horizon Press 1987). That was after 28 rejections from other publishers who didn’t think the topic was relevant or newsworthy. Fifteen plus years have passed, with international coverage from The Wall Street Journal, Time, People, even that bell-weather of gossipy news, The National Enquirer and 1000 radio and TV shows to date, those editors and their publishing houses were dead wrong. Sabotage and conflict among women was and is major news.
Post 2000, several books have been published by the same publishers who rejected Woman to Woman: From Sabotage to Support—from Susan Murphy and Patricia Hein’s In the Company of Women and Phyllis Chesler’s Women’s Inhumanity to Women, each claiming to be ground-breaking and the “first”. Suddenly, women’s undermining other women is big news. One side of me welcomes the company to the small circle of courageous authors and publishers who are willing to tackle a dicey topic; the other side says, “What took you all so long?”
My only complaint is that it would have been nice to be acknowledged for being the first who did a study, published it and has spent over a decade increasing workplace awareness to the problem nationally and internationally.
At this point, I felt it was critical to “officially” revisit the health care scene, a female dominated workplace that has an added hot potato to the topic—patients. When women don’t support other women, when women created conflict and sabotage because of old baggage and behaviors they create and embrace, patients are in jeopardy. With the completed new study, another book was birthed. It’s now in your hands.
2 The Survey Speaks—What Respondents Say About Conflict
Since my first book that focused on conflict, and undermining and sabotaging activities, I’ve criss-crossed North America speaking on the topic . . . and listening to women and men talk about their workplaces. I’ve heard the good, the bad and the ugly . . . the very good and the very ugly. Truth be told, comments about the ugly outweighed the good.
In the 21st Century, conflict is very much alive and unfortunately, doing quite well in its expansion activities. Most say,
Yes, we know there is bad behavior and conflict among staff, doctors, administrators, even the patients and their families agree with us often.
Simple enough. I then ask what steps are they taking to reduce and eliminate rotten behavior and conflict within their facility. Silence. Stammering. I’ll get back to you. Etc., etc., etc. You would have thought that I had asked them to strip naked and be the lead majorette or major in the local July 4th parade! Being snagged in the headlights of life is rarely fun. It’s a defining moment for all—leader, manager, support staff.
Conflict is when two or more people assume opposing and different positions in a situation or circumstance. The expression of the difference can be verbal or non-verbal and can be overtly or covertly presented. If conflict is not resolved within a timely manner, morale dives, loyalty diminishes, teams are splintered, distrust grows and turn-over increases.
Ongoing conflict costs an organization multimillions of dollars a year in lost productivity, search fees and training costs for replacement of personnel.
If conflict is not truthfully addressed, it can mean the difference between black and red—black meaning you have funds in the bank to continue your activities and work environment and red meaning . . . trouble; you are losing big money and your survival may be dependent on another’s pocketbook, as in a merger and take-over.
All is Not Well in Health Care
The present results for this latest book again showed that all is not well. This time, focusing on conflict, some of the questions I asked included—
• Is there conflict in your workplace?
• Has it increased, decreased or not changed in the past five years?
• What do you think the reasons for the change (if any) are?
• Do different generations handle conflict differently?
• How does your manager or co-workers handle conflict?
• How do you react when conflict occurs? • How do you rate yourself when handling
conflict?
When it comes to conflict and sabotaging behavior, men do not discriminate: they behave unprofessionally toward both genders, in equal measure. Their style of creating conflict and undermining activities are also different from women’s: men are more overt, and very direct; they let you know if they intend to undermine you. Few surprises are directed toward the intended target.
But if a woman is going to be unprofessional and a conflict creator, and if she displays other types of sabotaging behavior, her target is more likely to be another woman, and her style is likely to be covert, indirect. Sometimes her target doesn’t even know where the sabotaging behavior has come from. Lots of surprises.
Survey Respondents
The 2002 survey respondents solely came from the health care field—nurses, doctors, directors of women’s centers, vice presidents of nursing, educational departments, employees of pharmaceutical and other health related organizations, at randomly selected hospitals as well as on my website, www.Briles.com. At the time of the survey, 3,000 individuals received notice of a survey designed with ten questions. One set was for managers/administrative individuals to take and another set with the same questions for employees to take. Each questionnaire was accompanied by a cover letter.
