Intergroup Conflict and Organizational Performance: A Case of Kiboga Hospital, Uganda

The study aimed at finding out whether there is a relationship between intergroup conflicts and organizational Performance, using the case of Kiboga hospital. The study contributes to the body of existing literature by laying down strategies for managing and reducing intergroup conflicts. The study employed a cross-sectional research design along with a quantitative approach. The study population was 95 of which a sample size of 76 respondents was selected using Krejcie and Morgan table. Data was collected by the use of a questionnaire which was self-administered. Data were analyzed by the use of Statistical Package for Social Science (SPSS) through descriptive statistics and correlation analysis. Results revealed that respondents consented that intergroup conflicts affect performance with an average mean of 4.154 and a standard deviation of 1.092. A correlation coefficient of 0.903 which is significant at 0.01, revealed that there is a significant relationship between intergroup conflicts and performance which lead to the rejection of a null hypothesis. The study concluded that moderate levels of conflicts improve performance since they stimulate thinking and creativity in decision making towards goal achievement. However, extreme levels of conflict reduce performance in terms of patient care for our case of investigation. The study recommended strategies management can employ to manage extreme levels of conflicts to improve patient care.


Introduction
Conflicts are an inevitable part of organizational life since the goals of different participants such as managers and staff are often incompatible [1]. This results in a situation whereby they disturb each other in an attempt to achieve their objectives. Indeed, conflict is part of organizational life and may occur between individuals, and groups [1]. While conflict is generally apparently known as dysfunctional, it can also be functional because it may cause an issue to be presented in different perspectives. Therefore, conflict has both positive and negative effects [2]. It can be positive when it encourages creativity, new looks at old conditions, the clarification of points of view, improve quality of decisions by stimulating personality thinking and challenges individual to become better, and hence the growth of human capabilities to handle interpersonal differences.

Literature review 2.1 Intergroup conflicts
Organizational conflict is regarded as the discord that occurs when the goals, interests, or values of different individuals or groups are incompatible with those of individuals or groups block or frustrate each other in an attempt to achieve their objectives [1]. According to [11], organizational intergroup conflict is a condition between or among workers whose jobs are interdependent, who feel angry, who perceive the others as being at fault, and who act in ways that cause business problems. This analysis defines workplace intergroup conflict as a situation in which interdependent workers, perceive positions or action as irreconcilable, with the consequence that at least one of the parties perceive that disagreement are emotionally upsetting, causing a problem at workplace [12].
Many scholars [13,14] equate the aspect of team-based structures as a result of increasing complexity and environmental demands that force organizations to specialize and diversify their workforce, to focus efforts and efficiently handle their subtasks. However, utilizing these combined efforts as well as resources can be a challenge for team-based organizations, due to structural and psychological barriers between groups that hinder effective intergroup relations [15]. This is because groups pursue their own interests at the expense of the overall organizational goal [10]; they compete over scarce resources [16]; and fail to manage the disruptive dynamics of social categorization [17]. The imbalance of both differentiation of subsystems and the need for integrating these subsystems in pursue of superordinate organizational goals represents an inherent potential for interface or structural conflict between work units [18]. If not managed well, such interface conflict result into negative interdependence with the likely result that one group's goal achievement decreases the possibility of another group's goal achievement [19].

