Throughout the project conflict occurred among teams, between teams-operations leaders and in one instance, the team had conflict with us. Project progress depended on successful resolution of conflict and every shared decision making sub-process had conflict associated with it. Table 2 displays the process steps most associated with project conflict, the degree of conflict and who assisted with conflict management. The sites are arranged from least to most successful outcomes completion.
Conflict is ‘the process that begins when one party perceives that the other (party) has negatively affected or is about to affect something that he or she cares about’ (Thomas 1992, p. 563). For this study, we documented conflict when team activity became blocked. During these occasions, we often noted negative emotions, such as anger, anxiety and frustration, and ‘off-task’ conversations. We also noted that these conversations typically referred to ‘trust’, ‘respect’, or past history, such as past behaviours or performance. Trust and respect were closely related, although ‘trust’ was most frequently mentioned. These conflict issues were often associated with power dynamics: hierarchical role differences between RNs, LPNs and care aides, or formal power access to project resources. ‘I don’t think the LPNs and RNs show a lot of respect for us (care aides). Our opinion doesn’t count as much as theirs’. ‘She (operations leader) doesn’t trust us to think for ourselves. I’m afraid to say anything more to her, because it might be held against us with assignments’. ‘That’s the way it has always been. She’s always done it that way, regardless of us’. Conflict occurred early on, during project orientation, and unresolved conflict carried over or threatened other project work – a domino effect.
The shared decision making successful outcomes matrix
Table 3 is the outcomes matrix for the four sites, arranged left to right from least successful to most successful outcomes completion. Project deliverables represent successful completion of quick win action items and development of longer-term, strategic workload initiatives. In this project, quick wins were workload action items of high value to staff which teams could complete quickly within a few months. To achieve early project successes and raise staff awareness, we encouraged teams to initially address quick win action items. We also promoted teams’ ability to engage in strategy discussions with their operations leaders around workload issues, such as staffing plan processes, which required more planning and commitment from the operational leaders. Team pride is based upon team member statements, such as: ‘I’m really proud of what we’ve accomplished’. ‘We’re an awesome team’. As participant observers, we also had a sense of team collective identity and enthusiasm. Staff awareness and support refers to staff focus group statements, such as: ‘The project team did a survey and followed up on a lot of things of concern to us’. ‘I hope this is just the start of more nurse involvement for our unit’. We validated staff comments with team comments, such as: ‘The staff knows what we’re doing, and they’re supporting us’. Operations leaders showed project support and enthusiasm through statements such as: ‘I definitely support nurse autonomy, and this project has provided a means to that end’. Sustainability refers to statements from operations leaders that project work would continue beyond the funding period.