Of the 3,000 surveys sent out, 1,670 were returned by the cutoff date. An additional five percent were received after the cutoff date but were not included statistically; in a post-evaluation, they, however, revealed the same type of responses as in the surveys received before the cutoff date. Of the 1,670 surveys, 317 were returned by men. The largest number of responses from individual states came from Colorado, California, Iowa, Florida, Louisiana, Michigan, Texas, and Ohio.
The Latest Findings
Back in 1994, 71 percent of our female respondents reported that they had been undermined by another female and 58 percent by a man; 20 percent of the male respondents reported that they had been sabotaged by a woman with an increase to 60 percent by another man. In 1999, I took another look at conflict and sabotage in the general workplace, this time with 5000 respondents from multiple work environments (Woman to Woman 2000, New Horizon Press). Only five years had elapsed and the level of undermining behavior had not decreased, it increased. In the health care sector of that survey, the percentage (34 percent) reporting undermining and conflict activities increased to 81 percent. As the 2002 survey showed, sabotage and conflict has not gone away, it has only intensified.
It’s not unusual for potshots to be directed at any type of research. Purists would like to see multiple types of testing done that measure null hypothesis to populations that include mega thousands. I know, I’ve been there. In the past, I’ve done multiple national surveys that included testing for significant differences in various populations for both my Masters and Doctorate in Business Administration degrees. Elements included were engaging outside organizations that specialized in gathering data; random calling and mailings involving thousands using selected databases that were relevant to the population; distribution to all members of an entire association; and distributing written surveys during a six-month period to my audiences. At all times, respondents were able to use multiple selection of possible answers, including sections for writing fill-ins. Surveys were followed up with one-on-one interviews.
With advent of the Internet, times are changing. Researchers and probers like myself can reach thousands in a very short period of time. What’s fascinating about the Internet is that surveys can get directed to more venues than can be imagined.
The Conflict Survey used for this book was distributed in three ways. First, it was posted on my website, www.Briles.com and announced to approximately 3,000 email addresses that had obtained various articles that I’ve written and are posted on the site. Second, I was routinely asked by managers within hospitals and offices if they could print the survey out and have their teams take it—the answer was always yes with a request to mail or fax results to my offices (many did). And third, many respondents emailed colleagues to go to the site and take the survey. At my cutoff date, 1670 women and men had responded. The responses received after the closing date paralleled the others already analyzed.
The theme of conflict was woven into every question of the survey. The first question asked was, Has conflict increased, decreased or has there been no change in the respondent’s workplace? The overwhelming majority said yes, it had increased with 85 percent of the managers/administrators and 88 percent of staff reporting so. None of the staff had said it decreased (7.5 percent of managers/administrators replied it had) and 12 percent of the staff reported no change with 7.5 percent of the managers/administrators stating the same.
I’ve been speaking within health care for over 15 years and strongly believed that conflict and sabotaging activities had increased from the ongoing dialogues with conference and in-hospital personnel as well as from the input of several of the speaker-trainers that are in my network and whom I routinely encounter at health care conferences. Many of them have graciously taken their time to review the results and given feedback. Their thoughts and comments appear throughout this book as well as their contact information at the end of the book under Speakers and Consultants Who Deliver Results.
My next question was simply, Why—as in why has conflict increased? Respondents were able to choose multiple reasons and write in additional ones.
Comments on causes will be looked at in depth in other sections throughout Zapping Conflict in the Health Care Workplace.
Who’s Who?
Who was who in our survey? Nineteen percent were male and 81 percent female, not surprising for a health care sampling. Of the entire total, 57 percent identified themselves as employees-staff and 43 percent management-administration. Very few of the physicians and dentists (5 percent) in the sample consider themselves as managers or administrators—they either were employees of an organization or they hired others to fill that function in their offices.
Breakdown of Respondents
Male 19% (317)
Female 81% (1353)
Staff Nurse 43% (719)
Physician-Dentists 5% ( 83)
Manager-Administrator 42% (701)
Other (technicians, educators, clerical dental 10% hygienists, assistants) (167)
Women and Men and the Generations Are Different
When it comes to dealing with conflict and sabotage, women and men tackle the problems in different ways. So do the different generations. The GenXers and Yers (or Millennials or Nexters, depending on who you talk to) aren’t afraid of confronting conflict and sabotaging behavior, where the Boomers and Maturers (aka Veterans) would rather it just go away. One of the biggest differences that was acknowledged by respondents was that the younger generations weren’t afraid to deal with it, but their people skills were sorely lacking, thus offending many in their path.