Organizational performance
Performance is defined as the evaluation of the constituents that try to assess the capability and ability of a company in achieving the constituents' aspiration levels using efficiency and effectiveness. Since organizations perform various activities to accomplish organizational objectives, performance can also be referred to as the frequent assessments of organizations carried out in relation to the achievement or non-achievement of set objectives and goals [20]. However, many factors affect organization performance. Conflicts within the organization are among the factors that can either positively or negatively affect performance. Traditionally, conflicts are viewed as bad. It is considered harmful for organizational functioning since it is related to hostility, antagonism, and unpleasantness. A study carried out by [21], about the effects of conflict on employees performance pointed out that, in spite of the grim picture painted about conflict as an organizational tremor, this social action can also foster posterity for business ventures. With constructive and a prudent approach, conflicts can revolutionize new ideas which can take organizations to unprecedented heights in their endeavors. It was concluded that the effect of conflicts on the organization can either be positive or negative, but when managed properly, the positive effects can be used to encourage organizational innovativeness and build cooperation among the employees which enhances performance [21]. A recent research by [22] on the impact of conflicts on the Organizational Development, highlights the above point by stating that conflicts are not automatically destructive, but this aspect depends to a large extent on how they are perceived by those who observe them, but equally on how they are managed by the manager who has to take into consideration the constructive, positive aspects of a conflict and diminish the destructive peculiarities.
Indeed, conflicts are not all bad, it is just the level of conflicts that makes them functional or dysfunctional. According to [23], Organizational performance is low when conflict is at two extremes: high levels or low levels. Organizational performance is high at moderate levels of conflict. At a low level of conflict, that is, there is usually mutuality of opinion, people agree with each other and there is no stimulation to change. People are not adaptive to environmental challenges and, therefore, do not search for new ideas. The organizational performance, thus, Organizational Conflict tends to be low. At a high level of conflict, people do not agree with each other. There is lack of cooperation amongst their activities and behavior. This leads to lack of discipline in the organization resulting in low organizational performance. At optimum level of conflict, that is, people disagree with each other resulting in new ideas. People think differently in a constructive way. New solutions are developed to deal with problems and achieve the goals through optimum utilization of resources. Therefore, moderate levels of conflict are beneficial to organizational performance. A study by [24], elaborated this further by specifying the type of team conflict that benefit from moderate levels of conflict. The occurrence of moderate level of task conflict is more helpful during planning and strategizing phases of the work, when decision making is most needed, rather than during task execution phases. In fact, task conflict during task execution was found to interfere with effective integration of work activities and team creativity.
A study by [22], emphasized that conflicts are inevitable and often lead to the efficiency of the organization's activity, to its development. He adds that all organizations regardless of their size, the conflict is an integral part of the process of development and capitalization of human resources within the organization, which requires a permanent analysis in the direction of strategic development of those entities. This is because conflict is inherent in human interaction, appearing as a result of different systems of social values, differences in principles, culture, interests.

The effect of intergroup conflict on organization performance
One scholar [15] asserts that intergroup conflict is a common occurrence in workplace scenarios where one group of workers might find themselves at a face to face junction with another group. According to [25], goal differentiation between the organizational departments makes the environment competitive as each department has its own goals to achieve, for the magistrate's concern is primarily with quality and that of service staff primarily with speed. For each department to achieve its own goals and at the same time cooperate with other departments in achieving the overall goal of the organization while competing for scarce resources shared with other departments, results into both interdepartmental and intergroup conflict.
The above notion is supported by the Realistic Group Conflict Theory (RGCT), which states that perceived competition for limited resources can lead to hostility between groups. This is when valuable resources are perceived to be abundant, then groups cooperate and exist in harmony. However, if valuable resources are perceived as scarce, then these groups enter into a competition which leads to intergroup conflicts. The resources in question can be physical (such as land, food, or water) or psychological (such as status, prestige, or power). One group need only believe that competition exists for hostile feelings and discriminatory behavior to follow. How long and how severe the conflict becomes is determined by the perceived value and scarcity of the resource in question [26]. RGCT states that Interdepartmental or intergroup conflicts can be resolved when there is a performance situation that requires each group to depend on each other to achieve important goals equally valued by both groups where everyone's help and cooperation is needed. Therefore, management can solve intergroup conflicts by setting up organizational goals that require interdependence of different departments to maintain intergroup relations to improve performance.
Though the claim that well managed intergroup conflict automatically results in efficiency gains is challenged by some, it is generally accepted that the right kind of friction and constructive confrontation and arguments over ideas in an atmosphere of mutual respect can help an organization to have the potential to drive greater performance and creativity. Conflicts are also beneficial where intergroup conflict improves team dynamic within the group, by team increasing their cohesiveness and task-oriented when they face an external threat. Moderate intergroup conflict motivates members to work more efficiently toward their goals, thereby increasing the team productivity [27]. According to [28], there can be no intergroup conflict without a degree of information as to performance information in the basis period and, ideally, a targeted performance in a future time period. Intergroup conflicts can either be constructive or destructive in nature. However, it is important to note that intergroup conflict is a reality of our daily lives and intergroup conflict is thus inevitable in a human workplace.
A study by [29], states badly managed intergroup conflict, personal attacks are common, people can get visibly angry and feelings get hurt. When co-workers do not respect the fact that approaches in addressing issues at work can differ, everyone suffers due to unresolved intergroup conflicts risk with great potential to worsen the situation. Emotionally, the work environment grows more toxic and financially expensive, the toll can be a problem consequently affecting the performance of the organization from all angles. A big number of organizations are losing valuable resources including talent, time, and revenue from work conflicts arising from within and outside. So far, this matter has not been accorded much attention from a risk management perspective but, as a result of the emphasis on performance, researchers in human resource management have stressed the need for effective human resource strategy in conflict management with reducing conflict. Although conflicts differ in terms of sources and causes, they all have destructive consequences if handled poorly [30].
The Meta-Analysis research carried out on the three types of Team Conflict: Task, Relationship, and Process conflicts, highlights another perspective on how conflicts can be beneficial or unbeneficial. The research concluded that although relationship conflict which involves interpersonal tensions, frictions, and resentment can harm team performance, task conflicts which is concerned with different ideas, perspectives, and viewpoints regarding the work itself has the potential to improve team performance and team innovation [31]. In addition, the Pearson correlation findings by [21] indicated that whereas relationship conflict is negatively linked to performance, there is a positive correlation between task and process conflict and employee's performance. A recent study carried out by [32] regarding Conflicts on Team Trust and Team performance also concluded that task and relationship conflict, process conflict, team trust, have noteworthy effect on team performance. The study emphasized the importance of task conflicts on performance when members within a team engage in highly complex tasks. With highly complex tasks, task conflict fosters intensive information exchange as well as detailed information processing. Problems can be considered from different perspectives, different opinions or alternatives can be discussed, which may produce high quality solutions and enhance performance. Based on the literature the following null hypothesis was stated: There is no significant relationship between Inter-group conflicts and Organization Performance.

