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Leadership Series 2007, #2. The University of Kansas Medical Center 3901 Rainbow Boulevard Kansas City, KS . February 2, 2007. Conflict and Negotiating: When the Table is Uneven. Phyllis Beck Kritek, RN, PhD, FAAN Conflict Engagement Specialist Consultant, Trainer, Facilitator, Coach

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leadership series 2007 2

Leadership Series 2007, #2

The University of KansasMedical Center3901 Rainbow BoulevardKansas City, KS

February 2, 2007

conflict and negotiating when the table is uneven

Conflict and Negotiating:When the Table is Uneven

Phyllis Beck Kritek, RN, PhD, FAAN

Conflict Engagement Specialist

Consultant, Trainer, Facilitator, Coach

[email protected]

slide3

“Education

is not the filling

of a bucket but the lighting

of a fire”Yeats

the fire of conflict
The “Fire” of Conflict
  • Dictionary
    • War, battle, struggle, opposition
    • Difference, disagreement, discord, clash
  • Thesaurus
    • Divergence, argument, quarrel, contradiction
    • Dispute, fracas, controversy, skirmish, fight
  • Cultural connotations – the WEST
    • Adversarial, threatening, dangerous, harmful
    • “Bad” outcomes unless you “Win”
an alternative viewpoint conflict engagement frontrunners
An Alternative viewpoint:Conflict Engagement Frontrunners
  • Congratulations!
  • Reframing the experience
  • Enhancing analysis skills
  • Assessing existing competencies
  • Expanding competencies
  • Creating cultural change
  • Optimizing gains and growth
slide6

Creating an experience

of a different kind of fire …

through reflection

conflict in context
Conflict in Context…
  • All organizations have some type of conflict management system: the question is what type of system
  • Managing conflict is not resolving it
  • All organizations reside in, reflect, often further, and certainly adapt to the norms of the larger culture
  • All organizations have cultures that shape their approach to conflict
the roots of health care conflicts back arnold s let go advice jama vol 293 11 2005
The roots of health care conflictsBack & Arnold’s “Let Go” Advice(JAMA, Vol. 293, #11, 2005)
  • Avoiding or denying conflict
  • Acting in the heat of the moment
  • Assuming you know
    • The whole story
    • The other party’s viewpoint
  • Repeatedly trying to convince the other party of your viewpoint
slide9
Cont….
  • Proceeding as if the issue can be settled rationally or with evidence
  • Denying personal reactions, e.g., rage
  • Using anger or sarcasm
  • Declaring the other party
    • Responsible for the fix
    • Ethically questionable
slide10

A

prescription

for

enhancing

pride and

joy in

our work

enter the uneven table my preferred terrain
Enter the Uneven Table:(My Preferred Terrain)
  • Place where some parties are disadvantaged and some parties do not know and/or acknowledge this: justice and fairness unlikely
  • Specific challenges
    • Assumptions of entitlement
    • Assumptions of victimization
  • High risk of generation of “settlements” that are not settlements: continuing injustices
coming to terms negotiate
Coming to terms…Negotiate
  • To confer with another so as to arrive at the settlement of some matter
  • To deal with some matter or affair that requires ability for it successful handling
  • To arrange for or bring about through conference, discussion, and compromise
restated

Restated….

….a creative decision-making process

initiated to address conflict which involves inclusiveness, timing, sharing, active listening, rules, principles, fairness, reframing,

creative option generation…

And, often….

An uneven table

slide16

Rethinking old barriers

to constructive work

relationships

responses
Responses
  • Manipulation as historical MO of choice
    • “Unfair and Insidious”
    • Deceit
  • Thomas-Kilmann options (www.cpp.com)
    • Smoothing over (Avoidance)
    • Keeping the peace (Accommodation)
    • Cutting a deal (Compromise)
    • Counterattack (Competition) AND
    • Creative resolution (Collaboration)
power differentials as context
Power Differentials as Context
  • “Metaphors We Live By”: Lakoff and Johnson: central metaphor of war, argument, competition
  • Focused on dominance, on power “over”
  • Emerged from distinctive US style (USIP)
    • Forceful, explicit, legalistic, urgent, and results oriented
    • Viewed by others as power-based effort to persuade, sermonize, or browbeat to accede
  • Assumed a fair and even table where all parties were equal, normalized dominance dynamics, and sustained dominant culture
an alternative insight why smart people can be so stupid r j sternberg 2002
An Alternative Insight…Why Smart People Can Be So StupidR. J. Sternberg (2002)
  • Omniscience: thinking I know more than I do
  • Omnipotence: thinking power applies in all domains
  • Invulnerability: embracing an illusion of complete protection
slide20