Researchers see a significant difference within the generations. Robert Wendover is the CEO of the Center for Generational Studies in Colorado. Wendover reports that the generations, specifically the GenXers and Baby Boomers, have a very different take on handling conflict,
GenXers are very outcome oriented, Boomers are task oriented. GenXers don’t understand why Boomers put energy into tasks where an outcome isn’t created and measured—it’s a waste of time for them. When it comes to an issue that is generated from conflicts, their style is to jump in—decorum and diplomacy aren’t their strengths.
With conflict, managers and administrators were more inclined to feel that it was caused and created in a variety of areas that they couldn’t control—mergers, downsizing, workforce not being committed, too much change, turnover and confusion, and employees being incompetent.
Staff narrowed the primary cause of conflict to management being unclear with goals and objectives for the organization and their respective departments, followed by employees being underpaid, educational training reduced, management being incompetent, and confusion (see Figure 2.2).
Denial and Realty . . . Can They Co-exist?
We asked several questions about how conflict was handled— employee to employee, manager to employee and employee to manager. We also asked each respondent how they rated in handling conflict.
Beginning with, How do your employees handle conflict? and How does your manager handle conflict?, we found that a significant percentage of the managers felt that their staff and employees jumped in too soon before they knew what the facts were (46 percent) and 12 percent of the employees declared so. Employees and staff, on the other hand, thought that their managers ignored conflict (36 percent) where only 11.5 percent of managers admitted to ignoring it. Interestingly, 20 percent of the staff respondents believed that the managers and administrators created it.
When asked, What happens when there is conflict within your area of management or workplace?, variances also were apparent. The majority of the managers claimed that they acted as mediators (69 percent) and less than 10 percent reported they ignored it. Staff/employees had a different take about their managers, 36 percent said the managers
ignored conflict (see Figure 2.5). Fifteen percent of the managers told their employees to settle their differences.
Staff respondents had two areas that dominated their responses. They reported that they told co-workers to settle their differences (56 percent) and over a third of them confessed that they simply ignored it in their workplaces (34 percent). Staff was not inclined to act as a mediator with only 2.5 percent saying they took that role and very few of the staff respondents told co-workers to stop it by telling them what to do. None of the managers said that they told staff members how to stop it by telling them what to do.
How you believe you personally handle conflict can be quite telling, especially when you get input from others. It’s not surprising when the outside looking in doesn’t mirror the inside looking out. When our respondents were asked how they personally handled conflict, most gave themselves an “OK” to “great” rating. In looking at the both Figure 2.5 and 2.6, it’s clear that neither the managers or the staff get high marks.
The Cost Factor
A few years ago, I had a consulting contract with the mother ship of a hospital system. I was appalled at the level of duplicity among several of the staff, right under the noses of the senior administrators. The reported actions of the staff members toward others within the staff didn’t surprise
me nor did the overall inattentiveness to the problem from bosses and administrators—nothing was really new. I’d heard about it, seen it, and experienced it repeatedly since I had focused on the health care workplace in the early nineties.
After multiple interviews and training sessions, I wrote a detailed report and made recommendations on how to deal with the three women who were the primary creators of the conflicting behaviors among the 15 women who worked there. The administrators were told that if they didn’t deal with it fairly quickly, they would lose several key employees.
What happened? Nothing, absolutely nothing. Well, nothing with my recommendations. Within their office, several key employees tossed in the towel and said, “I’ve had it . . . enough is enough,” and sought work elsewhere. When will management learn?
The costs are huge. Employees and staff members re-
ported that it took them two to four times as long to complete their work, their morale nosedives, loyalty is diminished and their work becomes just a job and another paycheck. Recruiters will tell you that it could take an entire year’s salary to replace someone.
Replacement is not pocket change—ongoing conflict and sabotage that is not acknowledged and dealt with costs individual health care organizations MILLIONS of dollars each year.
The Cost—His, Hers and the Organization
Significantly, men and women not only have different styles of conflicting and sabotaging behaviors, but the results of their action also are different. Male and female victims have different experiences. It’s as if the men and women are playing in different ballgames; not only are the rules and players different, but so are the strikes and fouls. How? When men sabotage or create conflict with another, the effects are usually fairly straightforward—a loss of money or a lost promotion. In our survey, women are much more likely to be guilty of other less tangible costs, including causing their victims embarrassment or
damaged reputations. Why such differences? Again, it probably goes back to
the different agendas of men and women and what is more important to each. Men tend to be pragmatically oriented: when they decide to do someone in, they do so for what appears to be more practical reasons—to get more money or to get the other’s job. They are, likewise, more sensitive to losing money themselves when they are the victim. Women focused more on emotional factors, and, to a greater extent than did men, caused their victims to suffer other losses, such as embarrassment and damaged reputations. Many women who are saboteurs leave their victims in financial binds or cause the loss of jobs. But after such a loss, the victim is more likely to feel other types of devastation than he or she would if betrayed by a man.