Methodology
The researcher used a cross-sectional research design, this is where the data on the study variables are collected at the same point in time. There were 95 Health Care Providers at Kiboga Hospital in Uganda including Administration, Medical Doctors, and Nurses. Krejcie and Morgan Table [33] was used to determine a sample size of 76 respondents. A quantitative approach was used and data was collected by the use of a questionnaire using a five-point Likert scale ranging from 1 for strongly disagree, 2 = disagree, 3 = not sure, 4 = agree to 5 for strongly agree. Interpretations were based on 4.21-5.00 -Very High, 3.41-4.20 -High level, 2.61-3.40 -Moderate, 1.81-2.60 -Low, and 1.00-1.80 -Very low. Data were analyzed using the Statistical Package for Social Science (SPSS). Descriptive statistics were used to measure the central tendency and correlations were used to test the null hypothesis. The reliability of the research tool was tested and the Cronbach alpha value was 0.821 which is above 0.5. This suggests that the questionnaire was highly reliable as suggested by [34]. Before data collection, permission was granted by Kiboga hospital administration.

Response rate
The researcher had a total population of 95 and from which a sample of 76 respondents was selected for the study. Of those sampled respondents, a total of 74 returned their questionnaire, it is most likely that the two questionnaires were misplaced. This represented a response rate of 97.4% which was considered appropriate for the study. This correlates with [35] recommendation that a response rate of 50% is adequate for analysis and reporting; Therefore, 97.4% was an excellent response rate for the study.

Descriptive statistics of intergroup and organizational performance
In order to assess the level of agreement and disagreement on the different items used to measure intergroup conflict in the questionnaire, the mean and standard deviation were used to determine the central tendency. A low standard deviation implies that responses were closely related to the mean value while a high standard deviation implies that responses were highly deviating from the mean value. The results are shown in the table below: According to Table 1, there is a high agreement on all the measures of intergroup conflicts and their effect on performance. The average mean of 4.154 and the standard deviation of 1.092 implies that the majority were in agreement although the responses were varying a lot. From Table 2

