Conflict Management

Conflict Management Andrea M. Landis, PhD, RN UW LEAH November 30th, 2012

Conflict: Introduction • Definition • Fight, battle, war • Antagonistic state or action (as of divergent ideas, interest, or persons) • Mental struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands • Within or between • Where can conflict occur?

Conflict • Conflict can arises from: • Different goals • Differing sets of information • Differing perceptions • Horizontal violence • Perception that levels of appreciation are not equal

Conflict • GOAL: Advance collaborative practice and conflict competence among health professionals and industry leaders who are responsible for the following: • Improving patient safety • Achieving accountable care • Developing healthy work environments • Creating a resilient workforce

Part 1: Perspectives in Conflict

A “Nobody’s in Charge” World • Shared responsibility for the same programs & goals • UW – Shared Governance • Integrated and networked organizations require “power sharing” • Interdependence required to “get things done” places limits on individual authority • Disagreements & conflicts are not uncommon

How do you view conflict? • A battle to be won? • A problem to be solved? • A danger? • An opportunity? • Something to be avoided at all costs?

Perspectives of Conflict

Common Reactions to Conflict FIGHT FLIGHT • Confronting • Sabotaging • Over-reacting • Bypassing • Avoiding • Under-reacting

Consider your Shadow Side • What are your behavioral tendencies when you are… • Angry? • Exasperated? • Tired? • Stressed? • In a bad mood? • Can you recognize when you are…

Dealing with your Emotions • Take your emotional temperature • Resist your first negative reaction • Consider a time-out • Get the facts • Get another perspective • Vent to someone else • If time permits, plan your approach

Dealing with their emotions • Allow them to vent • Use restatement; don’t raise your voice • Accept their feelings as legitimate • Help them “save-face” – work towards a win-win • Don’t refute their statements – yet! • Don’t be afraid of silence • Don’t be afraid to say “You might be right”

Reduce Tension Through Listening • Listen to understand • Listen actively (in an involved way) • Listen with your eyes • Don’t tune out messages you think you’ve heard before • Listen first – THEN plan your next comment

Part 2: Strategies for Navigating & Resolving Conflict

Conflict Management • Comprehensive term indicating the range of attitudes and behaviors individuals, groups, and organizations manifest in dealing with conflict. • Always present • Range from denial, suppression, and retaliation to creative proactive programs

Alternative Dispute Resolution (ADR) (Gerardi, 2010) • Provides an array of processes designed to achieve that goal, negotiation, mediation, and arbitration for health care providers • Developed body of literature documenting best practices and empirical findings to guide both students and practitioners of ADR

ADR continued • Came to age in the 1990’s • Restructuring of health care organizations • Reductions in the number of acute care nurses; shortened length of stay that increased patient acuity concurrent with increased emphasis on patient safety. • IOM report (1999) “To Err is Human: Building a Safer Health Care System” • Documenting the magnitude and severity of preventable medical errors (adverse events) • Further catalyzed the patient safety movement • Creation of patient safety organizations that generated substantial data sets • Documented that problematic relationships among providers was a primary causal factor in adverse events.

ADR continued • ADR practitioners considered health care the “last frontier” persistently resistant to self-examination and action that might enhance existing conflict management practices. • Reasons for resistance: • Health care environments are complex adaptive systems; • Widespread inequalities and imbalances in power; • Includes numerous subcultures with significant variance; • Difficulty determining who should be “at the table” • History of litigation – pattern of conflict aversiveness, avoidance, suppression, and blame.