When it comes to damaging an organization, both men and women are successful. The biggest issue that these organizations are more likely to lose on are money, business and good employees. One of the best ways to eliminate the health care shortage gap and increase retention is to make an extensive effort to reduce the behaviors that create conflict and sabotage.
Gains and Losses from Conflict and Sabotage
Not only do men and women have different styles of undermining, the impact of their behavior toward women is different. Women reported that when they had been undermined by anyone, a man or a woman, the primary cost was embarrassment and loss of credibility. When undermined by another woman, 61 percent of the survey respondents reported so, while 74 percent reported embarrassment after having been undermined by a man. This discrepancy may be due to the male-female roles that society dictates. A woman may be more likely to feel that she must have done something to cause the other person to undermine her, particularly if the person has a higher status than she does. In most cases, the person with higher status, such as a physician, is a man. But when she is undermined by another woman, she will feel that they are on more equal footing; her reaction is more likely to include anger.
One cost area where there was a minimal difference related to gender, was in jobs and promotions. When women were undermined by another woman, 25 percent lost jobs or promotions. When undermined by a man, 23 percent lost jobs or promotions.
Women employers seemed to fare better. They stated that when the undermining behavior was performed by a woman employee, the primary cost was embarrassment, followed by low morale. When the undermining came from a man, the primary cost to the employer was perceived by women to be nothing; it was as though when a man undermined a woman, it was acceptable—no big deal.
Does society (or the workplace) expect men to display inappropriate, unsupportive, undermining behavior? Women’s responses indicated that this may be so. Therefore, there may be less severe reactions or responses to inappropriate behavior by men: it comes with the territory, it’s expected and accepted. In health care, the majority of practicing doctors, senior doctors, are still men, and most hospitals, health care associations, medical and dental practices subscribe to the premise that they are in the business of supporting the doctor’s need.
When one person sabotages another, the saboteur seeks to gain something, while the sabotaged person may lose something. In the previous studies, we’ve found that the respondents said that when they were undermined by another woman, the primary benefit (and goal) to the saboteur was an enhanced reputation, more power, or getting a promotion or job.
If the saboteur was a man, enhanced reputation or more power was the goal. Very few reported men gaining jobs or promotions through sabotage. In health care, as in business, men already occupy most positions of authority; they may not see any other gains but enhanced reputations or visibility.
Nothing was the answer that 17 percent of the respondents gave when asked what an employer gained by a woman’s unethical behavior. If an employer were to gain anything from a man’s unethical behavior, 5 percent of the respondents stated, it would be the employer’s enhanced reputation or visibility; otherwise, the majority of respondents said, employers gained nothing when men undermined them. Losses to the employer were another matter. Whether the saboteurs were men or women, loss of reputation, of employees’ loyalty, of employees’ productivity, of credibility, of team growth, and of effectiveness were all factors.
Money Talks . . .
The financial costs are unbelievable, ranging from lost productivity to placement fees for new personnel. Replacement experts and health care organizations report that replacing an employee, especially in a “shortage” environment like nursing, can range anywhere from $20,000 to $96,000, depending on location and speciality of the RN. If you have frontline turnover in a hospital of 15 percent (which many consider low and would actually like to achieve!) and have a minimum of 500 employees, turnover in the workplace can cost anywhere from $1,500,000 to $7,200,000 in replacement costs alone. A large percentage of that can be attributed to conflict and sabotage. Big, big bucks.
Now, add in the lower productivity issue. Employees reported that when unresolved conflict and sabotage are active in their areas and departments, it takes two to four times as long to get their work done. Using data from the Department of Labor for the number of women in the workplace coupled with the medium income and the reported percentage stating that they have or are experienced undermining activities, the problem grows to multi-billions a year.
Organizations are collectively losing a minimum of $38,000,000,000 a year due to lost productivity. Sabotage and conflict in the workplace is not a light-weight issue, nor should it be treated as one. Unfortunately, it is.