Correlation analysis
The main aim of the study was to establish a relationship between intergroup conflicts and organizational performance. Pearson's correlation coefficient has been computed so as to establish this relationship. A high correlation coefficient would suggest a strong relationship between the intergroup conflicts and organizational performance and vice versa for a low correlation coefficient. The results are presented in the table below.
Research findings in Table 3 below that there is a significant positive relationship between Intergroup conflicts and Organizational performance, generating a correlation coefficient of r = 0.903**, and significant at 0.01. This, therefore, implies that the null hypothesis that states: There is no significant relationship between Intergroup Conflict and Organization performance, is rejected and the alternative is accepted. The positive correlation indicated that as employees engage in intergroup conflicts it is likely to affect their performance positively or negatively. Intergroup conflicts can affect performance by causing changes to occur, both within the group and individuals, members will usually overlook individual differences in an effort to unite against the other side. According to [36], intergroup conflicts brings positive effects for the better, by removing barriers caused by different assumptions or misunderstandings about a team's tasks, or goals. Conflict can be constructive when it creates broader awareness about how team members are experiencing their work and thus leads to changes that improve members' productivity and they ought to work together toward achieving common goals. Conflict can also lead to process improvements, such as when it reveals a deficiency in how the team communicates, which can then be corrected. Clashes of ideas can lead to more creative solutions or otherwise provide perspectives that persuade the team to take a different approach that is more likely to lead to success [1]. The Pearson correlation findings by [21], indicated that whereas relationship conflict is negatively linked to performance, there is a positive correlation between task and process conflict and employee's performance. Therefore, it was concluded that the effect of conflicts on the organization can either be positive or negative, but when managed properly, the positive effects can be used to encourage organizational innovativeness and build cooperation among the employees which enhances performance. This is because organizational conflicts improves team dynamics by increasing cohesiveness among members.
A recent study carried out by [32] emphasized the importance of task conflicts on performance when members within a team engage in highly complex tasks. With highly complex tasks, task conflict fosters intensive information exchange as well  as detailed information processing since problems can be considered from different perspectives, different opinions or alternatives can be discussed, which may produce high quality solutions that enhance performance. Another recent research by [22], emphasized that conflicts are inevitable and if properly managed often lead to the efficiency of the organization's activity, which leads to its development. On the negative side, a study by [3] found out that conflicts between nurses and doctors consumes much of the time and attention that should be committed to patients. Therefore, the consequences here range from poor coordination of patient care, less patient satisfaction, poor perception and utilization of health care services, medication error, failure to rescue patients, and even deaths. The results further revealed that patients suffered neglect and abandonment as they are caught in-between the conflicts of these two groups. Therefore, it is important for hospital management to identify and properly manage intergroup conflicts to avoid performance distractions.

Conclusions and recommendations
The study findings revealed that there is a strong positive significant relationship between intergroup conflict and organizational performance. This implies that intergroup conflicts that occur in an organization either result in a negative or a positive effect on performance in the organization depending on the level it occurs. It is important to note that organization performance increase when conflicts are at moderate levels. However, conflicts can negatively affect performance especially at a low level where mutuality of ideas exists between members and if not managed well to escalate to high levels where members lack cooperation regarding activities and behavior. Therefore, in order to offer quality patient care, it is crucial for management to identify functional and dysfunctional conflicts and effectively manage them so as to enhance hospital performance.
Management of health organizations should always address and manage the issues related to intergroup conflicts, by building trust, promote leadership, address cultural differences, establish ground rules, and finally promote good communication and listening skills among the group members and members of other groups so as to improve on patient care.
Where groups have differing goals, it is prudent for management to establish a superordinate goal that can only be reached when the conflicting groups work together. A superordinate goal not only helps alleviate conflict, it focuses more on performance, which is what the organization needs to survive. If this is done in the right way it will eliminate or reduce intergroup conflicts.
Misperception of the abilities, goals, and motivations of others often leads to conflict, so efforts to increase the dialogue among groups and to share information should help eliminate conflict. As groups come to know more about one another, suspicions often diminish, and greater intergroup teamwork becomes possible, which improves performance.
Management should identify and make significant changes in the structural variables involving the conflicting groups such as changing jobs or rearranging reporting responsibilities among health care teams. For effectiveness, groups involved should participate in structural change decisions. If done well, this can lead to permanent resolution of intergroup conflicts within health care institutions. Given the relevance of task conflicts in decision-making teams, there is a need for better selection and training of team members, as well as a culture that enables team members to leverage task conflicts appropriately, as opposed to minimizing and avoiding them completely. By doing so, it enhances performance among health services teams.