Building new bridges

of self-awareness

gender another context
Gender: Another Context
  • Explicit and implicit differences – examples
    • A woman uses 20,000 words per day, while a man uses about 7,000
    • A woman remembers fights that a man insists never happened
  • Shifting cultural norms and practices
    • Workplace
    • Leadership
  • Habits of dominance and victim-think
slide22

The

search

for a

gender-

balanced

dialog

slide23

Who put her in charge,

and what’s the “ol’ buddy” act about?

generations another context
Generations: Another Context
  • Generations in the workplace: 4 distinct groups
    • Traditionalists: 1900-1945
    • Boomers: 1946-1964
    • Generation X: 1965-1980
    • Generation Y; Millennials: 1981-2000
  • Boomers are running the show, have for some time now and are reluctant to “let go”
  • Generation Xers are in line to take over, often with neither support nor mentors
a potential reframing
A Potential Reframing…
  • Leadership’s developmental stages could create new relationships in the workforce
  • Erikson’s “Eight Stages” – Stages 7 and 8
    • Adulthood: Generativity vs. Stagnation

Basic Virtue of CARE

    • Old Age: Integrity vs. Despair

Basic Virtue of WISDOM

slide27

“Beyond the clamor of clashing ideologies and the preening and jostling of sovereign tribes, a safer and more responsible world is waiting to be created.”Norman Cousins

slide28

Time for some

heavy lifting…

tim

a safer and more responsible world in context

“a safer and more responsible world…”in context

A brief guided tour of today’s

Health Care System Challenges

the overriding context the health care system
The Overriding Context: The Health Care System
  • It is a complex adaptive system, hence harder to understand, often seen as chaotic
  • It has widespread inequalities and imbalances of power
  • It includes a diverse cast of characters with widely divergent cultures and value systems
  • It lacks clarity on who should be at the table

Rob Robson and Ginny Morrison

layered with conundrums
Layered with Conundrums
  • Fundamental Ethos: DO NO HARM
  • Historical patterns of litigation as a problem-solving device
  • Industrialization and corporatization
  • Polarity management of cost containment and quality (with imbalances)
  • High stakes mission: life and death issues
balanced by key assets
Balanced by Key Assets
  • Humanistic, value-based practice,
  • Based on common goals among providers,
  • Who are invested in quality and advocacy,
  • Grounded in an ethical discourse, and
  • Granted credibility by the public
  • To do work that is integral to human existence and well-being
we are however moving toward a promising tipping point

We are, However,Moving Toward aPromising Tipping Point

Embracing creative new conflict management options…the “other” ADR

tipping point essentials
Tipping Point Essentials
  • A few people with
  • Contagious ideas with stickiness,
  • Making conscious choices,
  • Knowing little causes can have big effects,
  • With an awareness of context, and
  • Certain that change can happen in a moment

Malcolm Gladwell

catalysts for change
Catalysts for change
  • IOM
    • Crossing the Quality Chasm
    • Who Will Keep the Public Healthy?
    • To Err is Human
    • Keeping Patients Safe
  • JCAHO – Emerging Standards
  • Crucial conversations, Silence Kills
  • Leapfrog, Commonwealth Fund, etc.
  • Magnet Hospital movement and analogs
health care s crucial conversations aacn and vitalsmarts 2005
Health Care’s Crucial Conversations(AACN and Vitalsmarts, 2005)
  • Broken rules
  • Mistakes
  • Lack of support
  • Incompetence
  • Poor teamwork
  • Disrespect
  • Micromanagement
themes emerge