Summing Up
If conflict is a situation when two or more people are at opposite positions in a situation or circumstance, then the results of the Conflict Survey are certainly confirmed. In the health care environment, it’s not just co-workers who have conflicts and experience sabotage in their workplaces. Rather, conflict is woven throughout the organization. No level is immune. With the increasing levels of change that are fueled from multiple sources, conflict and sabotage will only accelerate within the workplace. Whether it’s addressed and viable resolutions are implemented will be the choice of every member within the organization. If it’s not, morale dives, loyalty diminishes, teams are splintered, distrust grows and turn-over increases.
You would wonder why an organization would choose to kiss off millions of dollars a year when investing in the “softer skills” of communicating more effectively and conflict resolution for both staff and managers could create a win-win environment. I contend that these skills are as important as the clinical ones.
3 The Survey Speaks—What Respondents Say About Sabotage
Everyone plays—women and men. Men don’t discriminate, women do. The findings from all five of my surveys (1987, 1994, 1996, 1999, and 2002) indicate that women are more likely to sabotage other women than they are men and to allow conflict to simmer without dealing with it. If a man is a saboteur, gender is not an issue; the target can be either sex. Men and women also engage in different styles: women are more inclined to be covert and indirect when it comes to sabotage and creating conflict, while men are more overt and direct.
The Dark Side
Conflict and sabotage go hand-in-hand and no book about conflict, especially in the health care arena, can ignore the dark side of the workplace where shadow movements often dictate horrendous behaviors and outcomes. A contributory
Sabotage is the erosion or destruction of your personal or professional credibility or reputation. It can be administered intentionally or unintentionally through overt or covert methods. If sabotage is not resolved within a timely manner, morale dives, loyalty diminishes, teams are splintered, distrust grows and turn-over increases.
Ongoing sabotage costs an organization multimillions of dollars a year in lost productivity, search fees and training for replacement of personnel.
factor to the dark side of the health care workplace is the overwhelming majority of women in specific areas (nursing, dental hygienists, assistants, clerical staff) and men in specific areas (administrators). A third of the women surveyed still report that if they had their druthers, they would prefer to work with men. As a woman working in health care—dream on, it’s not going to happen, not in your lifetime.
For years, I’ve pondered why women say this. The survey used for this book represents the fifth national one that included the question, “If you had your druthers, do you prefer working with men, women or it doesn’t matter.” Each time, approximately one-third of the respondents say they would rather work with men, not women. I’ve come to the conclusion that it surfaces because of the differences between men and women when sabotage and conflict exists—creating it and dealing with it. When it is done by a male, it is usually out in the open, the perpetrator even openly taking credit for the behavior and letting the victim know ahead of time what is coming. As if it were a game.
Women are different. Conflict and sabotage is not something usually carried in the brag bag. No, when it is created by another woman, it’s usually behind the scenes, similar to the wind. You can feel it, you just aren’t sure where it starts from. So, when women often say they would rather work with men, it means that at least they know what’s on the table. Still a game, but the rules are easier to understand.
Why?
Why should this be? Four key words summarize the findings: change, opportunity, power and increased competition in today’s workplace. Women are more likely to sabotage each other simply because women are more likely to work together and because they are viewed as weaker due to their lack of experience, not knowing the rules, or being naive and too trusting. Women are also less likely to deal directly with conflict. Rather, their general preference is to take it back to co-workers by discussing, grumbling or complaining about it.
In addition to power and opportunity, the ramifications of fear, jealousy, envy, and low self-esteem surfaced in our interviews. Titles usually carry a form of power—some earned, some assumed. If a man or woman is in power but has a low self-esteem, it’s improbable that subordinates or co-workers are going to be treated fairly. If a person doesn’t feel good about who he or she is or confidence in what he or she is doing, then those feelings will permeate the work environment.
The question arises: do most women follow the same style of sabotaging and handling conflict that has been traditional in the male-dominated business world? Do they create, work through or avoid conflict in their workplaces? Those questions become particularly important now. Many women feel that they are at a distinct disadvantage in getting ahead because of years of prior disrespect, discrimination and prejudice. If additional barriers are added by women to restrict other women, the resulting blockades become almost insurmountable. It’s not surprising that many in the nursing field feel that their only way to get ahead, to get paid more, is by unionizing. Maybe . . . and maybe not—it’s not a black and white issue.
It also appears that women were more likely to be motivated to sabotage another out of fear, which usually can be traced to the power imbalance of men and women. Women are more fearful, more threatened because generally they are further down the power ladder. The most common reasons why many women commit sabotage were that they were jealous, envious, or even afraid someone was after their jobs.
