He Said, She Said, and No One Is Listening!

It started a good day, and Mike reviewed the long list of items he needed to accomplish that day. He had planned to meet with his managers to discuss the department's operational budget goals and initiate discussion about needed capital equipment to be projected for the upcoming year. Mike was the director of medical-surgical services and had six direct reports who were nurse managers over the following units: oncology, general-medical, postoperative surgical, bariatric, orthopedics, and observational (short stay). In addition to the six nurse managers, the medical director for internal medicine and the medical director for surgical services also reported to Mike. The management team was an eclectic group with very different levels of education and experience, which made for lively discussions in their team meetings. Each nurse manager brought a list of capital needs to the meeting. It quickly became apparent that there was more need than an allocated budget because Mike's service line was only one of four for the entire hospital. As the nurse managers presented their proposed capital needs, the group dynamics changed from friendly to conflicting and competitive. The orthopedics department had the longest capital needs list with the most significant dollar amount. As the other managers started to defend their list of needs, the nurse manager of the orthopedics department mentioned that his service line also contributed the most outstanding amount of revenue compared to the other departments. He used that fact to justify why his department should receive a larger piece of the allocated budget. Other nurse managers argued fiercely about their contribution to the hospital's bottom line and their department's value to the organization. When the discussions heated, Mike suggested they take a recess as a "cooling off period." They agreed to meet again the next day to finalize the capital budget plan. The next day, the nurse managers came prepared to defend their units' needs and formed a coalition against the nurse manager of Orthopedics. They had met outside the meeting and agreed that they might have more power in the discussion if they presented their needs collectively rather than individually. The nurse manager at Orthopedics also had a strategy. He had met with the orthopedics service line chief and the surgical services medical director. He asked them to join him in the meeting and indicate how important it was for Orthopedics to receive the requested capital budget items. He also presented information about the hospital's market share threat if the orthopedics department did not keep up with state-of-the-art equipment. Not long after the meeting started, it was clear to Mike that the cooling-off period had not worked but served as an opportunity to strengthen the conflict. As each nurse manager stated their case and rationale for their requests, tempers began to flare, and accusations were made on both sides. Mike realized that further discussion was not going to help resolve the conflict. Although the capital budget for his department was due in 2 days, Mike decided to stop the meeting once again. He informed the group that he would meet with two representatives from the coalition group and two from the orthopedics group. Although the others were unhappy about this plan, they were also dissatisfied with the group's inability to negotiate a fair and equitable capital budget plan within all allocated amounts. The next day, Mike met with the four representatives in a quiet, subdued setting that he felt would facilitate the mediation process and create a favorable environment for open dialogue, negotiation, and resolution. His opening remarks addressed the need for the four representatives to make decisions for the entire team that would be appropriate within the budget limitations. Mike had reviewed the steps of the negotiation process in his head and reminded himself not to take sides or contribute to the discussion until both sides could find common ground and develop realistic solutions. Mike led them through the brainstorming meeting decision-storming process, with the participants agreeing to "rules" for the meeting. They agreed that they would (1) respect the person speaking, and only one person would speak at a time without interruption; (2) focus on the common good in contrast to their individual units' needs; (3) have a list of the top 10 priorities for the entire department, and then negotiate the list down to the allocated budget amount; and (4) vote on items until consensus was reached. It was initially not easy, and Mike had to continually remind them that a finite amount of money could be allocated and that they needed to make decisions for the whole based on the allocated budget amounts. With this constant reminder and norming process, the four began to work together, using the strategic plan for the department as a foundation for their decision-making. They also developed a rationale for each decision that could be presented to the whole group. It took a full two days of meetings to finally have a proposed budget that could be given to the rest of the group. Mike called the entire group and informed them of the decision-making process leading to the proposed budget. Two representatives prepared a presentation for the whole group and provided handouts of the proposed budget with a rationale for each item suggested. As it turned out, Orthopedics did receive a greater allocation than the other units, but there was clear justification for using the strategic goals for the department as a foundation. Not everyone in the group was happy with the proposed budget, but they did agree that the rationale was sound. After discussion, the group finally decided to adopt the new proposed capital budget and to develop proposals for the hospital's foundation to fund some of the other items that they felt were important to their units. Mike submitted his final capital budget on time, but he recognized that there was still some discontent among some managers within the group. He realized that he could not please everyone. Still, the method he used to resolve the open conflict resulted in a budget that supported the department's strategic initiatives, even though some capital items were not approved, as some had hoped.

How would you respond to the following scenario in memo format?

Understand that there are some issues between your managers and the budget.

What's going on?

You know this type of conflict is wrong for morale; what did you do to prevent this, and is there something you should have done differently?

At this point, what will you do to rectify this situation?