Themes Emerge:

Conflict, unresolved, leads to

Patient harms

Patient dissatisfaction

Poor work environments

Employee dissatisfaction and resignations

Failures in leadership

Wasted resources and poor cost containment

etc,etc,etc…

repetitive solutions are recommended

Repetitive Solutions Are Recommended

Communication

Collaboration

Courage

etc,etc,etc…

slide41

Authentic collaboration and constructive communication have become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.Negotiation competency has become an essential skill.

a yes but time out
A “Yes,but…” Time Out
  • “I do it all the time; I must be good at it…”
  • “I have to do it under impossible conditions so there is nothing I can do to improve it…”
  • “I have a list of people who need this more than I do…”
  • “I am real nice and it works…”
  • “I get what I want my way; why bother…”
  • “I know nothing will change anyway…”
slide45

How we like

To think

We present

ourselves

transition tracks
Transition Tracks
  • Structures
    • Hierarchical to participatory
    • Flat futures (generational differences)
  • Relationships
    • Authoritarian to courteous
    • Authentic (generational differences)
  • Competencies
    • Structure dictated to individualistic
    • Complex, chaordic congruence (generational differences)
you can t solve a problem from the same level of consciousness that created it albert einstein
“You can’t solve a problem from the same level of consciousness that created it.”Albert Einstein
steps in the shift in consciousness
From POWER: authority and competition

To RIGHTS: entitlement and adjudication

To INTERESTS: needs/desires/hopes of all involved parties

And RELATIONSHIPS: inclusive, fair, respectful and transparent

War

Legislation and policy

Negotiation

Collaboration

Steps in the Shiftin Consciousness
supplies for the shift
Supplies for the Shift
  • Existing
    • Competencies
    • Consciousness of deficiencies and habits
  • Necessary Acquisitions
    • Awareness of “self”: the things I control
    • Expanding relationship competencies: the things that will alter my behavior
    • Reframing collaboration: the seismic shift
a conversation in the mirror
A conversation in the mirror
  • Universal human cruelty
  • Denial of the dark side
  • Tyranny of attachment to habits
  • Tribalism
  • Impulse to rage and revenge…Fear…
  • Defeat, despair, acquiescence
  • Projection of problem onto others
  • “I thank thee, oh Lord, that I am not…”
expanding relationship competencies negotiation skills pbk s 20 years of experience
Expanding Relationship Competencies: Negotiation Skills(PBK’s 20 years of experience)
  • Slow down, ask questions, actively listen
  • Own your “stuff”/ own only your “stuff”
  • Reach out for inclusiveness
  • Do a comprehensive conflict analysis
    • Explore all sides of a story empathically
    • Learn the interests of all parties
    • Attend to context
slide60
Cont…
  • Reframe everything
  • Assume multiple solutions
    • Require expanded consciousness
    • Find and name the solutions
    • Reflect before deciding
  • Honor the moral agency of all parties
  • Relate from a place of compassion
  • Practice
why negotiate
Why Negotiate?
  • It takes less time than conflict
  • It costs less than conflict
  • It feels better than conflict
  • It has better outcomes than conflict
  • It creates better work environments than conflict
  • It improves patient care and outcomes
  • It is self-actualizing in nature and impact
slide63

Constructive conflict management through competent negotiationis essential to successful collaboration

We are going to use some kind of conflict management anyway…

Why not one that works?

in summary
In Summary
  • Change is not optional and is escalating
  • Change is disruptive, creates conflicts
  • If you have to deal with it anyway, you might as well learn to do something satisfying and constructive with it
  • Negotiation can provide tools to that end
  • Negotiation skills can be learned and will pay off in workplace change management
slide75
“Do not follow where the path may lead. Go instead where there is no path, and leave a trail…”Henry David Thoreau
outcomes you too can
Outcomes….You too can
  • Ably conduct negotiations (and mediations), even at uneven tables
  • Realize more authentic expressions of “Do No Harm”
  • Contribute to creating a safer and more responsible world
  • Become an official participant in the “tipping point” momentum in the HCS
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