Men, on the other hand, were more likely to undermine another to build up their egos, reflecting this traditional male push to be assertive. Men, much more so than women, failed to give someone else credit for their work or misrepresented it as theirs. Then, too, men were usually the ones accused of sexism or sexual harassment.
Women also sabotage for power reasons just as men do. Women’s power is more generally over other women; if there is sabotaging behavior, the recipient is more likely to be another woman. Failing to give credit or taking credit for work completed by others was at the top of the behavior list, along with the spreading of wrong or malicious gossip. Victims of bullying behavior fight back, but rarely at the perpetrator. Instead, the employer is the recipient of vented feelings (or other co-workers).
Few of the male respondents reported this experience in their dealings with women. It’s not always clear if their actions were intentional, yet the great majority felt that when sabotage was happening, it was intentional (90 percent).
The person who targets another individual for downfall does so to gain certain ends. As to the reasons for such behavior, the views of the men and women surveyed differed notably. Both men and women agreed on basic motivations for a man or woman sabotaging another. Most of the time they believed the man or woman wanted more money, more credibility or a better reputation, but not necessarily all three.
Differences suggest that men and women are coming to the workplace with dissimilar rules and motivations that affect how they act and what is important to them. The men surveyed were much more likely to think the individual acted to gain money. Men are more likely to be concerned about money, and they think other men are, also.
In contrast, for women, who have been spectators or second-string players within their organizations, the crucial elements of the game are quite different. Money may be central for some, but there are many other important factors that motivate their sabotaging behavior, when they are outside the main arena. Issues such as personal esteem, reputation, and embarrassment seem especially significant for most women. Women traditionally have been concerned about their images to others, so reputation and selfesteem are high on their agendas.
For men, the main goals of business success center on bottom line factors. Most men been traditionally brought up to measure success in material terms and this credo shows in the reasons why some men are unethical to others and the losses men experience when they become victims themselves. There are other issues that come up for men, of course, when sabotage surfaces, but men in the survey repeatedly mentioned money. Women felt that the motivation for sabotaging behavior was a better reputation and credibility, especially when a woman sabotaged another woman. The difference appears to relate to the different agenda men and women have. The exception is that women who head their own practices were the most likely to report about negative money issues rather than women who were hired employees.
ZAP Tip Too many health care organizations—
from hospitals, educational institutes or offices with a physician or dentist at the helm—foster a lack of respect toward support and frontline personnel. The result is substantial— dysfunctional workplaces, low morale,
lack of trust and loyalty and high levels of unresolved conflict—all a breeding ground for sabotage and more conflict.
Saboteurs-by-Proxy and Serial Saboteurs
Two new terms/phrases were created after an interview with an East Coast based pediatric neurologist. Martha contacted me after reading my first book on health care’s toxic workplace and shared a horrendous story about a nurse on her staff who was always the last person to find/deliver the “answer” or “missing item” when chaos was in play. After several months of keeping track of and documenting actions and behavior, the doctor concluded that the nurse was creating the chaos by hiding things, so that when they were found, she (the nurse) would be viewed as vital—important and very needed in the practice. She shared, For several years, my workplace was fairly positive. We had our share of normal conflicts and they would get resolved. When cutbacks started about three years ago, my primary nurse was a case manager. Jackie did a good job. With the cutbacks, she took on the role of charge nurse for the entire floor plus her duties as the case manager.
Things didn’t work well. After a year of requests to Administration for additional help, I finally got a Nurse Practitioner to assist me. Things were no longer efficient as they had been. At the end of the day, there were still 25-30 messages and phone calls not returned.
I took a family leave of absence for a few months. My Nurse Practitioner began to have problems with Jackie in my absence. Parents were complaining that neither she nor I returned calls—we never even knew that they had come in! The pharmacy would call my office about various prescriptions, including ones that no one could recall placing.
When I returned from my leave, I focused on making my practice better. I couldn’t figure out why things weren’t working well. After months of keeping track, and documenting, everything came back to my nurse. Information I would receive from her would be incomplete or wrong. Information that I sought was often withheld or delayed. She grumbled and complained about everything, including all personnel.
One day, documents and files were missing for Grand Rounds. Both the clerk and Nurse Practitioner ripped the office apart looking for it—it was nowhere to be found. Amazingly, Jackie found it 20 minutes later and said that it had been in the Nurse Practitioner’s office all along. We all knew that it wasn’t true.