Thomas-Kilmann Conflict Mode Instrument • 5 potential responses to conflict: • Avoidance • Compromise • Accommodation • Competition • Collaboration* * Both high cooperativeness and assertiveness and provides long-term solution to a conflict

Conflict Engagement • Part of ADR • De-emphasizes conflict resolution and shifts the focus to competent engagement • Blueprint for collaboration

“Silence Kills” • AACN (2005) sponsored a landmark study (1,700 nurses, physicians, clinical-care staff, and administrators) identifying conversations especially difficult for health care professionals, at the same time essential for people in healthcare to master – including: • 1. Broken rules • 2. Mistakes • 3. Lack of support • 4. Incompetence • 5. Poor teamwork • 6. Disrespect • 7. Micromanagement • Concurrently developed related standards for health work environments

“Silent Kills” • Majority of healthcare workers regularly see some of their colleagues break rules, make mistakes, fail to offer support, or appear critically incompetent; < 10% say anything • This study explored the frequency with which people experience these kinds of concerns and the consequences of their failure to speak up when they do • Online survey of nurses – 53% respondents reported that conflict while on the job was “common” • This study suggests that creating a culture where healthcare workers speak up before problems occur is a vital part of the solution.

Every utterance functions on two levels • Level 1: Communicates ideas • Level 2: Negotiates relationships

Develop a Negotiation Mindset • What is your personal goal in managing conflict more effectively?

Two Primary Concerns for Every Negotiator • Achieving the best outcome and agreement • Maintaining and building the relationship

Diagnosing Disagreement • What is the nature of the difference? • Facts • Goals • Methods • Values • What factors may underlie these differences? • Information: differences based on different set of facts • Perceptual: parties bring different sets of biases and beliefs • Role: position and status of parties can place constraints on the discussion

Underlying Causal Factors • Information Factors • Disagreement is based on different facts • Do the disagreeing parties have access to the same info? • Perceptual Factors • Different set of biases and beliefs • Do the disagreeing parties perceive the shared information differently? • Role Factors • Disagreement is influenced by the position or status of the parties in the organization and/or society • How much are the disagreeing parties influenced by their position or role in the organization?

Plan Your Approach • Know your goal for resolving the disagreement: what do you want? • Define the problem/issue for yourself • Consider how the other party defines the problem/issue

Execute Your Approach • State the problem/issue • Set a positive tone for the conversation • Explore each other’s needs • Start with, “How can we….” • Ask open-ended questions • Don’t include solutions in your questions • Watch your listen/talk radio • Observe non-verbal cues • Avoid interpreting motives • Identify possible options • Select the best one • Reach agreement

Handling Disagreements Without Resolving Them • Listen but don’t argue • Agree to disagree • Accept their feelings, not points • Focus on something else

Dealing effectively with differences depends on…. • Desire to resolve the differences • Ability to diagnose and understand the differences • Awareness and ability to use the appropriate behavioral responses • Ability to deal with your own feelings – especially those that might limit your effectiveness

Carefronting (Kupperschmidt,2008) • How to manage conflict when individuals have divergent values, beliefs, and attitudes • Goal is to guide individuals and/or teams to get past their day to day problems, conflicts, and communication issues • Augsburger (1981) – refers to the skill of caring enough about oneself, others, and desired goals to confront inappropriate behavior responsibly while offering the opportunity for change.

Carefronting • Act of inviting, not demanding, another to change and a creative way through conflict, a way to unite caring and candor in relationships • Key tenets: • Truthing it: A simplified speech style • Owning anger: Let both your faces show • Inviting change: Careful confrontation • Giving trust: A two-way venture • Ending blame: Forget whose fault the conflict is • Getting unstuck: The freedom to change • Peacemaking: Getting together again

Carefronting • Alternative to traditional conflict resolution • Useful in healthcare environments where team synergy and interdependence are required for high quality and safe patient care (think interdisciplinary) • Development of trust among team members on teams begins with communication in relationships, especially, when there is disagreements • Relationships live within the context of conversations that individuals have or do not have with one another

Peace cannot be kept by force; it can only be achieved through understanding. ~ Albert Einstein Whenever you are confronted with an opponent, conquer him with love." ~ Mohandas Gandhi We have to face the fact that either all of us are going to die together or we are going to learn to live together and if we are to live together we have to talk. ~ Eleanor Roosevelt

Conflict Management