Conflict Resolution A Core Leadership Attribute Seminar on Negotiation

1. Conflict ResolutionA Core Leadership Attribute Seminar on Negotiation Created By: Gus M. Garmel, MD, FACEP, FAAEM Clinical Professor, Department of Surgery Co-Program Director, Stanford/Kaiser Emergency Medicine Residency Stanford University, Palo Alto, California Tenet Editor: Barbara Blok, MD, FACEP Assistant Director, Denver Health Residency in Emergency Medicine University of Colorado School of Medicine, Aurora, Colorado

4. Course of Conflict Intensity Stalemate Communication Failures & Conflict Escalation Negotiation & Conflict Resolution Time

5. Outline • Definitions & Relevance • Types & Factors of Conflict • Conflict Resolution • Keys & Principles • Barriers • The Art of Communications • Process of Negotiation

6. DEFINITION Conflict • Any situation where incompatible activities, feelings, or intentions occur together. • A competitive or opposing action of incompatibles; an antagonistic state of action (divergent ideas, interests, or persons). • Mental struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands.

7. DEFINITION Conflict Resolution • A range of processes aimed at alleviating, eliminating, or resolving conflict or its sources. • The methods and process of negotiation, arbitration, and institution building which promote the peaceful ending of social conflict and war.

8. DEFINITION Negotiation • A dialogue intended to: • Resolve disputes • Agree upon course of action • Bargain for advantages • Satisfy various interests

9. RelevanceModel of the Clinical Practice of Emergency Medicine* *Created through collaboration of ABEM, ACEP, CORD, EMRA, RRC-EM, and SAEM COMMUNICATION AND INTERPERSONAL SKILLS ISSUES Complaint Management Conflict Resolution Interdepartmental and Medical Staff Relations Team Building Teaching

10. Relevance- For Emergency Medicine • Conflict is often outcomes-drivenand not process-driven • Physicians are typically goal-oriented • EPs want towin & desire control • EPs focus on immediate outcomes (want things to happen now) • great for patients • challenging for administrators/consultants

11. Relevance- For Emergency Medicine • Salaries & Schedules • Positions & promotions • Patient care • Interpersonal interactions • Medical legal protection • Professional satisfaction • Career security

12. E G Relevance- Example An emergency RN will not perform a certain task you have requested because she doesn’t feel it is necessary. You are a good clinician, but you have a reputation in your ED as being “difficult.”

13. E G Relevance- Example 76 year old female who doesn’t feel well is brought to the ED by her adult son. Her entire work-up is negative, but the son wants her admitted, despite no medical nor social indication.

14. E G Relevance- Example A consultant doesn’t think that he needs to see the patient you are calling about at 1 AM. You don’t know this individual, but you’ve heard he is not well-liked by your colleagues.

15. Conflict is Inevitable

16. Why Do We Conflict? • Personal differences • Information deficiency • Role incompatibility • Environmental stress

17. Types of Conflict • Intrapersonal • Interpersonal • Intragroup • Intergroup

18. Types of Conflict- Intrapersonal conflict • Conflict within • Example • Conflict in dealing with a particular type of patient

20. Types of Conflict- Intragroup conflict • Conflict between individual group members • Example • Your colleague always grabs the sickest patients and major resuscitations

21. Types of Conflict- Intergroup conflict • Conflict between 2 groups of people • Example • Who performs the ED thoracotomy in a trauma resuscitation (EM vs. Surgery)

22. Types of Conflict- Interpersonal conflict • Conflict between 2 persons • Example • Conflict with a patient’s family member or nurse

23. Factors in Conflict • Personal Attributes • Gender • Ethnicity/Culture

24. Factors in Conflict- Personal Attributes • Keirsey’s 4 Temperaments

25. Factors in Conflict- Personal Attributes • Keirsey’s 16 Categories

26. Factors in Conflict- Gender

27. Factors in Conflict- Gender

28. Factors in Conflict- Ethnicity & Culture • Language • Behavior nuances • Negotiation style • Passion • Tempo • Culture • Custom

29. Conflict Resolution How do we get there?

30. Conflict Resolution- The keys & principles • Gain insight • Truth always • Seek wisdom • Never criticize • Offer assistance

31. Conflict Resolution- The keys & principles * Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), 2008.

32. Conflict Resolution- The keys & principles * Garmel GM. Conflict Resolution in EM. In Adams Emergency Medicine (Elsevier), 2008. Adapted from Ahuja J, Marshall P. Conflict in the emergency department: Retreat in order to advance. Can J Emerg Med 2003;5:429-433.

33. Conflict Resolution- Barriers • Preformed judgments • Poor communication skills • Cultural/gender barriers • Lack of understanding of both sides • Not possessing the right skill set • Not understanding negotiable vs. non-negotiable • Pride

34. Conflict Resolution- Barriers • Cynicism • Criticism • Comparing • Competing • Complaining • Contending

35. Conflict Resolution- Pearls • Plan ahead for all possible outcomes • Know related policies &procedures • Respect your primary responsibilities & obligations • Seek to Gain consensus, not to prove a point • Recognize that the truth lies somewhere in the middle

39. The Art of Communication Effective Communication is essential for Conflict Resolution

40. The Art of Communication • Avoid (Obvious) Pitfalls • I’m the attending! • Because I said so! • I’m right! (or, You’re wrong!) • My way is the only way! • You’re just a … nurse/tech/NP/internist! • You’re an XXXXX !

41. The Art of Communication Strive to find mutual understandings • I can see your point, but I don’t feel you are considering mine. • Let’s discuss this a bit more from the patient’s perspective. • I’ve always respected (appreciated) your… • It seems that we disagree, which is fine, but I’m just not comfortable with…

42. Effective Smile Eye contact Avoiding emotion Active listening Concentration Attention Focused Ineffective Snarl Arms across chest Finger pointing Pacing Distracted Inattention Disengaged The Art of Communication- Effective vs. Ineffective

43. The Art of Communication Negotiation is the art of letting them have your way. - Daniel Vare

44. The Art of Communication Let us never negotiate out of fear - But let us never fear to negotiate. - President John F. Kennedy

45. Process of Negotiation- The definition revisited • Negotiation is a dialogue intended to: • Resolve disputes • Agree upon course of action • Bargain for advantages • Satisfy various interests

46. Process of Negotiation- Objectives • Mutually satisfactory structure • Executed agreement • Lasting and mutually beneficial relationship • Comfort with process and outcome • Accounts for feelings

47. I Win Lose/Win Win/Win You Lose You Win Win/Lose Lose/Lose I Lose Process of Negotiation- Outcomes

48. Process of Negotiation- Steps to success • Have a plan • Broad to narrow • Actively listen & learn • Take notes • Unbundle issues • Paraphrase don’t parrot

49. Process of Negotiation- Timeline • Initial - assess situation, gather information (from multiple sources), establish trust, build the relationship • Middle - patience, gather facts, consider counteroffers, mutual concessions • End - accept, get mediator, walk away, follow-up, be gracious and complementary

50. Process of Negotiation- Responses