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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 l.jpg

Leadership Series 2007, #2

The University of KansasMedical Center3901 Rainbow BoulevardKansas City, KS

February 2, 2007


Conflict and negotiating when the table is uneven l.jpg

Conflict and Negotiating:When the Table is Uneven

Phyllis Beck Kritek, RN, PhD, FAAN

Conflict Engagement Specialist

Consultant, Trainer, Facilitator, Coach

[email protected]


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Education

is not the filling

of a bucket but the lighting

of a fire”Yeats


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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”


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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


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Creating an experience

of a different kind of fire …

through reflection


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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


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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


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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


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A

prescription

for

enhancing

pride and

joy in

our work


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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


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“You must be the change you wish to see in the world.”Mohandas Gandhi


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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


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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


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Rethinking old barriers

to constructive work

relationships


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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)


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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


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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


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Building new bridges

of self-awareness


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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


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The

search

for a

gender-

balanced

dialog


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Who put her in charge,

and what’s the “ol’ buddy” act about?


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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


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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



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“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


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Time for some

heavy lifting…

tim


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“a safer and more responsible world…”in context

A brief guided tour of today’s

Health Care System Challenges


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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


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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


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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


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We are, However,Moving Toward aPromising Tipping Point

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


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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


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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


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Health Care’s Crucial Conversations(AACN and Vitalsmarts, 2005)

  • Broken rules

  • Mistakes

  • Lack of support

  • Incompetence

  • Poor teamwork

  • Disrespect

  • Micromanagement


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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…


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Repetitive Solutions Are Recommended

Communication

Collaboration

Courage

etc,etc,etc…


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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.


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Hope springs eternal… become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.


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A “Yes,but…” Time Out become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.

  • “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…”


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Lessons from the next generation… become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.

Visuals help…


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How we like become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.

To think

We present

ourselves


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“Things do not change. become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.We change”Henry David Thoreau


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Transition Tracks become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.

  • 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)


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“You can’t solve a problem become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.from the same level of consciousness that created it.”Albert Einstein


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From POWER: authority and competition become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.

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


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Supplies for the Shift become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.

  • 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


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A conversation in the mirror become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.

  • 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…”


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Expanding Relationship Competencies: Negotiation Skills become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.(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


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Cont… become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.

  • 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


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Why Negotiate? become moral imperatives, the refusal to take action is now viewed as a form of negligence and harm.

  • 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


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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?


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In Summary negotiation

  • 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


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This same summary negotiationcan be provided visually…


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“Do not follow negotiationwhere the path may lead. Go instead where there is no path, and leave a trail…”Henry David Thoreau


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Outcomes….You too can negotiation

  • 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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“Imagination is negotiationmore importantthan knowledge.”Albert Einstein


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